Background: Gestational Diabetes Mellitus (GDM) is the most prevalent metabolic disorder during pregnancy, however, the association between dyslipidaemia and GDM remains unclear. Methods: We searched Medline, Scopus, Web of Science, Cochrane, Maternity and Infant Care database (MID-IRS) and ClinicalTrials.gov up to February 2021 for relevant studies which reported on the circulating lipid profile during pregnancy, in women with and without GDM. Publications describing original data with at least one raw lipid [triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), or very low-density lipoprotein cholesterol (VLDL-C)] measurement were retained. Data extraction was performed using a piloted data extraction form. The protocol was registered with PROSPERO (CRD42019139696). Findings: A total of 292 studies, comprising of 97,880 pregnant women (28232 GDM and 69,648 controls) were included. Using random-effects meta-analysis models to pool study estimates, women with GDM had significantly higher (by 20%) TG levels, with a pooled weighted mean difference between GDM and non-GDM pregnancies of 0.388 mM (0.336, 0.439, p < 0.001). Further analyses revealed elevated TG levels occur in the first trimester and persist afterwards. Meta-regression analyses showed that differences in TG levels between women with GDM and healthy controls were significantly associated with age, BMI, study continent, OGTT procedure, and GDM diagnosis criteria.
BACKGROUND One in six couples suffer from infertility problems requiring in vitro fertilization therapy; however, the average birth rates in the past decade per IVF-embryo transfer cycle have remained static at around 25%. Although implantation failure is considered a major cause of infertility in otherwise healthy women, inadequate uterine receptivity is considered to be responsible for only two-thirds of implantation failures and problems with the embryo itself are responsible for the other third, such that only 30% of oocytes that are contacted by sperm result in successful human term pregnancies. Due to technical and ethical considerations, most research into the factors affecting the success of embryo implantation has been performed in mice, but this may be less than ideal. METHODS Selected relevant literature detailing the similarities and differences between rodent and human reproductive physiology surrounding implantation were nominated for inclusion. Primary papers and review articles (and primary sources within these), published between 1975 and 2012, with a clear indication for a particular ligand or cell being involved in the implantation process or placentation in the mouse or woman, were thoroughly examined and used to construct the review. RESULTS Mice have been identified as suitable models for investigating the processes of early pregnancy in women, for many reasons including their predictable, relatively short gestation and the ability to deliberately breed mice with the absence of a desired gene. There is, however, increasing evidence to suggest that the reproductive systems of humans and mice differ considerably when considering early pregnancy events. CONCLUSIONS In this review, we examine what is already known about the normal implantation process and the intrinsic factors that affect implantation, and then compare the differences between mice models and women in the context of early pregnancy. We highlight numerous differences between the mice and women and conclude it is becoming clear that all of the data from mouse studies cannot be confidently extrapolated to human reproduction.
Hypertensive disorders of pregnancy (HDP) are the most common medical complication in pregnancy, affecting approximately 10–15% of pregnancies worldwide. HDP are a major cause of maternal and perinatal morbidity and mortality, and each year, worldwide, around 70,000 mothers and 500,000 babies die because of HDP. Up-to-date high-quality systematic reviews quantifying the role of exercise and the risks of developing HDP are currently lacking. Physical exercise is considered to be safe and beneficial to pregnant women. Supervised exercise has been shown to be safe and to be more beneficial than unsupervised exercise in the general population, as well as during pregnancy in women with obesity and diabetes. Therefore, we undertook a systematic review and meta-analysis to investigate the effects of women performing supervised exercise during pregnancy compared to a control group (standard antenatal care or unsupervised exercise) on the development of HDP. We searched Medline, Embase, CINHAL, and the Cochrane Library, which were searched from inception to December 2021. We included only randomized controlled trials (RCTs) investigating the development of HDP compared to a control group (standard antenatal care or unsupervised exercise) in pregnant women performing supervised exercise. Two independent reviewers selected eligible trials for meta-analysis. Data collection and analyses were performed by two independent reviewers. The PROSPERO registration number is CRD42020176814. Of 6332 articles retrieved, 16 RCTs met the eligibility criteria, comparing a total of 5939 pregnant women (2904 pregnant women in the intervention group and 3035 controls). The risk for pregnant women to develop HDP was significantly reduced in the intervention compared to the control groups, with an estimated pooled cumulative incidence of developing HDP of 3% in the intervention groups (95% CI: 3 to 4) and of 5% in the control groups (95% CI: 5 to 6), and a pooled odds ratio (OR) comparing intervention to control of 0.54 (95% CI:0.40 to 0.72, p < 0.001). A combination of aerobic and anaerobic exercise, or yoga alone, had a greater beneficial effect compared to performing aerobic exercise only (mixed-OR = 0.50, 95% CI:0.33 to 0.75, p = 0.001; yoga-OR = 0.28, 95% CI:0.13 to 0.58, p = 0.001); aerobic exercise only-OR = 0.87, 95% CI:0.55 to 1.37, p = 0.539). Pregnancy is an opportunity for healthcare providers to promote positive health activities, thus optimizing the health of pregnant women with potential short- and long-term benefits for both mother and child. This systematic review and meta-analysis support a beneficial effect of either structured exercise (combination of aerobic, strength, and flexibility workouts) or yoga for preventing the onset of HDP. Yoga, considered a low-impact physical activity, could be more acceptable and safer for women in pregnancy in reducing the risk of developing HDP.
During pregnancy, a woman undergoes a multitude of normal physiochemical changes that are specific to pregnancy and with increasing frequency, challenged with pregnancy‐related conditions. Additionally, there are a number of problems affecting the unborn fetus that, in turn, affect normal maternal biochemistry, endocrinology and physiology. Furthermore, normal biochemical, hormonal and clinically relevant measurements for the nonpregnant state often no longer apply to the pregnant woman. This makes clinical laboratory measurement difficult and normal clinical diagnosis using nonpregnant values potentially dangerous, with inappropriate treatment (when it is not required) and no treatment (when it is required) being offered. Problems within early pregnancy, for example, spontaneous and recurrent miscarriage, thus become very complicated to predict or treat. Therefore, reexamining what clinical chemical tests are available and what is just emerging from the experimental laboratory (and thus becoming available in the standard clinical laboratory), should inform the unwary clinician. Key Concepts: ‘Normal’ pregnancy biochemical marker (Biomarker) concentrations fluctuate throughout pregnancy. No single maternal biomarker can be used to predict gestational disease. Both the concentrations of urinary, serum, plasma, salivary and amniotic fluid biomarkers and the timing of clinical sampling are critical in disease diagnosis. Many new biomarkers are emerging, which may help aid the prediction/diagnosis of pregnancy‐related conditions.
Midwives should be prepared to create individualised care plans, share data and liase with other departments, to improve maternal and fetal outcomes for pregnant women with these conditions
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