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ABSTRACT: One of the first steps in optimizing future prevention and appropriately allocating resources to future diagnosis and treatment of Gestational diabetes (GDM) is to quantify its burden. The aim of this study was therefore to conduct a systematic review of current international literature on the prevalence of GDM with a focus on advanced economies.
Based on literature searches with the database “PubMed” we included studies with a publication date between 2000 and 2011. All studies were classified independently by two authors. In accordance with the PRISMA Statement we identified 27 original studies.
The prevalence of GDM varies substantially between populations with a range of 1.7–11.6 %. Patient self-reports yield higher prevalence estimates than values that are based on medical diagnosis or clinical diagnostic tests. Prevalence seems to vary considerably within Europe with higher prevalence values being observed in Southern Europe than in Northern and Central Europe. Prevalence values from studies from Australia and North America were within this range.
This review provides a comprehensive and sound summary of the current state of research on the prevalence of GDM in advances economies as a fi rst step in identifying starting points for future interventions.
Journal of Perinatal Medicine 09/2012; 40(5):511-20. · 1.70 Impact Factor
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ABSTRACT: Cheap and simple interventions that are intended to minimize postpartum hemorrhage are of major public health concern. We report a case of postpartum hemorrhage in which conservative interventions had failed. The use of a chitosan-covered gauze that originally was developed for combat trauma allowed us to achieve hemostasis, and a seemingly inevitable hysterectomy was avoided.
American journal of obstetrics and gynecology 01/2012; 206(1):e12-3. · 3.28 Impact Factor
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ABSTRACT: Gestational diabetes and preeclampsia are leading causes of complications during pregnancy.
The aims of this study were to quantify the probability that both diseases occur together, to evaluate commonality of risk factor profiles, and to clarify the connection between gestational diabetes and preeclampsia in combination with the maternal body mass index.
We analysed data of the German Perinatal Quality Registry 2006, an annual full inventory of all hospital births in Germany.
The Registry contains the complete national birth cohort of 668,085 newborn infants and 647,392 mothers from 896 German obstetric clinics.
Each case of gestational diabetes or preeclampsia that was identified during pregnancy by a gynaecologist or in the hospital was fully registered.
The prevalence of GDM was 2.32% and that of PE was 2.31%, resulting in 0.09% of all pregnant women being diagnosed with both diseases. GDM was found to be an independent risk factor for PE. Increased maternal age, nulliparity, and multiple gestation pregnancies could be identified as common risk factors for both diseases, while increased pre-pregnancy body mass index was found to be the most important predictor for both diseases.
As PE and GDM share similar risk factors, identification of high-risk groups by simultaneous screening methods seems to be reasonable for prevention of complications. Further studies will be needed to investigate possible pathophysiological pathways increased body mass index has on the induction of both diseases.
Early human development 09/2011; 88(3):179-84. · 2.12 Impact Factor
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ABSTRACT: The purpose of this study was to determine whether optical methods can estimate cervix function during pregnancy and whether progestins modify this process.
Photos of the external cervix of timed-pregnant rats were taken every other day from day 13 until postpartum day 5 after daily treatments with vehicle (controls) or progestin treatments (progesterone, subcutaneously or vaginally; 17-alpha-hydroxyprogesterone caproate [17P] and RU-486 subcutaneously, once on day 16). The surface area of the cervix was estimated from photos.
The surface area of cervix increases throughout pregnancy and reverses after delivery in controls. In the progesterone subcutaneously or 17P subcutaneously groups, increases in surface area are lower (17P group until day 19 only; P < .05). Vaginal progesterone does not prevent surface area increases. Only the progesterone subcutaneously blocked delivery. RU-486 increases the surface area of the cervix (P < .05) during preterm delivery.
An optical method is useful for quantitative assessment of the cervix and evaluation of agents that modify cervical function.
American journal of obstetrics and gynecology 02/2011; 205(1):82.e15-20. · 3.28 Impact Factor
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ABSTRACT: We investigated risk factors and neonatal outcomes of preeclampsia.
We analyzed data of the German Perinatal Quality Registry 2006 that contains the complete national birth cohort of 668,085 newborn infants and 647,392 mothers from 917 German obstetric clinics.
The prevalence of preeclampsia in 2006 was at 2.31%. Higher maternal age, gestational diabetes, no previous as well as multiple births, pre-pregnancy obesity and above-average weight gain during pregnancy were significantly associated with preeclampsia. A positive relationship between social burden (e.g., low social status, psychosocial stress) and the risk of preeclampsia appeared. Smoking appeared to be negatively correlated. Neonatal complications associated with preeclampsia in the study were small babies, acute respiratory distress syndrome, postpartum neonatal hypoglycemia and low Apgar scores. We did not observe an increased rate of stillbirths with preeclampsia pregnancies.
Further studies and interventions regarding prenatal care should not focus only on how better diagnostic and treatment procedures can be implemented but also on how these diagnostic and treatment procedures can reach high-risk groups.
Journal of Perinatal Medicine 02/2011; 39(3):257-65. · 1.70 Impact Factor
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ABSTRACT: Objective. This study aimed to identify risk factors for gestational diabetes mellitus (GDM) and assess the effects of GDM on the risk of adverse pregnancy outcomes. Material and methods. This was a cross-sectional study using data from the German Perinatal Quality Registry, which is a complete national registry containing information on all hospital births across Germany. The Registry for 2006 contains data on a complete birth cohort of 668,085 newborn infants and 647,392 mothers from all 896 German hospitals. All data were taken from maternity log records and analyzed by multivariate logistic regression. Each recorded case of GDM was identified by a gynecologist or in hospital. Results. The prevalence of GDM was 2.3% (14,990 of 647,385). High-risk groups were migrants, women of lower socioeconomic status (adjusted odds ratio 1.16, 95% confidence interval 1.05–1.28) and obese women (adjusted odds ratio 4.96, 95% confidence interval 4.70–5.24). A higher risk of fetal malformations was found for those diagnosed with GDM (adjusted odds ratio 1.32, 95% confidence interval 1.15–1.53). Conclusion. The higher risk of fetal malformations with GDM suggests that many of these women may have high glucose levels even during the first trimester. Policies and interventions regarding prenatal care should therefore focus not only on how better diagnostic and treatment procedures can be implemented, but also on how they can reach older and migrant women as well as women of lower socioeconomic status.
Acta Obstetricia Et Gynecologica Scandinavica 12/2010; 90(3):231 - 237. · 1.77 Impact Factor
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ABSTRACT: interleukin (IL)-24 and -29 are novel cytokines, produced by immune cells in response to microbial antigens. The functions of these cytokines in the reproductive system are unknown. We examined the expression pattern of IL-24 and IL-29 in human fetal membranes from preterm and term births and in in vitro in response to microbial antigens.
fetal membranes collected from cesarean sections at term (normal, not in labor) were placed in culture for 48 h. These membranes were then stimulated with bacterial lipopolysaccharide (LPS) or viral antigen poly-inosinic and cytidylic acid (polyIC) for an additional 24 h. Amniotic fluids (AF) and fetal membranes were also collected from preterm and term deliveries. IL-24 and IL-29 expressions were studied by RT-PCR. ELISA documented culture media and AF cytokine concentrations.
IL-24 and IL-29 expressions were seen in cultured fetal membranes regardless of stimulation. Expressions were also found in preterm and term labor membranes, but not in non-labor tissues at term. IL-24 concentrations were higher after LPS stimulation whereas IL-29 concentrations were higher after polyIC-stimulation. AF analysis did not detect either of the cytokines either preterm or term.
this is the first study to report IL-24 and IL-29 expressions in human fetal membranes. Higher concentrations of these cytokines in response to distinct infectious stimuli suggest different pathways for fetal immune response during infection.
Journal of Perinatal Medicine 11/2010; 38(6):665-70. · 1.70 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate cervical changes and delivery at term during pregnancy in rats after various progestin treatments.
Pregnant rats were treated by various routes and vehicles with progesterone, 17-alpha-hydroxyprogesterone caproate (17P), R5020, and RU-486. Delivery time was determined and cervical ripening was assessed in vivo by collagen light-induced fluorescence.
The cervix is rigid in the progesterone injection, 17P, and vaginal R5020 groups vs controls. Vaginal progesterone had no effect. RU-486 treatment softened the cervix during preterm delivery. Only subcutaneous injected progesterone, R5020 (subcutaneous and vaginal), and topical progesterone in sesame and fish oil inhibits delivery. Delivery is not changed by subcutaneous injection of 17P, vaginal progesterone, oral progesterone, and topical progesterone in Replens (Crinone; Columbia Labs, Livingston, NJ).
Inhibition of cervical ripening and delivery by progestins depends on many factors that include their properties, the route of administration, and the vehicle. This study suggests reasons that the present treatments for preterm labor are not efficacious.
American journal of obstetrics and gynecology 05/2010; 202(5):455.e1-9. · 3.28 Impact Factor
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ABSTRACT: Maternal infection with parvovirus B19 during pregnancy can cause aplastic anemia in the fetus and may lead to nonimmune fetal hydrops and fetal demise. Twin pregnancies complicated by infection due to parvovirus B19 are very rare clinical events. We present a dichorionic, diamniotic, dizygotic twin pregnancy after in vitro fertilization with parvovirus B19 infection and viral transmission to both twins, but different outcomes. At 19 weeks gestation, hydrops fetalis was diagnosed for male twin A, female twin B did not show any abnormalities. At 22 weeks gestation an acute parvovirus B19 infection was detected and twin A was diagnosed with intrauterine fetal death (IUFD) by ultrasound at 23 weeks gestation. Viral DNA was detected in maternal blood as well as in placenta and liver tissue of this twin. Twin B was born at 35 weeks gestation asymptomatically and no signs of hydrops or other congenital anomalies but viral DNA was detected by PCR in serum. At the age of 2 years, both IgG titres against B19 and parvovirus DNA amplification copies were still positive in plasma of the surviving twin, but no clinical signs were detectable. It is remarkable that both twins were infected with parvovirus B19 early in pregnancy but showed a discordant clinical outcome. Our case report describes the rare occurrence of an intrauterine fetal death (IUFD) of one twin and the asymptomatic infection of the other in a twin pregnancy.
Twin Research and Human Genetics 05/2009; 12(2):175-9. · 1.70 Impact Factor
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ABSTRACT: To understand cervical ripening and especially the pathophysiology of cervical insufficiency, it is important to know the cervical composition: the cervix is dominated by fibrous connective tissue, consisting predominantly of Type I collagen (70%). Despite many studies of the cervix, we still rely upon relatively crude methods for clinical evaluation of the cervix. If the amount of cervical collagen plays a role in cervical insufficiency and in success of or length of induction of labor, then measurements of cervical collagen may provide an objective means of establishing the diagnosis or prognosis. We have established and reported a non-invasive means, called Collascope, to measure collagen cross-linking using light-induced fluorescence (LIF), and which is specifically designed to assess cervical ripening, and functions by measuring the natural fluorescence of non-soluble collagen in the cervix. Studies conducted in animals and humans in a variety of settings indicate that cervical function can be successfully monitored using the Collascope during pregnancy: LIF correlates negatively with gestational age and positively with time-to-delivery interval, and is predictive of delivery within 24h. Additionally LIF is significantly lower in women with cervical insufficiency. We suggest that the Collascope might be useful to better define management in cases of spontaneous preterm or induced term cervical ripening. From our studies and others, it is clear that in forecasting (pre-)term cervical ripening, the capability of the technologies and bioassays that have been generally accepted into clinical practice are limited. Any devices shown to be superior to the clinically accepted tests currently used should be quite useful for clinicians. The Collascope offers an objective measurement of both the function and state of the cervix, by directly measuring collagen cross-linking using LIF.
European journal of obstetrics, gynecology, and reproductive biology 04/2009; 144 Suppl 1:S70-6. · 1.97 Impact Factor
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ABSTRACT: At present, there is no effective treatment for preterm labor. The most obvious reason for this anomaly is that there is no objective manner in which to evaluate the progression of pregnancy through steps leading to labor, either at term or preterm. Understanding the physiology of the uterus during term and preterm parturition is important for developing methods to control uterine function and is essential to solving clinical problems related to labor. Several techniques have been adopted to monitor and/or to diagnose labor. Unfortunately they are either subjective or indirect and do not provide an accurate prediction especially for preterm labor. Uterine electromyography (EMG) may provide more objective, highly accurate, and clinically useful information. This may be especially important in clinical scenarios such as prediction of preterm labor, differentiation between true and false labor, and management of labor augmentation, labor induction or tocolysis. Thereby EMG would enable clinicians to apply much better treatment for pregnant patients.
European journal of obstetrics, gynecology, and reproductive biology 04/2009; 144 Suppl 1:S33-9. · 1.97 Impact Factor
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ABSTRACT: To determine the effect of bilateral pelvic neurectomy (BPN) on cervical ripening in pregnant rats by measuring cervical extensibility and changes in collagen cross-linkages.
Timed-pregnant rats were randomly laparotomized on days 9 or 10 of gestation and the pelvic nerves were exposed and either bilaterally transected, or left intact in sham control animals. The rats were sacrificed on day 18 and the uterine cervices obtained. Cervical ripening was assessed by cervical resistance-to-stretch, light-induced autofluorescence (LIF) of cross-linked collagen, and collagen changes analyzed by picrosirius polarization microscopy.
Measurements of extensibility and collagen cross-linkages indicated that after BPN the cervix was significantly more ripened than the cervix from sham control animals.
BPN stimulates cervical ripening instead of inhibiting this event as previously proposed. Further studies in this area could be critical for developing treatments for dystocia, preterm labor, and cervical insufficiency.
Journal of Perinatal Medicine 03/2009; 37(3):263-9. · 1.70 Impact Factor
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Wolfgang Henrich,
Daniel Surbek,
Franz Kainer,
Oliver Grottke,
Hartmut Hopp,
Holger Kiesewetter,
Jürgen Koscielny, Holger Maul,
Dietmar Schlembach,
Georg-Friedrich von Tempelhoff,
Werner Rath
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ABSTRACT: Severe peripartum hemorrhage (PPH) contributes to maternal morbidity and mortality and is one of the most frequent emergencies in obstetrics, occurring at a prevalence of 0.5-5.0%. Detection of antepartum risk factors is essential in order to implement preventive measures. Proper training of obstetric staff and publication of recommendations and guidelines can effectively reduce the frequency of PPH and its resulting morbidity and mortality. Therefore, an interdisciplinary expert committee was formed, with members from Germany, Austria, and Switzerland, to summarize recent scientific findings. An up-to-date presentation of the importance of embolization and of the diagnosis of coagulopathy in PPH is provided. Furthermore, the committee recommends changes in the management of PPH including new surgical options and the off-label use of recombinant factor VIIa.
Journal of Perinatal Medicine 10/2008; 36(6):467-78. · 1.70 Impact Factor
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ABSTRACT: Mother to infant transmission of hepatitis B virus (HBV) represents a major factor in maintaining chronic infection and depends on the degree of maternal infectivity status.
To examine the seroprevalence of hepatitis B virus surface antigen (HBsAg) in women at reproductive age admitted to the Department of Gynaecology at a German university hospital.
The seroprevalence of hepatitis B surface antigen (HBsAg) in 5518 women at reproductive age was examined, HBsAg-positive samples were tested for additional HBV markers to verify the infection status.
Out of 5518 samples from women at reproductive age, 88 women (1.59%) were positive for HBsAg and 7 of these HBV-positive women (7.95%) were additionally positive for HBeAg. The majority of the study population were German citizens, however most HBV infected persons originated from countries with a high HBV prevalence. The HBV seroprevalence in our study group is about two times higher compared to the average seroprevalence in the German citizen adult population, thus probably resulting in an underestimation of the infection rate in a multinational setting.
Screening for HBsAg during pregnancy is still necessary and important for reduction of perinatal HBV transmission even in countries with low HBV prevalence.
Journal of Clinical Virology 09/2008; 42(4):422-4. · 3.97 Impact Factor
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Proceedings of the First International Conference on Biomedical Electronics and Devices, BIOSIGNALS 2008, Funchal, Madeira, Portugal, January 28-31, 2008, Volume 2; 01/2008
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ABSTRACT: First trimester risk assessment for fetal aneuploidies is computed on the base of a general background risk, which is depending on the maternal age. Thereby, the adjusted risk tends to rise with increasing age. Obversely, more unsuspicious fetal parameters [measurement of the nuchal translucency (NT) and biochemical parameters, free beta human chorionic gonadotropine (fbetaB-Hcg) and pregnancy associated plasma protein A (Papp-A)] have to be observed to result in an unsuspicious test at higher age. It was the aim of this study to investigate the potential value of a novel risk assessment algorithm explicitly disregarding the maternal age.
This was an ultrasound cohort study of 1,463 singleton pregnancies at 11-14 weeks of gestation undergoing a first trimester screening for fetal aneuploidies by measuring the (NT), Papp-A and fbeta-hCG. In each case, the pregnancy outcome was obtained. Regarding either the detection of genetic affections or the combined detection of genetic or somatic anomalies, the test performance parameters (sensitivity, specificity, positive and negative predictive values) were calculated and compared with each other. For risk calculation the standard Fetal Medicine Foundation (FMF)-Software and an alternative software with a similar algorithm (JOY-Software) were utilized. Compared to this, the risk assessment had been modified by implementing a novel calculation algorithm (advanced first trimester screening algorithm, AFS) purposely disregarding the maternal age and again, the test performance parameters had been computed and were compared with the first ones.
At the mere genetic analysis, all four test-strategies revealed to have identical sensitivity and negative predictive values. Compared to the standard FMF-Software, the JOY-Software showed a reduced false positive rate. In addition, in both softwares, the false positive rate is highly significant-reduced by implementing the AFS-algorithm. At combined genetic and somatic analysis, analogous results on different counts could be found.
In the effort to create an algorithm characterising somatic and fetal conditions of the fetus most properly, the inclusion of maternal age is not a helpful value and excluding the age from risk calculation leads to a high significant reduction of the false positive rate. Further, a comparable marked increase of both, specificity and positive predictive values, can be achieved for the FMF- and JOY-Software on the background of the generally more favourable JOY test performance.
Archives of Gynecology and Obstetrics 09/2007; 276(2):159-66. · 1.28 Impact Factor
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Wolfgang Wagner,
Frederik Wein,
Christoph Roderburg,
Rainer Saffrich,
Anne Faber,
Ulf Krause,
Mario Schubert,
Vladimir Benes,
Volker Eckstein, Holger Maul,
Anthony D Ho
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ABSTRACT: The significant role of direct contact between hematopoietic progenitor cells (HPC) and the cellular microenvironment for maintaining "stemness" has been demonstrated. Human mesenchymal stem cell (MSC) feeder layers represent a surrogate model for this interaction. Specific adhesion molecules are responsible for this cell-cell contact.
To define cell-cell contact between HPC and MSC, we have studied adhesive interaction of various fractions of HPC by using a novel assay based on gravitational force upon inversion. Adherent and nonadherent cells were separated and further analyzed with regard to gene expression and long-term hematopoietic culture initiating cell (LTC-IC) frequency.
HPC subsets with higher self-renewing capacity demonstrated significantly higher adherence to human MSC (CD34(+) vs CD34(-), CD34(+)/CD38(-) vs CD34(+)/CD38(+), slow dividing fraction vs fast dividing fraction). LTC-IC frequency was significantly higher in the adherent fraction than in the nonadherent fraction. Furthermore, genes coding for adhesion proteins and extracellular matrix were higher expressed in the adherent subsets of CD34(+) cells (fibronectin 1, cadherin 11, vascular cell adhesion molecule-1, connexin 43, integrin beta-like 1, and TGFBI).
In this study we have demonstrated that primitive subsets of HPC have higher affinity to human MSC. The essential role of specific junction proteins for stabilization of cell-cell contact is indicated by their significant higher expression.
Experimental Hematology 03/2007; 35(2):314-25. · 2.90 Impact Factor
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ABSTRACT: To study if spontaneous contractions augmented by proteinase-activated receptor-2 (PAR-2)-activating peptide serine-leucine-isoleucine-glycine-arginine-leucine (SLIGRL) involve coactivation of membrane chemoceptors and are associated with expression of PAR-2 mRNA in non-pregnant and pregnant rat myometrium.
Non-pregnant, mid-pregnant, and late pregnant rat uterine horn and small intestine segments were snap-frozen in liquid nitrogen to determine PAR-2 mRNA levels by real time polymerase chain reaction (PCR). Uterine rings were used for isometric tension recording. Effect of SLIGRL (0.1 mM) on spontaneous contractions before and after exposure to ibuprofen (cyclooxygenase inhibitor, 1.0 microM), SQ-29548 (thromboxane A(2) receptor inhibitor, 1.0 microM), ketotifen (histamine 1 receptor inhibitor, 10 microM), WEB-2170BS (platelet-activating factor (PAF) receptor inhibitor, 10 microM), atropine (muscarinic receptor inhibitor, 0.1 microM), or ketanserin (serotonin receptor inhibitor, 10 microM) were compared. Paired t-test and one-way ANOVA followed by Dunnett's or Newman-Keuls post hoc tests were used for statistical analysis when appropriate.
P<0.05.
The agents did not significantly affect time-associated decay in spontaneous contractile activity in any group of the tissues. Activation of spontaneous contractions induced by SLIGRL in non-pregnant rat myometrium did not involve coactivation of membrane chemoceptors, while in mid-pregnant rat myometrium coactivation of prostanoid, histamine, and serotonin receptors and in late pregnant rat myometrium coactivation of thromboxane receptors was noted. Expression of PAR-2 mRNA was similar in non-pregnant, mid-pregnant, and late pregnant rat myometrium.
Expression of PAR-2 in rat myometrium is not dependent on gestational age. Stimulation of PAR-2 is associated with production/release of cyclooxygenase pathway product(s) activating thromboxane/prostaglandin H2 receptors, partial involvement of histamine H1 receptors and serotonin receptors in midpregnancy and thromboxane A2/prostaglandin H2 receptors in late pregnancy.
European Journal of Obstetrics & Gynecology and Reproductive Biology 01/2007; 130(1):51-9. · 1.97 Impact Factor
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ABSTRACT: The physiologic and pathologic changes of the uterine cervix during pregnancy leading to cervical ripening are not well understood though are related to the chief pathology and a commonly performed intervention in obstetrics: Preterm birth and labor induction. Normal cervical ripening is thought to be controlled by a variety of hormonal changes occurring during pregnancy leading to softening and dilation. Abnormal premature ripening, usually resulting in preterm labor, is thought to be associated with infection and inflammatory events. Despite many studies of the cervix, we still rely upon relatively crude methods for clinical evaluation of the cervix. In the past several years, we have developed and evaluated a method to measure cervical collagen noninvasively using an instrument called Collascope. Studies in animals and humans conducted in a variety of settings indicate that cervical function can be successfully monitored using the Collascope during pregnancy. We suggest that this technique might be useful to better define management in cases of spontaneous preterm and induced term cervical ripening.
Clinical Obstetrics and Gynecology 10/2006; 49(3):551-63. · 1.93 Impact Factor
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ABSTRACT: This study examines the relationship between inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in the control of cervical ripening and parturition under normal (normal term pregnancy) and abnormal (preterm labor and prolongation of pregnancy) conditions by (a) measuring changes in the collagen both visually and quantitatively, (b) localizing and characterizing iNOS and COX-2 under normal conditions, and (c) characterizing the changes in iNOS and COX-2 under abnormal conditions. Cervices are obtained from estrus and timed pregnant Sprague-Dawley rats (n=4-10 per group). Preterm labor is induced with Onapristone (3 mg/rat; progesterone antagonist) and the prolongation of pregnancy with progesterone (2.5 mg, twice daily). Collagen changes are measured and visualized with the picrosirius polarization method. RT-PCR is used to characterize the mRNA expression (p<0.05), and immunohistochemistry is used to localize the protein expression for iNOS and COX-2. The organization and birefringence of the collagen during pregnancy decreased and is supported by changes in the luminosity (p<0.001). The iNOS and COX-2 enzymes were localized in cervical smooth muscle, vascular smooth muscle, and epithelium. Under normal conditions, iNOS mRNA levels decreased as COX-2 mRNA levels increased demonstrating an inverse correlation (Spearman r = -0.497; p=0.00295). Onapristone stimulated preterm labor, increasing the iNOS and COX-2 mRNA (p<0.05). The increase demonstrated a positive correlation (Spearman r = 0.456; p=0.03). Progesterone prolonged pregnancy, decreasing the iNOS and COX-2 mRNA (p=0.036). In conclusion, there may be an interaction between the nitric oxide and prostaglandin pathways in cervical ripening and parturition.
Journal of Histochemistry and Cytochemistry 06/2006; 54(6):623-39. · 2.72 Impact Factor
