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Maternal hepatitis C (HCV) infection and Anti-D immunoglobulin therapy: study testing antibodies, RNA and Genotype of HCV in Baghdad

Al-Kubaisy W, Daud S, Al-Kubaisi MW, Al-Kubaisi OW, Abdullah NN

J Matern Fetal Neonatal Med, 2019 Oct;32(20):3464-3469.
PMID: 29656685 DOI: 10.1080/14767058.2018.1465557

Introduction: Hepatitis C virus (HCV) infection is a serious health problem. It is a major contributor to end-stage liver disease. Worldwide, 1-8% of all pregnant women were infected. Women with viral hepatitis may be at an increased risk of pregnancy complications. There are several obstetrics intervention acts as risk factors, which are specific to women pertaining the HCV infection; anti-D immunoglobulin (Ig) therapy may be one of them. Our objectives were to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy. Materials and methods: A cross sectional study was conducted. A sample of 154 Rhesus negative (Rh - ve) pregnant women regardless of the anti-D Ig therapy was collected. Anti-HCV were tested using third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia Tek-111), subsequently. In addition, 89 serum samples were subjected to molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) method for the detection of HCV-RNA and genotypes. Results: Anti-HCV, and HCV-RNA seroprevalence were significantly higher (17.1, 35.5%) among women with anti-D Ig than their counter group (6.4, 13.16%), p = .038, .018, respectively. Significant direct positive dose response correlation (r = 0.78, p = .005) had been seen between number of anti-D Ig therapy and anti-HCV seropositive rate. Anti-D Ig therapy act as a risk factor (odds ratio (OR) = 3.01, 95%CI: 1.01-8.9) especially from the third dose onward. Women with anti-D Ig therapy were at higher risk (3.6 times more) of positive HCV-RNA (OR =3.6, 95%CI =1.19-10.837). Genotype HCV-1b showed higher prevalent (52.9%) among the recipients of anti-D Ig therapy while genotype HCV-3a (6.6%) was the lowest. Conclusions: Our study showed that Anti-D immunoglobulin therapy acts as a risk factor for acquiring HCV infection. Screening for HCV should be recommended for all recipients of anti-D Ig. Not only HCV antibodies but HCV-RNA detection being recommended for the diagnosis of HCV infection. A brief rational: Pregnant women with HCV infection are at risk of adverse obstetric outcome. Anti-D Ig therapy may be a risk factor for HCV infection. Hence, we conducted a cross sectional study with the objectives to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy. We found that anti-HCV and HCV-RNA seroprevalence were significantly higher in women with anti-D Ig. In addition, women with anti-D Ig therapy were 3.6 times more at risk of positive HCV-RNA with genotype HCV-1b showed higher prevalence. Therefore, anti-D Ig therapy is a risk factor for acquiring HCV infection and we recommend screening for HCV for all recipients of anti-D Ig. In addition, the diagnosis of HCV infection, should be made with HCV antibodies and HCV-RNA detection.
Chlorhexidine-alcohol versus povidone-iodine for skin preparation before elective cesarean section: a prospective observational study

Elshamy E, Ali YZA, Khalafallah M, Soliman A

J Matern Fetal Neonatal Med, 2020 Jan;33(2):272-276.
PMID: 30021481 DOI: 10.1080/14767058.2018.1489533

Introduction: The ideal antiseptic agent for skin preparation before elective cesarean section (CS) is not yet determined. The aim of the study was to assess the impact of skin preparation by chlorhexidine-alcohol compared with povidone-iodine before elective CS on the rate of surgical site infection (SSI).Materials and methods: This prospective observational study included a total of 1424 pregnant women at term who were candidates for the elective CS and were divided into two equal groups of 712 patients in each, group 1 (chlorhexidine-alcohol group) and group 2 (povidone-iodine group). Patients were followed up at 1 week and 1 month postoperative to determine the rate of SSI.Results: The rate of SSI was 3.7% (26 patients) in the chlorhexidine-alcohol group compared with 4.6% (33 patients) in the povidone-iodine group (odds ratio: 0.7798, 95% CI: 0.46-1.3, p = .35), nine patients in the chlorhexidine-alcohol group, and 10 patients in the povidone-iodine group required resuturing (odds ratio: 0.9, 95% CI: 0.36-2.2, p = .82). Four patients (0.56%) in the chlorhexidine-alcohol group and five patients (0.7%) in the povidone-iodine group developed endometritis (p = .74). The rate or readmission because of SSI was 2.7% (19 patients) in the chlorhexidine-alcohol group and 2.9% (21 patients) in the povidone-iodine group (p = .75).Conclusions: Skin preparation with either chlorhexidine-alcohol or povidone-iodine resulted in comparable rates of SSIs. Accordingly, both are suitable antiseptic agents for skin preparation before elective CS.
Treatment of preeclampsia with hydroxychloroquine: a review

Abd Rahman R, DeKoninck P, Murthi P, Wallace EM

J Matern Fetal Neonatal Med, 2018 Feb;31(4):525-529.
PMID: 28142291 DOI: 10.1080/14767058.2017.1289511

In this review, we discuss the potential use of antimalarial drugs as an adjuvant therapy for preeclampsia, focusing on the mechanisms of action of this class of drugs in the context of preeclampsia. In particular, hydroxychloroquine has been shown to have various beneficial effects on patients with systemic lupus erythematosus. There are several pathways targeted by the antimalarial drugs that are similar to the pathophysiology of preeclampsia and hence offering opportunities to develop novel therapies to treat the disease. Given the safety profile of hydroxychloroquine in pregnancy, there is merit in exploring the efficacy of this drug as an adjuvant therapy in women with early onset preeclampsia.
Cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix: PRISMA compliant systematic review and meta-analysis

Thangatorai R, Lim FC, Nalliah S

J Matern Fetal Neonatal Med, 2018 Jun;31(12):1638-1645.
PMID: 28412851 DOI: 10.1080/14767058.2017.1319930

BACKGROUND: Preterm births occur frequently in multiple pregnancies with a short cervix. The cervical pessary is a potential intervention for prevention of preterm births.
OBJECTIVE: To assess the effectiveness of cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix (<25 mm).
SEARCH STRATEGY: Major databases from 2006 to 20th November 2016 were searched for relevant terms.
SELECTION CRITERIA: We included randomized controlled trials that assessed the effectiveness of cervical pessary on pregnancy outcomes in multiple pregnancies with a short cervix.
DATA COLLECTION AND ANALYSIS: Risk ratio was used as the summary measure with random effects model. We assessed heterogeneity between studies using the I2 index. Quality assessment was done based on Cochrane Handbook Method.
MAIN RESULTS: Pooled data showed no benefit of using cervical pessary in the prevention of preterm births, birth weights less than 1500 g, less than 2500 g, adverse neonatal events and fetal/neonatal deaths in twin pregnancies with a short cervix.
CONCLUSION: We are unable to show benefit of using cervical pessary in preventing preterm births in twin pregnancies with a short cervix. However, as cervical pessary is a reasonable intervention, there is a need for more randomized controlled trials in this area.
Hypoechoic liver in fetuses with trisomy 21

Omar PM, Lim WT, Ting YH, Lao TT, Law KM, Cheung AHK, et al.

J Matern Fetal Neonatal Med, 2019 Oct;32(19):3315-3317.
PMID: 29631451 DOI: 10.1080/14767058.2018.1459556

The association between hypoechoic hepatomegaly in the third trimester and transient abnormal myelopoiesis (TAM) was reported previously in six fetuses with trisomy 21 (T21). We report a series of three cases of T21 in which hypoechoic liver (HL) was found in the second trimester but without evidence of TAM on both hematological and histological examination. We postulate that the hypo-echogenicity may be due to liver congestion secondary to hemodynamic disturbances seen in T21 fetuses. All three cases had negative first trimester Down syndrome screening and one case was detected solely because of the isolated finding of HL. HL per se may be associated with T21 and more positive cases are required to support this association.
Quantitative analysis of fetal DNA in maternal plasma in gestational diabetes mellitus, iron deficiency anemia and gestational hypertension pregnancies

Zamanpoor M, Rosli R, Yazid MN, Husain Z, Nordin N, Thilakavathy K

J Matern Fetal Neonatal Med, 2013 Jul;26(10):960-6.
PMID: 23339569 DOI: 10.3109/14767058.2013.766710

OBJECTIVE: To quantify circulating fetal DNA (fDNA) levels in the second and third trimesters of normal healthy pregnant individuals and pregnant women with the following clinical conditions: gestational diabetes mellitus (GDM), iron deficiency anemia and gestational hypertension (GHT).
METHODS: The SRY gene located on the Y chromosome was used as a unique fetal marker. The fDNA was extracted from maternal plasma and the SRY gene concentrations were measured by quantitative real-time polymerase chain reaction (PCR) amplification using TaqMan dual labeled probe system.
RESULTS: No significant differences were observed in the mean fDNA concentration between normal and GDM pregnancy samples (p > 0.05) and also between normal and anemic pregnancy samples (p > 0.05) in both trimesters, but significant differences were observed between the third trimester normal and GHT pregnancy samples (p = 0.001). GDM and iron deficiency anemia do not affect the levels of fDNA in maternal plasma while GHT significantly elevates the levels of fDNA in maternal plasma.
CONCLUSIONS: Increased amount of circulating fDNA in maternal plasma could be used for early identification of adverse pregnancies. GDM and anemia do not affect the levels of fDNA in maternal plasma while GHT significantly elevates the levels of fDNA in maternal plasma. Hence, the elevated fDNA values could be used as a potential screening marker in pregnancies complicated with GHT but not with GDM and iron deficiency anemia.
Is there a place for selective vaginal breech delivery in Malaysian hospitals: experiences from the Ipoh Hospital

Nalliah S, Loh KY, Japaraj RP, Mukudan K

J Matern Fetal Neonatal Med, 2009 Feb;22(2):129-36.
PMID: 19197787 DOI: 10.1080/14767050802509520

The 'Term Breech Trial' (TBT) results of 2001 have impacted on the mode of delivery of breech with a low threshold for caesarean delivery (CD) worldwide.
Interleukin 1 receptor type 2 gene polymorphism is associated with reduced risk of preterm birth

Langmia IM, Apalasamy YD, Omar SZ, Mohamed Z

J Matern Fetal Neonatal Med, 2015 Dec 23.
PMID: 26607028

Interleukin 1 receptor type 2 (IL1R2) regulates the inflammatory pathway that results in preterm delivery. We aim to investigate the impact of IL1R2 gene polymorphisms on the risk of preterm delivery.
Prevalence of antenatal depressive symptoms among women in Sabah, Malaysia

Mohamad Yusuff AS, Tang L, Binns CW, Lee AH

J Matern Fetal Neonatal Med, 2016;29(7):1170-4.
PMID: 26037724 DOI: 10.3109/14767058.2015.1039506

To investigate the prevalence of antenatal depression and to assess whether the common risk factors identified in previous studies were applicable to women in Sabah, Malaysia.
Characteristics of pregnant women with diabetes using injectable glucose-lowering drugs in the EVOLVE study

Mathiesen ER, Ali N, Anastasiou E, Cypryk K, de Valk HW, Dores JM, et al.

J Matern Fetal Neonatal Med, 2022 Dec;35(25):7992-8000.
PMID: 34182866 DOI: 10.1080/14767058.2021.1940132

AIMS: To examine clinical parameters, glycemic control, folic acid supplementation, and the presence of other chronic diseases during early pregnancy in the EVOLVE study population (women with pre-existing diabetes treated with injectable glucose-lowering drugs).
METHODS: Cross-sectional baseline evaluation of EVOLVE: an international, multicenter, non-interventional study investigating the safety of injectable glucose-lowering drugs in pregnant women with pre-existing type 1 (T1D) or type 2 diabetes (T2D). Data were collected at enrollment visit interviews before gestational week 16.
RESULTS: In total, 2383 women from 17 mainly European countries were enrolled in the study: 2122 with T1D and 261 with T2D; mean age was 31 and 33 years, and duration of diabetes was 15 and 6 years, respectively. For women with T1D or T2D, 63% and 75%, respectively, received basal and rapid-acting insulin, 36% and 3% rapid-acting insulin only, 0.7% and 14.0% basal insulin only, 0.2% and 5.4% premix insulin, 0.0% and 1.2% injectable glucagon-like peptide-1 receptor agonist treatment without insulin. In women with T1D or T2D, respectively, during early pregnancy, 59% and 62% had HbA1c <7.0% (53 mmol/mol); 16% and 36% reported not taking folic acid before or during early pregnancy. Overall, >40% of women had ≥1 chronic concomitant condition (predominantly thyroid disease or hypertension). Retinopathy was the most commonly reported diabetic complication. The most commonly reported previous pregnancy complication was miscarriage.
CONCLUSIONS: Baseline data from this large multinational population of women with pre-existing diabetes indicate that sub-optimal glycemic control, poor pregnancy planning, and chronic concomitant conditions were common in early pregnancy.