European journal of obstetrics, gynecology, and reproductive biology

Publisher: Elsevier

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Impact factor 1.97

  • 5-year impact
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  • ISSN
    1872-7654

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Elsevier

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To investigate the effect of bladder distention before outpatient hysteroscopy (OH). Study design Initially, 120 eligible patients were approached, and a total of 102 patients were recruited into the randomised controlled trial. OH was completed successfully in 97 patients. Pain scoring (visual analogue scale) and the ease of cervical entry (Likert scale) were the primary outcome measures. The secondary outcome measures in this study were the duration of the procedure and patient acceptability (Likert scale). Result(s) Bladder distention before OH was related to easier cervical entry, a shorter procedural time and low pain scoring in patients who underwent the procedure with a full bladder. Conclusion(s) Bladder distention before OH significantly improved the pain score of patients and increases the feasibility of the hysteroscopy procedure.
    European journal of obstetrics, gynecology, and reproductive biology 09/2014; 180:89–92.
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    ABSTRACT: Objective To report basic measurements of clitoral anatomy, and explore potential relationships between the clitoral complex and female sexual function using MRI assessment. Study design: In this retrospective descriptive study, 20 sexually active women (≥ 18 years) who had a recent pelvic MRI for various gynecologic concerns were invited to participate. Outcome measures included demographic data, medical and sexual history, quality of life questionnaires: Female Sexual Function Index (FSFI), Body Exposure during Sexual Activities Questionnaire (BESAQ), and Short Form Quality of Life Questionnaire (SF-12). These data were then compared to detailed clitoral MRI measurements and analyzed using the Pearson correlation and Chi square test. Results FSFI domains of desire, arousal, lubrication, and orgasm were inversely correlated with clitoral size (p = 0.01-0.04), as were SF-12 physical composite scores (p = 0.003), suggesting improved sexual function and physical health in women with smaller clitoral structures (specifically the clitoral body and crus). Conclusion Sexual function was improved in women with a smaller-sized clitoris, specifically the clitoral body and crus.
    European journal of obstetrics, gynecology, and reproductive biology 09/2014;
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    ABSTRACT: Glassy cell carcinoma (GCC) is a histologically aggressive subtype of cervical cancer with rapid growth and early metastases. The prognosis for patients with GCC is poor. This article reviews the literature pertinent to the epidemiology, cytology, pathology, immunohistochemistry, treatment and prognosis of GCC. MEDLINE (PubMed) was searched for all articles or abstracts on patients diagnosed with GCC published (in English) since the original definition by Glucksmann and Cherry in 1956. Accurate diagnosis of GCC enables implementation of the correct treatment strategy. Early-stage GCC should be treated with hysterectomy and pelvic lymph node dissection, with adjuvant radiochemotherapy if at least one intermediate or high risk factor for cervical cancer is present. Advanced GCC should be treated with neoadjuvant radiochemotherapy or chemotherapy with the aim of making the disease operable. There is a need for retrospective evaluation of GCC treatment from several centres to explore knowledge about this rare entity. Future studies should explore the role of targeted therapies and the most efficient chemotherapy regimen for the management of GCC.
    European journal of obstetrics, gynecology, and reproductive biology 08/2014;
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    ABSTRACT: Objective The aim of this study was to evaluate the cure effect of a transurethral injection (TUI) of Bulkamid® for female urodynamic stress (USI) and stress-predominant mixed urinary incontinence. The hypothesis was that the cure effect of Bulkamid® is positive in patients who have undergone previous unsuccessful anti-incontinence surgery and in patients with ISD (Intrinsic Sphincter Deficiency). Study design: This retrospective clinical study was performed on 52 patients for whom previous anti-incontinence surgery had failed (n = 40) and on patients with ISD. Five patients had a reinjection of Bulkamid®. The efficacy of TUI was evaluated an average of 22 months (minimum - 6 months, maximum - 50 months) after the procedure. Subjective assessment of the leakage of urine was based on the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF). Objective assessment of leakage of urine was assessed by the cough test. The cure effect of procedures was evaluated by VAS (Visual Analogue Scale: VAS score 0-100; 100–without leakage of urine, dry) and by using the five-point Likert scale. The statistics were calculated using the software STATISTICA 10-StatSoft. Inc software (Tulsa, USA). Results A retrospective study was performed on 52 women with urinary incontinence (stress 43, mixed 9), and 51 patients completed the study. One patient with SUI died during the study. Their mean age was 70 years, mean body mass index (BMI) was 28.65, and mean parity was 1.76. Objective assessment by cough test showed that 19.6% of patients had negative results for this test 22 months after the operation. Subjective assessment by the ICIQ-UI SF questionnaire showed that 15.7% of patients were completely dry, while 45.1% of patients were dry or improved. The mean VAS score was 51.3, and on the Likert scale the cure effect was evaluated as 5 or 4 (“cured” or “improved”) in 54.9% of patients. Conclusions The hypothesis that the cure effect of Bulkamid® is positive in patients who have undergone previous unsuccessful anti-incontinence surgery, and in patients with ISD, was confirmed. The procedure is an option for failed anti-incontinence surgery or for patients with ISD.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective To establish a new mouse model for autoimmune-type recurrent spontaneous abortion (AI-RSA) and demonstrate the potential role of intrauterine immunization with β2GP-1-like antigen in AI-RSA, we performed an intrauterine injection of human β2GP-1 in BALB/c mice and unrelated protein, adjuvants, and normal saline (NS) as controls. The mean number of embryos implanted (MNEI), embryo loss rate (ELR), mean embryo bulk (MEB), and mean placental weight (MPW) were analyzed. Compared with the control mice, BALB/c mice injected with human β2GP-1 showed increased anti-β2GP-1 and MPW. Moreover, BALB/c mice immunized with human β2GP-1 exhibited hypercoagulability and vascular thrombus formation in the placenta. Electron microscopy confirmed the existence of platelet aggregation, mitochondrial swelling, and endothelial cell necrosis in the placentas of BALB/c mice immunized with human β2GP-1. These finding indicated that intrauterine immunization with β2GP-1 successfully induced AI-RSA in mice. Increased anti-β2GP-1 antibody could independently induce hypercoagulability, vascular endothelial injury, and vascular thrombus formation in the placenta, which led to AI-RSA.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective Thoracic endometriosis is a relatively rare type of endometriosis and includes catamenial pneumothorax, hemothorax and hemoptysis, and presence of intrathoracic endometriotic nodules. We want to clarify and resume the most appropriate management of this pathology. Study design We retrospectively reviewed all the cases of thoracic endometriosis diagnosed and followed up in our Unit from 2005 to 2013. This search revealed five women, with a mean age of 34.5 (26–44). Four had previous history of endometriosis or severe dysmenorrhea. One patient complained of chronic shoulder pain with diaphragmatic implants, another one presented catamenial hemoptysis, and three women suffered from catamenial pneumothorax, with right-side preference. Results Three patients underwent surgery and all of them were treated with GnRH agonists at least during 6 month referring improvement in symptoms. After 1–8 years follow-up, all these patients remain asymptomatic. Conclusion The optimal management of thoracic endometriosis needs further evaluation but the combined approach by hormonal therapy and surgery could be the best option.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective(s) To identify factors associated with a successful see-and-treat hysteroscopic polypectomy. Study design We have retrospectively studied a population of 229 women with endometrial polyps who were referred to office hysteroscopy at the hysteroscopy unit of a large university hospital. See-and-treat polypectomy with 5-French microinstruments was routinely attempted. Cases where the endometrial polyp was successfully removed were compared to those who had to be referred to polyp resection with the resectoscope. Bivariate and multivariate statistical analyses where used to identify factors associated to the success of see-and-treat polypectomy. Results Outpatient hysteroscopy was feasible on 223 patients, confirming endometrial polyps in all of them. See-and-treat polypectomy with 5-French micro-instruments was successful in the 65.5% of the cases (146/223). Bivariate analysis suggested an association of successful see-and-treat with younger age, lower BMI, premenopausal status, smaller polyps, easy hysteroscopic access and painless examinations. Multiple logistic regression confirmed the independent association of a successful see-and-treat polypectomy with premenopausal status (OR 3.623; 95%CI 1.302-10.084) and smaller polyp size (OR 0.891; 95%CI 0.846-0.938). Pain was confirmed as an independent, limiting factor (OR .085; 95%CI 0.034-0.214). Conclusion See-and-treat hysteroscopic polypectomy with 5-French instruments is effective and feasible but its success is lower in case of pain, larger polyps and postmenopausal patients.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objectives Oral contraceptives (OCs) containing androgenic second and third generation progestins decrease insulin sensitivity (SI). In this study we investigated whether an oral contraceptive containing the anti-androgenic progestin drospirenone (DRSP) still alters SI. Lipid modifications were investigated as well. Study design Eleven young healthy women were allocated to receive for 6 months ethinyl-estradiol (EE) 30 μg plus DRSP (3 mg). SI and glucose utilization independent of insulin (Sg) was investigated by the minimal model method. Lipid modifications were also analyzed. Results SI did not vary during EE/DRSP (from 3.72 ± 2.62 to 3.29 ± 2.93; p = 0.73). Similarly, values of Sg did not vary (from 0.03 ± 0.02 to 0.032 ± 0.014; p = 0.87). An increase was observed in HDL cholesterol (9.4 ± 9.8 mg/dl; p = 0.05) and triglycerides (46.9 ± 75.1 mg/dl; p = 0.046), with no modification in LDL cholesterol (−4.64 ± 1.704 mg/dl; p = 0.6). Conclusions EE/DRSP does not deteriorate SI. These results are reassuring for the long-term use of this association.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective To demonstrate the performance of Hb Bart's Disease prevention in Guangxi Zhuang Autonomous Region, China. Study design A prenatal control program for Hb Bart's disease was conducted from January 2006 to December 2012. A total of 17,555 pregnant women were screened for α-thalassemia in our prenatal screening program. Pregnancy at-risk for Hb Bart's disease was offered the choice of direct invasive testing or the non-invasive approach with serial ultrasonography. Results A total of 1425 at-risk couples attended the prenatal diagnosis. Three hundred ninety couples were screened at our own hospital, and the remaining 1035 couples were referred from other hospitals. Two hundred and three pregnant women chose non-invasive approach, and 1122 chose invasive testing. A total of 365 fetuses were diagnosed with Hb Bart's disease. All cases were finally confirmed by fetal DNA analysis. Eighty-two cases (22.4%) were diagnosed by chorionic villous sampling and 194 (53.2%) by amniocentesis samples. The other 89 (24.4%) cases were performed by cordocentesis. All of the affected pregnancies were terminated. Conclusion Implementation of a prevention and control program accompanying with a referral system for prenatal diagnosis is technically feasible in Guangxi Zhuang Autonomous Region, China.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective To study the effect and mechanism of environmental estrogens bisphenol A (BPA) on uterine leiomyoma (UL) cells. Methods Primary cultures and subcultures of human UL cells, which were identified by immunocytochemical staining with a monoclonal anti-α-smooth muscle actin antibody, were performed. The viability of cells in different concentration of bisphenol A of 24 hrs, 48 hrs and 72 hrs were analyzed by CCK-8. The expressions of mRNA of ERα, IGF-1 and VEGF in all groups were detected by real-time quantitative PCR assay, and then the expressions of proteins detected by western blot assay. Results BPA promoted the growth of UL cells and the expressions of ERα, IGF-1 and VEGF, which had positive correlation with the concentration and action time of BPA treatment. Conclusion BPA promotes the growth of leiomyoma cells. The expressions of IGF-1, VEGF can be up-regulated by ERα, which may be possible mechanism of BPA promote the growth of leiomyoma cells.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective Accurate measurement of fetal head biometry is important for fetal weight estimation (FWE) and is therefore an important prognostic parameter for neonatal morbidity and mortality and a valuable tool for determining the further obstetric management. Measurement of the head circumference (HC) in particular is employed in many commonly used weight equations. The aim of the present study was to find the most accurate method to measure head circumference for fetal weight estimation. Study design : This prospective study included 481 term pregnancies. Inclusion criteria were a singleton pregnancy and ultrasound examination with complete fetal biometric parameters within 3 days of delivery, and an absence of structural or chromosomal malformations. Different methods were used for ultrasound measurement of the HC (ellipse–traced, ellipse-calculated, and circle-calculated). As a reference method, HC was also determined using a measuring tape immediately after birth. FWE was carried out with Hadlock formulas, including either HC or biparietal diameter (BPD), and differences were compared using percentage error (PE), absolute percentage error (APE), limits of agreement (LOA), and cumulative distribution. Results The ellipse-traced method showed the best results for FWE among all of the ultrasound methods assessed. It had the lowest median APE and the narrowest LOA. With regard to the cumulative distribution, it included the largest number of cases at a discrepancy level of ± 10%. The accuracy of BPD was similar to that of the ellipse-traced method when it was used instead of HC for weight estimation. Conclusion Differences between the three techniques for calculating HC were small but significant. For clinical use, the ellipse-traced method should be recommended. However, when BPD is used instead of HC for FWE, the accuracy is similar to that of the ellipse-traced method. The BPD might therefore be a good alternative to head measurements in estimating fetal weight.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective To show whether a clinically significant difference in success rates exists between expectant and surgical management of early pregnancy loss. Study design Randomized controlled trial comparing expectant versus surgical management of early pregnancy loss over a one-year period from 1st January to 31st December 2009 at Sultanah Aminah Hospital, Johor Bahru. Pregnant women with missed or incomplete miscarriages at gestations up to14 weeks were recruited in this study. The success rate in the surgical group was measured as curettage performed without any complications during or after the procedure, while the success rate in the expectant group was defined as complete spontaneous expulsion of products of conception within 6 weeks without any complication. Results A total of 360 women were recruited and randomized to expectant or surgical management, with 180 women in each group. There was no statistically significant difference in the success rate between the groups and between the different types of miscarriage. With expectant management, 131 (74%) patients had a complete spontaneous expulsion of products of conception, of whom 106 (83%) women miscarried within 7 days. However, the rates of unplanned admissions (18.1%) and unplanned surgical evacuations (17.5%) in the expectant group were significantly higher than the rates (7.4% and 8% respectively) in the surgical group. The complications in both groups were similar.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective The recent characterization of possible stem/progenitor cells in the endometrium has shed new light on the origins of ectopic endometrial tissue and the mechanism for the pathogenesis of endometriosis, but has raised new questions. Is it possible that abnormal endometrial stem/progenitor cells increase their capacity to implant and establish themselves as ectopic tissue, or that normal stem cells implant in abnormal peritoneum? This study investigated key stem cell properties in cologenic epithelial and stromal cells obtained from eutopic endometrium of women with endometriosis. Study design Single cell suspensions of endometrial epithelial and stromal cells were cultured at densities of 20, 50, 100 and 200 cells/cm2. Cloning efficiency (CE) was determined, and stem cell phenotypic surface markers were detected using Western blotting and quantitative real-time polymerase chain reaction. Results CE was significantly higher in cells cultured at a density of 50 cells/cm2 compared with the other groups. After 15 days of culture, small and large colonies were observed. Large-colony-derived epithelial and stromal cells had high proliferative potentials, producing millions of cells in vitro, with strong expression of epithelial and stromal stem cell phenotypic surface markers EMA, CK, CD49f, THY-1(CD90), collagen type I, 5B5 and vimentin. Conclusion Adult stem cells were found in eutopic endometrium of women with endometriosis, and this may play an important role in disease development.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Postpartum haemorrhage (PPH) is an urgent obstetric condition requiring an immediate response and a multidisciplinary approach. The aim of this study was to review PPH management guidelines implemented in clinical practice, to evaluate their impact regarding prevention, diagnosis and treatment, and to analyze how the numbers of PPH cases changed in the post-intervention period. A systematic search in the PubMed database was performed. The references of all included articles were examined. Studies evaluating the management of PPH and the impact on the numbers of cases of this pathology after the implementation of new or updated guidelines were involved in the analysis. Two reviewers independently examined the titles and abstracts of all identified citations, selected potentially eligible studies, and evaluated their full-text versions. Methodological quality was assessed using a checklist based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. We analyzed seven articles that evaluated the impact of new or updated guidelines for PPH management implemented in clinical practice. In four trials, the numbers of PPH cases declined after the intervention. Guidelines for PPH management can have a positive impact on the reduction of the number of PPH cases.
    European journal of obstetrics, gynecology, and reproductive biology 07/2014;
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    ABSTRACT: Objective To determine the immunological effect of dienogest (DNG), an oral anti-endometriosis drug, on peritoneal fluid (PF) macrophages collected from women with endometriosis. Although it has been suggested that DNG has direct effects on endometriotic cells, including decreased cell proliferation and decreased anti-inflammatory cytokine production, the effects of DNG on PF cells are unclear. Study design The effects of DNG on PF cells from 34 women with endometriosis and 22 women without endometriosis (controls) were investigated. Expression of human leukocyte antigen (HLA)-DR in PF macrophages, obtained from the peritoneal cavity during laparoscopic surgery, was determined by flow cytometry. HLA-DR expression was measured again after PF cells had been cultured for 72 h in a humidified atmosphere at 37 °C in 5% CO2–95% air with or without DNG. After 72 h of incubation, the concentration of pro-inflammatory tumour necrosis factor (TNF)-α in the media was measured by enzyme-linked immunosorbent assay. Results HLA-DR expression was lower in PF macrophages from women with endometriosis compared with controls. However, after DNG treatment, HLA-DR expression in PF macrophages from women with endometriosis was increased to the same level as in controls. The TNF-α concentration in the media was decreased by DNG. Conclusions DNG can restore the antigen-presenting ability of PF macrophages by increased HLA-DR expression, and may have an anti-inflammatory effect on PF macrophages in women with endometriosis.
    European journal of obstetrics, gynecology, and reproductive biology 06/2014;
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    ABSTRACT: Objective A possible correlation between uterine leiomyoma and thyroid disease was reported decades ago. We aimed to evaluate the possible associations between the presence of uterine leiomyomas and (i) the presence of overt hypothyroidism, (ii) the level of anti-thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (TG-Ab), and (iii) thyroid stimulating hormone (TSH) levels. Study design In a retrospective study, all 215 sterile women who underwent reproductive surgery (hysteroscopy and laparoscopy/laparotomy) at our department from January 2007 to January 2011 were included. All leiomyomas suspected on gynecologic ultrasound were verified during surgery. As risk factors for uterine leiomyomas, thyroid parameters, age, African heritage, age at menarche, parity, and body mass index were included. Results One or more uterine leiomyomas were found in 51 cases (23.7%). After multivariate analysis, three parameters remained significant, with African heritage the most important (odds ratio, OR, 27.80), followed by overt hypothyroidism (OR 3.10) and increasing age (OR 1.23). Larger leiomyomas were found in women with overt hypothyroidism than in those without overt hypothyroidism (median, 70 mm; range, 5–88 vs. median, 30 mm; range, 2–93, respectively; p = 0.007). Conclusions Overt hypothyroidism, but not autoantibodies against the thyroid gland, was associated with the presence of uterine leiomyoma in our study.
    European journal of obstetrics, gynecology, and reproductive biology 06/2014;
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    ABSTRACT: Objectives To determine the prevalence rate of women with a diagnosis of schizophrenia or related psychotic disorder in assisted reproductive technology (ART) treatment and to study these women's fertility treatment outcome in comparison to women with no psychotic disorders. Study design: We used a national register-based cohort of 42,915 Danish women in ART treatment from 1.1.1994 to 30.9.2009. All women with a diagnosis of schizophrenia or related psychotic disorders before, during or after their ART treatment were identified by individual-level linkage of nationwide registers of ART treatment, psychiatric admission, birth and socio-demographic status. The comparison group (N = 42,671) consisted of all women in the study cohort never diagnosed with psychotic disorders. Conventional descriptive methods were used for the statistical analyses. Results Two hundred and forty-four (0.6%) women in the study cohort received a diagnosis of psychotic disorder before (n = 135 ∼55.3%), during (n = 7 ∼2.9%) or after (n = 102 ∼41.8%) ART treatment. The mean time from last diagnosis of psychotic disorder to their first ART treatment in the 135 women with a psychiatric diagnosis prior to their first ART treatment was 7.1 ±5.6 years (25%-75% percentile: ±2.8-10.4 years). The most frequent diagnoses were acute and transient psychotic disorder. Women with a diagnosis of schizophrenia or related psychotic disorder before their first ART treatment had a lower ART treatment success rate as significantly fewer women obtained a live birth (40.0% vs. 51.9%, p < 0.01). However, we found no statistical differences in perinatal outcomes for the children born by women in the study population and comparison group. Conclusions The prevalence of women with a psychotic diagnosis in fertility treatment is lower than the prevalence in the general population. Women with a psychotic disorder prior to ART treatment have a lower fertility treatment success rate compared to women without psychotic disorder. Women with a psychotic disorder achieving delivery show similar obstetric outcomes to women with no psychotic disorder.
    European journal of obstetrics, gynecology, and reproductive biology 06/2014;
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    ABSTRACT: Objective The active form of vitamin D (1,25[OH]2D3) has been established to have potent anti-proliferative, immuno-modulatory, and anti-microbial action in addition to its effects on bone. The nuclear vitamin D receptor (VDR) is expressed in the placenta-decidua, regulating genes associated with implantation and implantation immuno-tolerance. If VDR polymorphisms regulate VDR functionality at the placenta-decidua interface, VDR genotypes may be involved in idiopathic preterm birth (PTB). Study design Maternal and fetal (umbilical cord) blood samples from 33 Jewish and Arab mothers with PTB of a singleton neonate were compared to 98 samples from Jewish and Arab maternal and fetal blood samples from full-term, uncomplicated singleton births. Maternal age and ethnicity were comparable between groups. PCR amplification/digestion identified the VDR SNPs: FokI, ApaI, TaqI, and BsmI. Results Allele frequency for the FokI VDR in maternal blood samples from preterm births (but not umbilical cord samples) was significantly different (p = 0.01) from that in maternal and umbilical cord blood samples from full-term singleton births, with an odds ratio for FokI carriers of 3.317 (95% CI, 1.143, 9.627) for preterm birth. The FokI VDR variant may therefore be a maternal risk trait for PTB among these women. Conclusion This study may support a future platform for the study of vitamin D during pregnancy and treatment of selective target populations with vitamin D and/or VDR “tissue-specific therapeutic intervention” for prevention of PTB
    European journal of obstetrics, gynecology, and reproductive biology 06/2014;