Objective To evaluate the performance of fetal middle cerebral artery peak systolic velocity (MCA‐PSV) ≥ 1.5 multiples of the median (MoM) for the prediction of moderate–severe anemia, in untransfused and transfused fetuses. Methods A systematic search was performed to identify relevant observational studies reported in the period 2008–2018 that evaluated the performance of MCA‐PSV, using a threshold of 1.5 MoM for the prediction of fetal anemia. Diagnosis of fetal anemia by blood sampling was the reference standard. A hierarchical summary receiver–operating characteristics (hSROC) curve was constructed using random‐effects modeling. Subgroup and meta‐regression analyses, according to the number of previous intrauterine transfusions, were performed. Results Twelve studies and 696 fetuses were included in the meta‐analysis. The area under the hSROC curve (AUC) for moderate–severe anemia was 83%. Pooled sensitivity and specificity (95% CI) were 79% (70–86%) and 73% (62–82%), respectively, and positive and negative likelihood ratios were 2.94 (95% CI, 2.13–4.00) and 0.272 (95% CI, 0.188–0.371). When considering only untransfused fetuses, prediction improved, achieving an AUC of 87%, sensitivity of 86% (95% CI, 75–93%) and specificity of 71% (95% CI, 49–87%). A decline in sensitivity for the prediction of moderate–severe anemia by MCA‐PSV ≥1.5 MoM was observed (estimate, –5.5% (95% CI, –10.7 to –0.3%), P = 0.039) as the number of previous transfusions increased. Conclusions MCA‐PSV ≥ 1.5 MoM for the prediction of moderate–severe anemia in untransfused fetuses shows moderate accuracy (86% sensitivity and 71% specificity), which declines with increasing number of intrauterine transfusions. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Osteocalcin is no longer regarded as a molecule exclusive to bone remodeling and osteogenesis, but as a hormone with manifold functions. The discovery of the interaction of osteocalcin with the G protein-coupled receptor family C group 6-member A (GPRC6A) receptor has accompanied the characterization of several roles that this peptide serves in body regulation and homeostasis. These roles include the modulation of memory in the brain, fertility in the testis, fat accumulation in the liver, incretins release in the intestine and adaptation to exercise in muscle, in addition to the well-known effects on β-cell proliferation, insulin release and adiponectin secretion. The aim of the present review was to provide a practical update of the multi-organ effects that osteocalcin exerts through its interaction with GPRC6A and the clinical implications of this.

Background: In healthy pregnancies, components of the Renin-Angiotensin system (RAS) are present in the placental villi and contribute to invasion, migration, and angiogenesis. At the same time, soluble fms-like tyrosine kinase 1 (sFlt-1) production is induced after binding of ANG-II to its receptor (AT-1R) in response to hypoxia. As RAS plays an essential role in the pathogenesis of COVID-19, we hypothesized that angiogenic marker (sFlt-1) and RAS components (ANG-II and ACE-2) may be related to adverse outcomes in pregnant women with COVID-19; Methods: Prospective cohort study. Primary outcome was severe pneumonia. Secondary outcomes were ICU admission, intubation, sepsis, and death. Spearman’s Rho test was used to analyze the correlation between sFlt-1 and ANG-II levels. The sFlt-1/ANG-II ratio was determined and the association with each adverse outcome was explored by logistic regression analysis and the prediction was assessed using receiver-operating-curve (ROC); Results: Among 80 pregnant women with COVID-19, the sFlt-1/ANG-II ratio was associated with an increased probability of severe pneumonia (odds ratio [OR]: 1.31; p = 0.003), ICU admission (OR: 1.05; p = 0.007); intubation (OR: 1.09; p = 0.008); sepsis (OR: 1.04; p = 0.008); and death (OR: 1.04; p = 0.018); Conclusion: sFlt-1/ANG-II ratio is a good predictor of adverse events such as pneumonia, ICU admission, intubation, sepsis, and death in pregnant women with COVID-19.