Sudha Prasad

Effect of lycopene on pre-eclampsia and intra-uterine growth retardation in primigravidas

Objectives: To observe the effect of the antioxidant lycopene on the occurrence of pre‐eclampsia and intrauterine growth retardation in primigravida women. Methods: A total of 251 primigravida women were enrolled in this prospective, randomized controlled study in the second trimester. A total of 116 women were given oral lycopene (Group I) in a dose of 2 mg twice daily while 135 women were given a placebo (Group II) in the same dose until delivery. The criteria for recruitment included gestational age of 16–20 weeks, singleton pregnancy, absence of any medical complication and willingness on the part of the women to participate in the study. The women were followed‐up until delivery for development of pre‐eclampsia, mode of delivery and fetal outcome. Results: The two groups were comparable in their maternal characteristics. Pre‐eclampsia developed in significantly less women in the lycopene group than in the placebo group (8.6% vs. 17.7%, P=0.043 by chi‐square test). Mean diastolic blood pressure was significantly higher in the placebo group (92.2±5.98 mmHg vs. 86.7±3.80 mmHg, P=0.012). Mean fetal weight was significantly higher in the lycopene group (2751.17±315.76 g vs. 2657±444.30 g, P=0.049). The incidence of intrauterine growth retardation was significantly lower in the lycopene group than in the placebo group (12% vs. 23.7%, P=0.033). Conclusions: The results of the present study suggest that the antioxidant lycopene reduces the development of pre‐eclampsia and intrauterine growth retardation in primigravida women.

Association of maternal periodontal health with adverse pregnancy outcome

Aim:  The present study aims to determine the association of periodontal disease (identified early in pregnancy) and adverse pregnancy outcomes in a North Indian population.

Latent celiac disease in reproductive performance of women

OBJECTIVE To investigate the prevalence of positive serologic findings for celiac disease in Indian women with poor reproductive performance. DESIGN Cross-sectional except that the women with intrauterine growth restriction were followed prospectively until delivery. SETTING Department of Obstetrics and Gynecology of a tertiary teaching hospital, New Delhi. PATIENT(S) Eight hundred ninety-three women (104 women with idiopathic recurrent abortion, 104 women with unexplained stillbirth, 230 cases of unexplained infertility, 150 pregnant women with idiopathic intrauterine growth restriction, 305 control cases). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The presence of antigliadin IgA and IgG, anti-tissue transglutaminase IgA by ELISA, and IgA antiendomysium antibody by indirect immunofluorescence microscopy. RESULT(S) The seroprevalence of transglutaminase IgA was 6.70% in the group with recurrent abortion, 5.70% in the group with stillbirth, 5.65% in the group with infertility, 9.33% in the group with intrauterine growth restriction, and 1.30% in the control group. Rates of previous preterm births, low-birth-weight infants, and cesarean section were higher in seropositive women compared with seronegative subjects. CONCLUSION(S) Women having poor reproductive performance had subclinical celiac disease. The serology for celiac disease can be considered in idiopathic cases.

Oral dydrogesterone treatment during early pregnancy to prevent recurrent pregnancy loss and its role in modulation of cytokine production: a double-blind, randomized, parallel, placebo-controlled trial.

OBJECTIVE To study the impact of administration of dydrogesterone in early pregnancy on pregnancy outcome and its correlation with Th1 and Th2 cytokine levels. DESIGN Double-blind, randomized, placebo-controlled study. SETTING A medical college and its associated hospital. PATIENT(S) Women with either: [1] a history of idiopathic recurrent pregnancy loss (RPL), in either a dydrogesterone group or a placebo group, or [2] no history of miscarriage. INTERVENTION(S) Dydrogesterone 20 mg/day from confirmation of pregnancy to 20 weeks of gestation. MAIN OUTCOME MEASURE(S) Occurrence of another pregnancy loss and concentrations of T-helper (Th)1 (interferon-γ and tumor necrosis factor-α) and Th2 (interleukin (IL)-4 and IL-10) cytokines in serum at recruitment (4-8 weeks of gestation) and at abortion or 20 weeks of gestation, using commercially available ELISA kits. RESULT(S) Occurrence of another abortion after 3 consecutive abortions was significantly higher (29 of 173; 16.76%) in women with RPL compared with healthy pregnant controls (6 of 174; 3.45%). Risk of occurrence of miscarriage after 3 abortions was 2.4 times higher in the placebo group vs. the treatment group (risk ratio=2.4, 95% CI=1.3-5.9). Mean gestational age at delivery (excluding those aborted before 20 weeks of gestation) increased significantly in the dydrogesterone group (38.01±1.96 weeks) compared with the placebo group (37.23±2.41 weeks). Baby weight was significantly lower in the placebo group (2421.4±321.6 g) compared with the healthy pregnant controls (2545.3±554.3 g). At recruitment, serum IL-4 and tumor necrosis factor-α levels were significantly lower in the RPL group compared with the healthy pregnant controls. However, serum interferon-γ level was significantly higher in the RPL group (8.87±0.72 pg/mL) compared with the healthy pregnant controls (8.08±1.27 pg/mL). CONCLUSION(S) The present study supports the use of dydrogesterone in women with recurrent abortions to improve pregnancy outcome, such as a reduction in abortions and improved gestational age and baby weight at delivery. However, these outcomes were not modulated by Th1 and Th2 cytokine production. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2010/091/000373.

IL-10, TNF-α & IFN-γ: potential early biomarkers for preeclampsia.

The present study was designed to evaluate levels of IL4, IL10, TNF-α & IFN-γ at early second trimester and 24h from delivery to assess potential correlation of cytokine variation with preeclampsia. A total of 176 consecutive healthy, normotensive primigravidas with uncomplicated singleton pregnancies were recruited at 14-18weeks of gestation. Serum cytokine levels were estimated at recruitment and 24h from delivery. In present study, 14(7.95%) women developed preeclampsia. Levels of IL-10, TNF-α and IFN-γ (Mean±SE) at recruitment were statistically significantly lower in preeclamptic group (39.21±9.46pg/mL, 73.57±13.37pg/mL and 0.70±0.20pg/mL, respectively) than non-preeclamptic group (86.02±4.55pg/mL, 601.37±63.54pg/mL and 1.67±0.08pg/mL, respectively) (p<0.05). In preeclamptic group, IL-4 and TNF-α levels (Mean±SE) were significantly higher 24h from delivery (5.35±0.95pg/mL and 381.21±43.28pg/mL, respectively) than at recruitment (2.39±0.71pg/mL and 73.57±13.37pg/mL) (p=0.019 and 0.0001, respectively) while IL-10 and IFN-γ levels decreased after delivery but the change was not statistically significant. Therefore, the levels of IL-10, TNF-α and IFN-γ between 14 and 18weeks of gestation may act as potential early biomarkers in the diagnosis of preeclampsia.

Effect of psychological stress on fertility hormones and seminal quality in male partners of infertile couples.

The present study evaluated the effect of psychological stress on male fertility hormones and seminal quality in male partner of infertile couples. Seventy male partners of infertile couples were evaluated for level of psychological stress using Hospital Anxiety and Depression Score (HADS) questionnaire, serum total testosterone, luteinising hormone (LH) and follicle‐stimulating hormone (FSH) by electrochemiluminescence assay and serum GnRH by ELISA. Seminal analysis was performed as per WHO guideline. Nineteen (27%) of them had HADS anxiety and depression score ≥8 (abnormal HADS score). The persons having abnormal HADS had lower serum total testosterone, higher serum FSH and LH than those of persons having normal HADS. Serum total testosterone correlated negatively with HADS, but LH and FSH correlated positively. There was no change in GnRH with the change in stress or testosterone levels. Sperm count, motility and morphologically normal spermatozoa were lower in persons having abnormal HADS. Sperm count correlated positively with total testosterone and negatively with FSH and LH. Abnormal sperm motility and morphology were related to lower testosterone and higher LH and FSH levels. Psychological stress primarily lowers serum total testosterone level with secondary rise in serum LH and FSH levels altering seminal quality. Stress management is warranted for male infertility cases.

High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India.

Background: Thyroid dysfunction is a common occurrence in pregnancy and affects both maternal and fetal outcomes. There are limited data on prevalence of hypothyroidism during pregnancy from India. Therefore, this study was designed to evaluate the prevalence of thyroid dysfunction especially hypothyroidism during first trimester in a large public hospital in North India. Materials and Methods: All the consecutive first trimester pregnant women attending Lok Nayak and Kasturba Hospitals were enrolled in the study after institutional ethics approval and consent from the study subjects. The pregnant women with diagnosed thyroid disease and on thyroid medications were excluded from the study. Morning samples of study participants were analyzed for thyroid hormone profile which included free T3, free T4, TSH, and TPO Ab. In addition, all study participants were tested for CBC, LFT, KFT, and lipid profile. Results: A total of 1000 women were enrolled for this prospective observational study. The mean (SD) age of study subjects was 25.6 (11.1) years, and mean (SD) gestational age was 10.3 (3.4) weeks. One hundred and forty-three (14.3%) subjects had TSH values more than 4.5 mIU/L above the cutoff used for definition of hypothyroidism. Out of these, 135 had normal free T4 and therefore labeled as subclinical hypothyroidism and 7 had low free T4 suggestive of overt hypothyroidism. TPO Ab was positive in 68 (6.82%) of total, 25 (18.5%) of subclinical and 5 (71%) of overt hypothyroid patients. Conclusion: Hypothyroidism, especially subclinical, is common in North Indian women during first trimester. Further countrywide studies are needed to evaluate the prevalence and etiology of hypothyroidism to prevent maternal and fetal adverse effects of hypothyroidism in India.

Treatment of leishmaniasis in pregnancy.

In north India leishmaniasis (Kala-azar) is uncommon; hence there exists a lot of ignorance and misconceptions regarding its treatment in pregnancy. The case of a 28-year-old patient second gravida para one with approximately 36 weeks period of gestation diagnosed to be Kala-azar is presented. If leishmaniasis is not treated during pregnancy it may lead to congenital leishmaniasis in the newborn. The drugs available to treat leishmaniasis namely sodium stibogluconate and pentamidine are not considered safe in pregnancy. In a study of five pregnant women administered with amphotericin B at a dose of 1 mg/kg body weight daily starting with 0.5 mg/kg body weight until a dose of 20 mg/kg body weight the drug was found effective in treating the disease and no harmful effect on children was found. However long-term results are not yet available about the teratogenic effect and safety of the drug. In view of this the specific treatment of leishmaniasis was deferred until after delivery of this case.

Targeted detection of 65 kDa heat shock protein gene in endometrial biopsies for reliable diagnosis of genital tuberculosis.

OBJECTIVE To evaluate the clinical utility of PCR compared with other available diagnostic modalities in prompt diagnosis of female genital tuberculosis causing infertility. STUDY DESIGN Prospective case-controlled trial. Premenstrual endometrial biopsy specimens were collected from 150 infertile women of reproductive age group suspected of having genital tuberculosis. All patients underwent diagnostic endoscopy (laparoscopy and hysteroscopy) and the samples obtained were subjected to microscopy, culture by the BACTEC 460 TB System, histopathology and polymerase chain reaction (PCR) for detection of 165 bp region of 65 kDa gene of Mycobacterium tuberculosis. The results were correlated with the laparoscopic findings. RESULTS While the laparoscopy/hysteroscopy findings were indicative of tuberculosis in 12.6% of cases, 14.6% of the specimens showed evidence of 65 kDa gene of M. tuberculosis and only 3.33%, 1.33% and 0.66% were positive by culture, smear and histopathology, respectively. CONCLUSION Since laparoscopy, hysteroscopy other endoscopic procedures are associated with operative risks and may cause flaring of infection, and other conventional laboratory tests including histopathology have poor sensitivity, PCR-based detection of 65 kDa gene of M. tuberculosis in endometrial biopsy specimens could be a promising molecular diagnostic technique compared to conventional methods of diagnosis.

Risk factors for vertical transmssion of hepatitis E virus infection

Hepatitis E virus (HEV) infection can be vertically transmitted, but the factors that transmit the disease to foetuses are still unclear. We studied a total of 144 pregnant women with HEV infection. Cord blood and newborn samples were taken for analysis. Nutritional factors were evaluated on the basis of anthropometric parameters and biochemical factors, and HEV viral load was quantified by real‐time PCR. Sequencing of HEV‐positive samples was performed. Approximately 14.63% (6/41) of pregnant patients with acute liver failure (ALF) died before delivery. Vertical transmission was observed in 46.09% (59/128) of HEV‐IgM‐positive mothers. Approximately 23.80% (10/42) of newborns in the acute viral hepatitis group and 29.41% (5/17) in the ALF group were positive for HEV‐RNA. No significant difference was observed in the occurrence of vertical transmission in HEV groups. Viral load was found to be a significant predictor for vertical transmission of HEV infection adjusted with haemoglobin and folate in derivation cohort group. Incorporating these variables, a new score predicting vertical transmission of HEV was derived. Using these significant predictors, the probability for vertical transmission of HEV was well stratified in the validation group (P>.05). In conclusion, viral load was associated with vertical transmission of HEV infection. A valid prediction score model was generated that was verified in a validation cohort group.