Triplets conceived by ART had similar perinatal outcomes compared with spontaneously conceived triplets.

INTRODUCTION: To evaluate the association of obesity in early gestation and weight gain during pregnancy to pre-eclampsia, pre-gestational and gestational diabetes rates. METHODS: We conducted a retrospective cohort study at our center from January 2013 to December 2015. Women with singleton pregnancies, who started prenatal care at less than 20 weeks, and who completed delivery at our center were included. The primary outcome was pre-eclampsia. Secondary outcomes were pre-gestational (PGDM) and gestational diabetes (GDM). Body mass index (BMI) was taken from the initial OB visit and stratified into five different categories: 18–24.9, 25–29.9, 30.0–34.9, 35.0–39.9, and ≥40 kg/m2. Obesity was defined as BMI ≥30 kg/m2. Weight gain was stratified into four different categories: <5, 5–10, 11–15, >15 kg. Statistical analysis was performed using Chi-square test for group comparisons. A P-value of <0.05 was considered significant. RESULTS: 687 women met inclusion criteria and were included in this study. There was a direct relationship between pre-eclampsia and increasing BMI (9.25%, 10.61%, 15.58%, 15.79%, 20.0%, P=.0795). When BMI was divided into non-obese (<30) versus obese (≥30), there was a significant association with pre-eclampsia (P=.0127). There was a significant association with PGDM as BMI increased (P<.0001); as well as a trend to higher rates of GDM. There was no association between pre-eclampsia and weight gained during pregnancy (P=.912). CONCLUSION: Obesity appears to be more important than weight gained during pregnancy in the development of pre-eclampsia and gestational diabetes. This highlights the importance of pre-conception weight reduction and optimization for the prevention of morbidity in pregnancy.

Diabetes complicates 6 to 7% of all pregnancies in the United States. Poor glycemic control is associated with multiple immediate and long-term adverse effects on both the mother and fetus. Although uniformity exists in the antenatal management of this disease, there is a paucity of evidence-based studies upon which to dictate the optimal time of delivery among affected women. The potential risks of delayed neonatal pulmonary maturation including respiratory distress syndrome and transient tachypnea of the newborn associated with early delivery must be balanced with the increased incidence of fetal demise, overgrowth, and birth injury related to diabetes in late gestations. Even among diabetic women with optimal glycemic control, the risk of stillbirth in the third trimester is considerably higher than their normal counterparts. The current paradigm of delaying delivery to 39 weeks in women with controlled and uncomplicated diabetes has been challenged by recent evidence advocating delivery by 38 weeks to improve perinatal outcomes. However, additional well-designed and adequately powered prospective studies are needed to better understand the short- and long-term implications of the optimal timing of delivery in this high-risk population. This article reviews the most current literature regarding the optimal timing of delivery in pregnancies complicated by diabetes mellitus and gestational diabetes mellitus.

To analyse the influence of cold ischemic time (CIT) (2-24 h) and of cryopreservation (liquid phase) on the viability of the valvular fibroblasts and in the presence of apoptosis. Cardiac valves from 10 pigs were evaluated by anatomo-pathological study of the wall, muscle and leaflet. At the same time, the presence of cellular death due to apoptosis was investigated in two ways; directly on tissue by Apodetec system and by two-colour flow cytometry assay analyzing a suspension of fibroblast from valve leaflets using Anexina V and propidium iodure (PI). We established three groups of samples to compare different experimental conditions: 2 h of ischemia (group 1), 24 h of ischemia (group 2), and a programme of cryopreservation (-1 degrees C/min) after 2 h of ischemia, followed by storage in liquid nitrogen during a week and thawing was performed (group 3). The analysis of viabilities showed slight differences between all three groups. The results indicated CIT of 24 h undergoing more structural affectation than CIT of 2 h. Flow cytometry analysis did not show important differences between groups; however cryopreserved samples (group 3) slightly less viability and a higher percentage of death by apoptosis than group 1 and 2 using flow cytometry. Apoptosis was confirmed on tissue from all valves but mainly in samples of group 2 and group 3. In summary, the viability of the valves in the case of ischemic times of 2 h, 24 h or after cryopreservation/thawing differs slightly. The death of the cells is mainly mediated by necrosis and not by apoptosis.