Tomislav Strinić

Maternal pre-pregnancy underweight and fetal growth in relation to institute of medicine recommendations for gestational weight gain☆

PURPOSE Maternal nutritional status is one of the most important factors of fetal growth and development. Consequently, the currently increasing prevalence of underweight women worldwide has come in the focus of interest of perinatal medicine. The aim of the study was to assess the effect of low pre-pregnancy body mass index (BMI) on fetal growth. MATERIALS AND METHODS Data on 4678 pregnant women and their neonates were retrospectively analyzed. Pre-pregnancy BMI of study women was categorized according to the WHO standards. Fetal growth was assessed by birth weight and birth length, birth weight for gestational age, and ponderal index. RESULTS Study group included 351 (7.6%) women with pregestational BMI<18.5kg/m(2), while all women with pregestational BMI 18.5-25kg/m(2) (n=3688; 78.8%) served as a control group. The mean birth weight and birth length of neonates born to underweight mothers were by 167g and 0.8cm lower in comparison with the neonates born to mothers of normal nutritional status, respectively (P<0.001 both). The prevalence of small for gestational age (SGA) births was twofold that found in the control group of mothers of normal nutritional status (9.7% vs. 4.9%; P<0.001). The inappropriately low gestational weight gain additionally increased the rate of SGA infants in the group of mothers with low pre-pregnancy BMI (21.4% vs. 10.4%; P=0.02). Pre-pregnancy BMI category did not influence neonatal growth symmetry. CONCLUSION Low maternal pregestational BMI is associated with fetal growth assessment. Improvement of the maternal nutritional status before pregnancy can increase the likelihood of perinatal outcome.

Difference in expression of collagen type I and matrix metalloproteinase-1 in uterosacral ligaments of women with and without pelvic organ prolapse

OBJECTIVE To compare the expression of collagen type I and matrix metalloproteinase-1 (MMP-1) in uterosacral ligament biopsies from women with and without pelvic organ prolapse (POP). STUDY DESIGN Uterosacral ligament biopsies were obtained from women with POP (n=46) and control subjects (n=49). Immunohistochemistry for collagen type I and MMP-1 was performed on formalin-fixed and paraffin-embedded sections. The two groups were matched for age, body mass index, parity and postmenopausal status. Statistical Package for the Social Sciences Version 13.0 was used for statistical analysis. RESULTS The expression of collagen type I (p=0.034) and MMP-1 (p=0.038) differed between women with POP and control subjects. There was increased expression of MMP-1 and decreased expression of collagen type 1 in uterosacral ligaments of women with POP compared with control subjects. CONCLUSIONS This difference indicates a possible relationship between POP and the immunohistochemical expression of collagen type I and MMP-1 in uterosacral ligaments.

Matrix metalloproteinases-1, -2 expression in uterosacral ligaments from women with pelvic organ prolapse

OBJECTIVE This study investigated matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-2 (MMP-2) immunohistochemical expression in uterosacral ligament biopsies from women with pelvic organ prolapse (POP), and controls with normal pelvic support. DESIGN Prospective observational experimental study. SETTING A tertiary Urogynecology Unit and Institute of Pathology, University Hospital Split, Croatia. POPULATION Women referred for hysterectomy for prolapse or benign gynecological disease. METHODS Eighty postmenopausal women were included in the study after Ethical Committee approval and informed consent. During surgery, uterosacral ligament biopsies were obtained from patients with POP (n=40) and women without evidence of pelvic floor weakening (n=40). Immunohistochemistry for MMP-1 and MMP-2 was performed on formaline fixed and paraffin embedded sections. Statistical evaluations were made by Student t-test or chi(2) test. MAIN OUTCOME MEASURES Immunohistochemical expression of MMP-1 and MMP-2 in the uterosacral ligaments of women with and without genital prolapse. RESULTS Forty women with POP and 40 controls without POP were included. The controls were matched to the women with POP in age, body mass index, parity and duration of postmenopausis. A significant increase in MMP-1 immunohistochemical expression was seen in uterosacral ligament tissue from women with POP (P=0.029). In contrast, there was no difference in immunohistochemical expression of MMP-2 between women with POP and those without (P=0.899). CONCLUSION These data suggest that MMP-1 may be marker of collagen degradation. Increased MMP-1 immunohistochemical expression in uterosacral ligaments is associated with urogenital prolapse.

Cord blood cortisol level is lower in growth‐restricted newborns

Aim:  To establish the difference in plasma cortisol concentrations between newborns with intrauterine growth‐restricted (IUGR) and appropriate for gestational age (AGA) birthweights.

Oral contraceptives improve lung mechanics

OBJECTIVE To determine whether oral contraceptives affect lung mechanics. DESIGN Open-label study. SETTING Academic medical center. PATIENT(S) Thirty-six healthy nonsmoking women. INTERVENTION(S) Administration of an oral contraceptive containing ethinyl estradiol, 35 microg, and norgestimat, 250 microg for 6 months. MAIN OUTCOME MEASURE(S) Forced vital capacity; forced expiratory volume in 1 second; peak expiratory flow; and flow at large, medium, and small lung volumes. RESULT(S) At 6 months, all forced expiratory flow and volume had increased significantly (from 6.5% to 15%). Flows at small lung volumes especially increased. CONCLUSION(S) Combination oral contraceptives have a measurable effect on lung mechanics.

Trisomy 1 in an early pregnancy failure

About half of all human conceptions abort spontaneously even before clinical recognition of the pregnancy [Boklage, 1990]. Furthermore, approximately 10–15% of clinically recognized pregnancies end in spontaneous abortion, mostly before the end of the first trimester [NyboAndersen et al., 2000]. Fifty to 70% of these early miscarriages are caused by chromosome abnormalities with the most common abnormality observed being trisomy, accounting for about 60% of all abnormal karyotypes [Philip and Kalousek, 2002]. To date, trisomies of all chromosomes have been observed, and the most rare trisomy is trisomy 1 [Hassold and Jacobs, 1984; Banzai et al., 2004]. Although, cytogenetic analysis of preimplantation embryos, donated from patients undergoing in vitro fertilization (IVF), showed that trisomy 1 does occur [Bahçe et al., 1999], so far only three cases with a full trisomy 1 in a clinically recognized pregnancy have been reported. In these three cases pregnancies were terminated before 9th week of gestation with a blighted ovum [Hanna et al., 1997; Dunn et al., 2001; Banzai et al., 2004]. Herein we present the fourth report of a full trisomy 1 in an early pregnancy failure. This 27-year-old G3PO female was referred for sonographic examination which demonstrated the presence of gestational sac and yolk sac, but the absence of embryonic pole development and fetal heart beat. The diagnosis was blighted ovum and dilatation and curettage (D&C) was performed at 51 days post-last menstrual period (LMP). Products of conception were sent to our laboratory for cytogenetic analysis. Chorionic villi, isolated from products of conception, were cultured and cytogenetic analysis by G-banding showed a 47,XX, þ1,inv(9)(p11q13) karyotype (Fig. 1). Her family history was negative, except for two previous spontaneous abortions. The first, at the age of 25, and the second, at the age of 26, terminated at 9 and 7 weeks of gestation, respectively. Since the couple had infertility, cytogenetic analysis of their blood samples was performed. The father’s karyotype was normal, 46,XY, and the mother’s was 46,XX,inv(9)(p11q13), showing that the variant pericentric inversion of chromosome 9, present in conceptus, was of maternal origin. Autosomal trisomies are found in more than half chromosomally abnormal spontaneous abortions. The most commonly seen is trisomy 16 which accounts for approximately 30% of all trisomies found in miscarriages [Hassold and Jacobs, 1984]. In contrast, trisomy 1 is the rarest, since it has been identified, in only four cases, including our report [Hanna et al., 1997; Dunn et al., 2001; Banzai et al., 2004]. The origin of autosomal trisomies is, in most cases, nondisjunction during maternal meiosis. Although, theoretically all chromosomes should have equal frequency of nondisjunction, Hassold and Jacobs [1984] suggest that the rate of nondisjunction varies among chromosomes and that chromosome 16 has the highest rate among autosomes. Furthermore, chromosomal analysis of human oocytes showed that chromosomes of some groups (A and C) have lower frequency of nondisjunction than expected [Pellestor et al., 2005]. Thus, lower rate of nondisjunction of chromosome 1 could be one of the reasons why trisomy 1 is so infrequent. Although, rarely found in spontaneous abortions, cytogenetic analysis of embryos from patients undergoing IVF showed that trisomy 1 occurs in greater rate in preimplanted embryos [Bahçe et al., 1999]. However, analysis of embryo development showed that chromosomally abnormal embryos, especially those with monosomies and rare trisomies, are

Spirometric disorders in women with genital descensus

Background. We hypothesized that abnormalities in connective tissue, found in women with genital descensus, could impact their pulmonary function.

Estrogen Replacement Therapy Improves Pulmonary Function in Postmenopausal Women with Genital Prolapse

OBJECTIVE This study examined the impact of estrogen replacement therapy with spirometry on pulmonary function in surgically castrated (salpingo-oophorectomy) postmenopausal women with genital prolapse. METHODS The study included 60 postmenopausal women with pelvic organ prolapse. The study received institutional Ethics Committee approval, and all subjects signed an informed consent. Women were randomly divided into two groups of 30 subjects: Group 1 (n=30) was administered estrogen replacement with 1 mg of stradiol hemihydrate (1 mg/day) orally for 6 months, and group 2 (n=30) was not taking estrogen. Both groups were matched by age, height, body mass index, parity, and duration of postmenopause. All subjects were evaluated with spirometry initially and after 6 months. For statistical analysis, descriptive and analytical methods were used, based on data type and distribution. The mean and standard deviations were used as measures of central tendency and variability. Categorical data were expressed as absolute and relative numbers (percentage). The t-test for independent samples (for comparison of groups) and t-test for dependent samples (for comparison of serial measurements in the same patients) were used. The analysis was performed using R software ( www.r-project.org ), with the level of significance set at p<0.05. RESULTS Analysis of spirometry parameters showed statistically significant differences between the estrogen users and the nonusers groups. CONCLUSION The most important study result was the significantly improved lung respiratory function in postmenopausal women with genital prolapse after 6 months of taking estrogen, confirming that hormone replacement therapy should be recommended to postmenopausal women. The findings of our study suggest the need for further research into the effect of estrogen on pulmonary function.