Association of serum levels of perfluoroalkyl substances with gestational diabetes mellitus and postpartum blood glucose

This study was conducted to examine the association of perfluoroalkyl substance(PFAS)exposure with gestational diabetes mellitus(GDM) risk and postpartum fasting blood glucose.We used a 1:2 matched case–control study with 84 GDM subjects and 168 healthy pregnant women from Beijing, China. The maternal blood was collected at 1–2 days before delivery, and eight linear isomers and fourteen branched isomers were determined in maternal serum.Logistic regression analyses were performed to evaluate the associations after adjusting for potential confounders. The median of the sum of levels of total PFASs was 4.24 ng/m L with a interquartile range(IQR) of 2.82–6.54 ng/m L. Although maternal PFAS exposure was not associated with risk of GDM, significant positive associations were observed between evaluated exposure to specific PFAS congeners and increasing blood glucose. The odds ratio(ORs) of the highest category of postpartum fasting blood glucose for perfluoro-1-metylheptylsulfonat(1 m-PFOS), perfluoro-3/4-metylheptylsulfonat(3 m+4 m-PFOS), perfluoro-5-metylheptylsulfonat(5 m-PFOS), and perfluorohexane sulfonate(PFHx S) were 2.03(95% CI: 1.09–3.77), 1.93(95% CI:1.04–3.58), 2.48(95% CI: 1.33–4.65), and 2.26(95% CI: 1.21–4.21), respectively, suggesting negative effects of maternal exposure to specific PFAS compounds on glucose metabolism.     

Maternal serum alfa-fetoprotein levels in the pregnancy complicated by hypertension

Maternal serum alpha-fetoprotein (MSAFP) was determined in patients 33 to 40 weeks pregnant, and the results were analysed with consideration of the presence and quality of hypertensive disease that complicated many of the pregnancies. Patients with incompletely controlled hypertension had significantly higher MSAFP levels than control patients with pregnancies uncomplicated by any risk factor. MSAFP elevation was greatest in pre-eclampsia (301·6 ± 147·6 kU/L, n = 35) > chronic hypertension with superimposed pre-eclampsia (240·4±74.7 kU/L, n = 30) > chronic hypertension (204·1± 105·3 kU/L, n=141). Each was significantly increased (P< 0·0001) over control pregnant patients' levels (104·3 ± 38·8, n= 187). At each gestational week from 33 weeks to term, MSAFP of combined hypertensive women was significantly greater than corresponding control levels (P< 0·003 to < 0·000l). The magnitude and time of onset of MSAFP increase may indicate severe fetal distress.     

Prenatal diagnosis and management of twin pregnancies complicated by a co-existing molar pregnancy

Recent advances in ultrasound and molecular genetics have increased our understanding and hence enhanced the perinatal management of complete and partial hydatidiform mole. By contrast, the management of a twin pregnancy combining a normal pregnancy with a normal fetus and a complete hydatidiform mole (CHM) remains complex and controversial due to conflicting data from different parts of the world. The aim of this review is to analyse the international literature on twin pregnancies that include a mole, present the complications and outcome of pregnancy and to discuss the perinatal management. Management is complicated and women should be counselled about the maternal and fetal complications, and the pregnancy monitored carefully by a perinatal team with experience in high-risk obstetrics and access to neonatal care. The data reviewed here suggest that a woman who decides to continue with the pregnancy including a CHM must be aware that, overall, she only has a one in four chance of live birth and in around 35% of cases she will develop persistent trophoblastic disease (PTD) after delivery. In ongoing pregnancies, there will be, in at least 20% of the cases, an early onset of pre-eclampsia (PET) and a 29% risk of fetal loss due to late miscarriage, intrauterine death and neonatal death. Maternal serum human chorionic gonadotrophin (MShCG) could be useful in predicting outcome in twin pregnancy combining normal pregnancy and CHM, but this needs to be investigated prospectively. Copyright © 2005 John Wiley & Sons, Ltd.     

Prenatal exclusion of late infantile metachromatic leucodystrophy in a late-presenting pregnancy by assay of fetal leucocytes

Metachromatic leucodystrophy was excluded in a fetus at risk, by assay of fetal blood collected at fetoscopy. Isolated fetal leucocytes were shown to have activities of arylsulphatase A and cerebroside sulphatase in the heterozygous range. The prediction was confirmed in the newborn.