Guidelines of the Polish Society of Gynecologists and Obstetricians, the Polish Society for Vaccinology, and the Polish Society for Family Medicine on vaccinating women with reproductive plans and pregnant or breastfeeding women

The following Guidelines present the most up-to-date treatment and management recommendations, which may be modified and altered after detailed analysis of a specific clinical situation, which in turn might lead to future modifications and updates.

Hyperglycemia in pregnancy - prevalence and perinatal outcomes. A retrospective multicenter cohort study in Poland

OBJECTIVES

Hyperglycemia in pregnancy (HIP) is one of the most common complications of pregnancy. Recently adopted new criteria for the diagnosis of HIP as well as the greater prevalence of risk factors could have a significant impact on HIP prevalence. The objective of the study was to assess the rates of HIP and the associated complications.

MATERIAL AND METHODS

This was a retrospective analysis of clinical records from pregnant women who delivered in eight tertiary hospitals in Poland in 2016.

RESULTS

The number of pregnant women with hyperglycemia totaled 1280 (7.25%), including gestational diabetes mellitus (GDM) in 1169 (6.62%) women and pregestational diabetes mellitus (PGDM) in 111 (0.63%). In addition to dietary modifications, 477 (41% of the GDM group) women received medical treatment (GDMG2). In women with PGDM multiple daily insulin injections (MDI) were used in 53 (47.7%) cases, continuous subcutaneous insulin infusions (CSII) in 57 (51.3%) cases and one woman was treated with metformin. The rate of cesarean sections was 69.4% and 62.9% for PGDM and GDM, respectively. Large-for-gestational-age (LGA) infants accounted for 38% and 21% of births in the PGDM and GDM groups, respectively. Of note are high rates of hyperbilirubinemia in infants born to mothers treated with insulin (13.5% for PGDM and 14.4% for GDMG2) vs infants born to mothers with diet (GDMG1) (3.4%).

CONCLUSIONS

In Poland, the prevalence of HIP has nearly doubled in the past twenty years. Even with appropriate management, HIP is a significant risk factor for a cesarean section delivery, bearing an LGA infant and adverse neonatal outcomes.

The Polish Society of Gynecologists and Obstetricians Guideline for the diagnostic assessment and management of multiple-gestation pregnancy complicated by fetal growth restriction

The aim of the Guideline is to unify the diagnostic-therapeutic management of multiple-gestation pregnancies complicated by fetal growth restriction in at least one fetus.

The association between imbalances in vaginal microflora and duration of pregnancy as well as selected maternal and neonatal parameters

OBJECTIVES

Abnormal vaginal flora (AVF) is a result of excessive growth of some aerobic bacteria and fungi in relation to the scarce presence of Lactobacillus spp. It has been suggested that AVF is responsible for preterm birth and such neonatal conditions as infections or sepsis. The aim of the study was to assess the influence of excessive vaginal colonization with aerobic bacteria and fungi on the selected postnatal parameters of newborns, duration of pregnancy and length of hospitalisation of neonates.

MATERIAL AND METHODS

Retrospective data of all 1057 patients who delivered between 01.2019 and 06.2019 in the Department of Perinatology of Medical University of Lodz was analyzed. Eight hundred nine patients were included in this retrospective study. The study group consisted of 396 patients with abundant growth of aerobic bacteria and fungi obtained between 26 and 42 weeks of gestation, while 413 patients with physiologic vaginal biocenosis constituted the control group. Two hundred forty-eight patients (23.46%) were excluded from the study due to incomplete data.

RESULTS

Patients with abnormal vaginal flora (AVF) gave birth prematurely (9.09%) more often than patients with balanced microflora (5.31%), p = 0.038. Newborns of mothers with AVF obtained an Apgar score under four more frequently (1.21% vs 0%; p = 0.024). Eutrophic neonates were born less frequently in the study group (82.08% vs 88.65%; p = 0.025). Hospitalisation period was longer for children of mothers with AVF (mean of 6.30 ± 9.87 days) than those of mothers from the control group (mean of 5.06 ± 5.30), p = 0.025. Newborns of mothers with AVF developed perinatal infections more often (23.97% vs 15.94%; p = 0.004). Four infants died in the study group whereas no deaths were recorded in the control group (p = 0.045). The most prevalent pathogens were: Streptococcus agalactiae (GBS) 57.32%, Candida spp. 39.64%, Klebsiella spp. 9.85%, Staphylococcus aureus 7.32%. Signs of infection were more frequently recorded in newborns of mothers infected with Klebsiella spp. (35.90% vs 19.16%; p = 0.011). Premature birth was more prevalent in GBS carriers (11.81% vs 6.28%; p = 0.022).

CONCLUSIONS

Abundant growth of aerobic bacteria in the 3rd trimester of gestation contributes to preterm birth, causes the development of infection signs in newborns, increases their mortality rate and prolongs hospitalisation period.

COVID-19 impact on perinatal care: risk factors, clinical manifestation and prophylaxis. Polish experts' opinion for December 2020

Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 (COVID-19). Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.

Enhanced expression of IFI16 and RIG-I in human third-trimester placentas following HSV-1 infection

The innate immune response in the placenta depends on the ability of maternal immune cells and fetal trophoblast cells to detect and eliminate invading pathogens through germline-encoded pattern recognition receptors (PRRs). In the present study, we analysed the transcripts and protein expression of interferon (IFN)-inducible protein (IFI)16, melanoma differentiation-associated protein 5 (MDA5), RIG-I-like receptor (RIG-I) and Toll-like receptor (TLR)-3 in third-trimester human placentas and investigated cytokine profiles generated during herpes simplex type 1 (HSV-1) infection. Decidual and chorionic villous biopsies (38-42 weeks of gestation) were obtained from healthy women immediately after a caesarean section. The expression of the DDX58 (RIG-I), IFIH1 (MDA5), IFI16 and TLR3 transcripts was measured using quantitative real-time polymerase chain reaction (qRT-PCR). Extracellular cytokine and PRRs levels were then quantified by enzyme-linked immunosorbent assays (ELISAs). All examined PRRs genes, including DDX58, IFIH1, IFI16 and TLR3, were expressed constitutively at the mRNA and protein levels in the placental biopsies. The concentration of the IFI16 protein was increased in HSV-1-infected decidual and chorionic villous explants compared to those of mock-infected tissues (P = 0·029). Higher protein expression levels of RIG-I in both the maternal and fetal parts of the placenta were found (P = 0·009 and P = 0·004, respectively). In addition, increased production of IFN-β by HSV-1-infected tissues was noticed (P = 0·004 for decidua, P = 0·032 for chorionic villi). No significant differences in the IFN-α, interleukin (IL)-6 and IL-8 levels were found. These results showed that HSV-1 infection can enhance the expression of IFI16 and RIG-I proteins in the human term placenta.

Angiogenic factor screening in women with mild preeclampsia - New and significant proteins in plasma

INTRODUCTION

The aim of this study was to analyse a panel of 60 angiogenic factors (pro-angiogenic and antiangiogenic) in the plasma of women with mild preeclampsia.

MATERIALS AND METHODS

We recruited 21 women between 25 and 40 weeks gestation with diagnosed mild preeclampsia into the study group and 27 healthy women with uncomplicated pregnancies of corresponding gestational age to that of the study to the control group. We used a quantitative protein macroarray method that allowed for analysis of 60 angiogenic proteins per sample simultaneously.

RESULTS

We showed a statistically significant increase in the concentration of 8 proteins, interferon gamma (IFN-γ), interleukin 6 (IL-6), leukaemia inhibitory factor (LIF), heparin-binding EGF-like growth factor (HB-EGF), hepatocyte growth factor (HGF), C-X-C motif chemokine 10 (IP-10), leptin and platelet-derived growth factor BB (PDGF-BB), as well as a significant decrease in the concentration of 3 proteins, vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and follistatin, in the plasma of women with preeclampsia.

CONCLUSION

Based on our findings, it seems that protein factors may play an important role in the pathogenesis of preeclampsia, and there are many proteins that have not been studied in PE to date. There are no previous studies assessing the LIF, follistatin, HGF, HB-EGF and PDGF-BB concentrations in the plasma of women with PE; therefore, our obtained results indicate that these proteins are new factors that can play an important role in the pathomechanisms of PE.

Sphingolipids as a new factor in the pathomechanism of preeclampsia - Mass spectrometry analysis

Objective(s) and design

The aim of the study was to analyse a panel of 11 sphingolipids in plasma and three blood fractions (platelet-poor plasma, platelets and red blood cells) of women with mild preeclampsia.

Materials and methods

We recruited 21 women between 25–40 weeks gestation with diagnosed mild preeclampsia to the study group and 36 healthy women with uncomplicated pregnancies, who corresponded with the study group according to gestational age, to the control group. To assess the concentration of 11 sphingolipids in the blood plasma and blood fractions, we used ultra-high performance liquid chromatography coupled with triple quadrupole mass spectrometry (UHPLC/MS/MS).

Results

We showed a significant increase in the concentration of eight sphingolipids in the plasma of women with preeclampsia in comparison to the control group: Sph (p = 0.0032), S1P (p = 0.0289), C20-Cer (p < 0.0001), C18-Cer (p < 0.0001), C16-Cer (p = 0.012), C18:1-Cer (p = 0.003), C22-Cer (p = 0.0071), and C24:1-Cer (p = 0.0085).

Conclusion

We showed that selected sphingolipids, especially C20-Cer and C18-Cer, are totally new factors in the pathomechanism of PE and that these bioactive lipids may play an important role in apoptosis and autophagy.

IL-1β, IL-6 promoter, TNF-α promoter and IL-1RA gene polymorphisms and the risk of preterm delivery due to preterm premature rupture of membranes in a population of Polish women

INTRODUCTION

Our previous study revealed that anti-inflammatory cytokine gene polymorphisms increase the risk of spontaneous preterm delivery (PD) in a population of Polish women. Different genetic background of PD due to preterm premature rupture of membranes (pPROM) than PD without pPROM has been suggested. The aim of this study was to examine the relationship between the maternal carriage of polymorphic alleles of the following genes: interleukin 1β(IL-1β [+3953C>T]), interleukin 6 promoter (IL-6 [-174G>C]), tumour necrosis factor promoter (TNF-α [-308G>A]) and interleukin 1 receptor antagonist (IL-1RN) and the risk of PD caused exclusively by pPROM in a population of Polish women.

MATERIAL AND METHODS

A case-control study. 95 Caucasian women were examined including 32 cases and 63 controls. Case subjects experienced a delivery at less than 36 weeks and 6 days of gestation due exclusively to pPROM while control subjects gave birth at term. Polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP).

RESULTS

NO STATISTICALLY SIGNIFICANT RELATIONSHIP BETWEEN POLYMORPHISMS OF EXAMINED GENES AND RISK OF PD DUE TO PPROM IN A POPULATION OF POLISH WOMEN WAS FOUND: OR = 0.84 (95% CI: 0.34-2.01) for IL-1β, OR = 0.77 (95% CI: 0.27-2.13) for IL-6, OR = 0.72 (95% CI: 0.26-1.90) for TNF-α and OR = 1.74 (95% CI: 0.66-4.64) for IL-1RN.

CONCLUSIONS

Maternal carriage of polymorphic alleles of IL-1β, IL-6 promoter, TNF-α promoter and IL-1RA seems to have no impact on the risk of PD due to pPROM in the population of Polish women.The genetic contribution and pathomechanism of PD related to pPROM seems to differ from those of spontaneous PD without pPROM.

Meeting report: atmospheric pollution and human reproduction

BACKGROUND

There is a growing body of epidemiologic literature reporting associations between atmospheric pollutants and reproductive outcomes, particularly birth weight and gestational duration.

OBJECTIVES

The objectives of our international workshop were to discuss the current evidence, to identify the strengths and weaknesses of published epidemiologic studies, and to suggest future directions for research.

DISCUSSION

Participants identified promising exposure assessment tools, including exposure models with fine spatial and temporal resolution that take into account time-activity patterns. More knowledge on factors correlated with exposure to air pollution, such as other environmental pollutants with similar temporal variations, and assessment of nutritional factors possibly influencing birth outcomes would help evaluate importance of residual confounding. Participants proposed a list of points to report in future publications on this topic to facilitate research syntheses. Nested case-control studies analyzed using two-phase statistical techniques and development of cohorts with extensive information on pregnancy behaviors and biological samples are promising study designs. Issues related to the identification of critical exposure windows and potential biological mechanisms through which air pollutants may lead to intrauterine growth restriction and premature birth were reviewed.

CONCLUSIONS

To make progress, this research field needs input from toxicology, exposure assessment, and clinical research, especially to aid in the identification and exposure assessment of feto-toxic agents in ambient air, in the development of early markers of adverse reproductive outcomes, and of relevant biological pathways. In particular, additional research using animal models would help better delineate the biological mechanisms underpinning the associations reported in human studies.

Correlations of selected vaginal cytokine levels with pregnancy-related traits in women with bacterial vaginosis and mycoplasmas

The aim of this study was to examine correlations between vaginal inflammatory cytokines (IL-1alpha, IL-1beta, IL-6 and IL-8) and pregnancy-related traits (gestational age, birth-weight, BMI, weight gain during pregnancy and vaginal pH). Differences in correlation coefficients were examined among bacterial vaginosis (BV) status and the presence or absence of mycoplasmas. A total of 105 women between the 22nd and 34th week of pregnancy were enrolled in this study. There was a strong negative correlation between IL-1alpha and weight gain during pregnancy (r=-0.877, p<0.001) and a strong positive correlation between IL-6 and BMI (r=0.670, p=0.024) in women with normal vaginal flora and mycoplasmas. These correlations were not present in women who had normal flora and no mycoplasmas. In women with BV and no mycoplasmas, there were significant correlations of gestational age with IL-6 (r=0.727, p=0.027) and IL-8 (r=0.689, p=0.040); however, these correlations were not significant in women with mycoplasmas. Our findings support the conclusion that correlations between inflammatory cytokines and pregnancy-related traits are dependent on context, suggesting that expression is labile. In particular, BMI and gestational age correlation differs depending on BV status and the presence or absence of BV-related mycoplasmas such as Mycoplasma hominis and Ureaplasma urealyticum.

Cytokine imbalance in pregnancy complications and its modulation

The phenomenon of pregnancy can be compromised by a number of complications, such as threatened abortion, recurrent spontaneous miscarriage, preeclampsia, and preterm delivery. Research conducted during the last decade has opened up the possibility that cellular immune effectors may underlie such pregnancy complications. Particularly interesting are the effects of pro-inflammatory and anti-inflammatory cytokines on the conceptus and thus on the success or failure of pregnancy. This review focuses on the association between cytokines and the different complications of pregnancy as well as on the possible pathways of the effector function of cytokines in pregnancy loss. This review also goes on to discuss the redirection of the cytokine profile towards one that is more conducive to pregnancy. Among the most promising agents for the modulation of the Th1/Th2 balance are progestogens such as progesterone and dydrogesterone. Recently published studies lead us to propose that a therapeutic approach worth pursuing would be to assess the individual cytokine profiles of women with pregnancy complications and then to adjust individual therapy using the most effective progestogen.

The characterization and role of regulatory T cells in immune reactions

Regulatory T cells (Tregs) having CD4+ CD25+ Foxp3+ or CD4+ IL-10+ (Tr1) phenotype and capable of inducing anergy towards self- and alloantigens play an important role in autoimmunity, as well as in tolerance of allografts, pregnancy and cancer. Both thymus-derived T CD4+ CD25+ Foxp3+ natural cells and peripherally-induced T CD4+ CD25+ Foxp3+ cells prevent migration of effector immunocytes to target organs and inhibit their cooperation with antigen-presenting cells. The suppressive function of CD4+ CD25+ Foxp3+ Tregs depends on interactions between stimulatory (IL-2, CTLA-4) and inhibitory (GITR, CD28) signals, on stimulation of indoleamine 2,3-dioxygenase (IDO) activity in dendritic cells via CD80/CD86 molecules, and finally on cell-cell inhibition of effector cells by membrane-bound TGF-beta. Anergy of effector cells caused by Tregs could provoke them to secretion of IL-10/TGF-beta in mechanism of "bystander suppression". Tr1 cells constitute the distinctive Tregs population which originates from IL-10-primed naïve T cells or from T cells induced by tolerogenic IL-10/TGF-beta-expressing dendritic cells. The suppressive activity of Tr1 cells is based on local IL-10/TGF-beta secretion in the peripheral tissues. Tregs have a privileged place in the net of immunological interactions which makes them a possible common target for therapeutic interventions in different diseases.

The role of T-regulatory cells in pregnancy and cancer

The acceptance of paternally-derived alloantigens during pregnancy and escape from host immunosurveillance by cancer are based on similar immunological mechanisms. Among them both natural and peripherally-induced T CD4+ CD25+ Foxp3+ and Tr1 regulatory cells (Tregs) play important role. Interactions of Tregs with other immunocytes including dendritic cells, mechanisms of Tregs recruitment and their suppressive properties in cancer and pregnancy have been presented in this paper. Despite the fact that mechanisms of Treg regulation are still in progress, there is a hope for use of Tregs-related immunotherapy in clinical practice, and the first attempts of such management have already been described. However, more information about the function of Tregs cells is needed to provide safe treatment devoid of potential side-effects. Resolving the secrets of Tregs cells will probably offer new options of cancer treatment and will help to improve the management of pregnancy failure.

RCAS1 decidual immunoreactivity in severe pre-eclampsia: immune cell presence and activity

PROBLEM

Pre-eclampsia seems to be related to the disturbance of immune tolerance regulation during pregnancy. Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) decidual level alterations were concomitant with changes in immune cell number and activity in decidua. As decidual immunomodulating activity participates in the development of immune tolerance during pregnancy, we aimed to evaluate the immunoreactivity level of decidual RCAS1 with respect to the presence and activity of immune cells.

METHOD OF STUDY

RCAS1, CD3, CD56, CD69, and CD25 immunoreactivity was assessed by immunohistochemistry in 30 decidual samples derived from patients with severe pre-eclampsia (sPE) and from a healthy control group.

RESULTS

RCAS1 immunoreactivity was statistically significantly higher in decidual tissue samples derived from patients with sPE tissue than in those derived from healthy patients in whom elective cesarean section at term was performed. A statistically significantly lower number of CD56(+) and CD3(+) cells and lower immunoreactivity level of CD69 were found in patients with sPE compared with those from the control group.

CONCLUSION

The limited immune cells infiltration in decidua during sPE is associated with increase in RCAS1 decidual level.

The differences in RCAS1 and DFF45 endometrial expression between late proliferative, early secretory, and mid-secretory cycle phases

RCAS1 expression is related to the regulation of activated immune cells and to connective tissue remodeling within the endometrium. DFF45 seems to play an important role in the apoptotic process, most likely by acting through the regulation of DNA fragmentation. Its expression changes within the endometrium seem to be related to the resistance of endometrial cells to apoptosis. The aim of the present study was to evaluate RCAS1 and DFF45 endometrial expressions during ovulation and the implantation period. RCAS1 and DFF45 expression was assessed by the Western-blot method in endometrial tissue samples obtained from 20 patients. The tissue samples were classified according to the menstrual cycle phases in which they were collected, with a division into three phases: late proliferative, early secretory, and mid-secretory. The lowest level of RCAS1 and the highest level of DFF45 endometrial expression was found during the early secretory cycle phase. Statistically significantly higher RCAS1 and statistically significantly lower DFF45 endometrial expression was identified in the endometrium during the late proliferative as compared to the early secretory cycle phase. Moreover, statistically significantly higher RCAS1 and statistically significantly lower DFF45 expression was found in the endometrium during the mid-secretory as compared to the early secretory cycle phase. The preparation for implantation process in the endometrium is preceded by dynamic changes in endometrial ECM and results from the proper interaction between endometrial and immune cells. The course of this process is conditioned by the immunomodulating activity of endometrial cells and their resistance to immune-mediated apoptosis. These dynamic changes are closely related to RCAS1 and DFF45 expression alterations.

Association between abnormal microbiological flora of the lower genital tract in early pregnancy and socio-economic, demographic and environmental risk factors

BACKGROUND

The main aim of this study was to determine the socioeconomic, demographic and environmental factors which may be associated with the occurrence of pathological microflora of the lower genital tract in early pregnancy.

MATERIAL AND METHODS

A group of 96 pregnant women was selected at random from the patients of 10 district maternity units in the Lodz region of Poland. Only singleton pregnancies below 24 weeks were qualified for inclusion in the survey. A standard questionnaire covering medical, socio-economic, demographic, constitutional, and environmental items was administered to every subject and checked against medical records. Based on microbiological results, two groups of pregnant women were distinguished: Group I, with normal cervicovaginal flora, predominantly Lactobacillus spp. with coagulase-negative staphylococci and viridans streptococci, and Group II, with abnormal flora. The latter included two subgroups: IIA, intermediate microbial flora, dominated by M. hominis, U. urealyticum, G. vaginalis, gram-negative anaerobic rods, Ch. trachomatis, and few Lactobacillus spp, and IIB, highly abnormal flora, containing similar microbial components as in IIB but without Lactobacillus spp.

RESULTS

Based on the results of microbiological culturing, 18 (18.7%) of the 96 women examined were classified to Group I, and 78 (81.2%) to Group II: 32 (33.3%) in group IIA and 46 (47.9%) in IIB. Groups IIA and IIB were combined for further analysis. An excessive risk of abnormal vaginal flora was observed in connection with such socio-economic factors as marital status, unemployment, and smoking, Moreover, the first pregnancy was also found to be a potential risk factor for this pathology. The risk of developing abnormal vaginal flora, although exceeding unity for each of these factors, was not considered statistically significant.

CONCLUSIONS

Socio-economic and environmental factors may influence the course and outcome of pregnancy. Pregnant women who present with risk factors for abnormal cervicovaginal microflora should be included in comprehensive prenatal surveillance, which enables early detection and treatment of this pathology.

Employment status of pregnant women in central Poland and the risk of preterm delivery and small-for-gestational-age infants

BACKGROUND

Unemployment is one of the consequences of the ongoing transformation of the Polish economy. The main objective of the present study was to investigate the relationship between women's employment status and preterm delivery (PD) and/or small-for-gestational-age (SGA) infants, in Central Poland during the socio-economic transition.

METHODS

The study population comprised 8% random sample of 2,080 women from the Lodz macro region who gave birth to a child during a one-year period (1996-1997). Based on the employment status, three groups were distinguished: the employed (n = 1238), the unemployed (n = 128)--women who lost their job before pregnancy (at least 12 months prior to delivery) and were actively seeking employment, and the housewives (n = 714). Women with chronic medical problems diagnosed before pregnancy were excluded from the study.

RESULTS

The rates of preterm delivery were found to be 6.3%, 11.7% and 4.9%, respectively for the employed, unemployed, and housewives. After adjustment for age, marital status, education, maternal height, smoking, own apartment, presence of cervical insufficiency and uterine irritability, an excess risk of PD was observed among the unemployed women (OR = 1.92, 95% CI: 1.01-3.64). Unemployment was associated, though not significantly, with higher rates of SGA births.

CONCLUSION

In Central Poland, the unemployed pregnant women are characterised by an excess risk of preterm delivery. The impact of unemployment on the community's health, which seems to be underestimated, should be given more consideration in the national and local policies for public health.

[The effect of environmental tobacco smoke on birthweight: a prospective study employing biomarkers of exposure]

The main goal of the project was to estimate the effect of environmental tobacco smoke (ETS) exposure on the birthweight. In a cohort of 196 pregnant women in 20-24 week of pregnancy the serum and urine cotinine levels were determined. The cohort included randomly selected pregnant patients of a maternity units in Lodz, Poland. To assess a 24 h exposure to ETS preceding the day of examination, both serum and urine cotinine measurements were applied. A statistically significant relationship was found between serum cotinine concentration and brithweight. The newborns of nonsmoking mothers whose serum cotinine levels were characteristic for passive smoking (2-25 ng/ml) had their birthweight lower by an average of 30 g, compared to those of women who were not exposed to ETS (serum cotinine below 2 ng/ml). It was concluded that more effective public health measures should be undertaken to ensure a tobacco smoke-free environment for pregnant women. Until this goal is achieved, pregnant women should be informed about health risks from ETS exposure so that they would avoid it both at home and workplace.

[Influence of environmental smoke exposure during pregnancy on umbilical blood flow velocity]

Influence of environmental smoke exposure during pregnancy on umbilical blood flow velocity and newborns birthweight was assessed in prospective study among 116 pregnant women between 20 and 24 week of pregnancy. The main aim was to search for a possible correlation between cotinine, an effective marker of smoke exposure, and umbilical blood flow as measured by S/D, RI and PI ratios. This study shows a significant increase of systolic/diastolic velocity ratio of the umbilical artery according with increased cotinine levels, either for active or passive smokers. Increase of S/D ratio > 3.0 in umbilical artery in 20-24 week of pregnancy was negatively correlated with newborns birthweight. The results of this study suggest that active and passive smoking by pregnant women causes a direct increase in the vascular resistance of the placenta and contribute to the decreased of the newborns birthweight associated with smoking.

Heavy physical work during pregnancy--a risk factor for small-for-gestational-age babies in Poland

BACKGROUND

Heavy physical work is still considered one of the most prevalent risk factors of negative pregnancy outcome. The present study was undertaken to evaluate the impact of heavy physical work during pregnancy, based on subjective assessment of workload, on the risk of delivering a small-for-gestational-age (SGA) baby.

METHODS

Job characteristics were compiled for 1,064 working women from the Lódź region (8% population sample) based on questionnaire responses. Energy expenditure during daily work was estimated. SGA was diagnosed when the birth weight was below the 10th percentile of the standard curves for central Poland. The SGA group comprised 78 women who delivered SGA babies, while the non-SGA group consisted of 986 women with eutrophic newborns.

RESULTS

An excessive risk of SGA was found in the group reporting heavy physical effort at work. The physical effort perceived as heavy by pregnant women appeared to be a better predictor of SGA manifestation than the estimated energy expenditure at work.

CONCLUSIONS

The information obtained from a pregnant worker should constitute an essential decisive factor for determining the time of work cessation during pregnancy.

Passive smoking and pregnancy outcome in central Poland

1. The present investigation was undertaken to evaluate the effect of environmental tobacco smoke (ETS) on the risk of preterm delivery (PD) and small-for-gestational age (SGA) infants in a female non-smoking population of central Poland. 2. The study group were 1751 women classified as non-smokers in the comprehensive project on 'Socio-economic and environmental risk factors of preterm delivery and small-for-gestationaI-age babies in central Poland' conducted on a randomly selected population of 2080 women who gave birth to a child between June 1, 1996 and May 31, 1997. The PD group comprised 95 non-smoking women who delivered before 37 weeks of pregnancy and the SGA group included 111 non-smoking mothers of babies with birthweight below the 10th percentile of the standard curves for central Poland. Passive exposure to tobacco smoke was determined based on a structured interview. 3. In the stepwise multiple logistic regression model maternal passive smoke exposure lasting 7 h or more was found to be a significant risk factor for preterm delivery. No significant effect of passive smoking on the risk of SGA was observed. 4. The information about the adverse effects of ETS exposure on pregnancy duration and outcome should be incorporated in the health promotion programmes for women.

[Evaluation of the effectiveness of a low-dose aspirin in the treatment of intrauterine growth retardation (IUGR)]

OBJECTIVE

To evaluate the benefits of IUGR treatment by low doses of acetylsalicylic acid (ASA) (1.5 mg/kg) compared to the standard method. The study was based on the reports that aspirin at low doses shifts prostacyclin/tromboxan A2 balance to the dominance of prostacyclin by inhibiting cyclooxygenase activity in platelets, which results in the improvement of the utero-placental circulation.

MATERIAL AND METHOD

31 pregnant women with diagnosed fetal IUGR were randomly assigned to two groups, receiving either low-dose ASA (n = 22) or the standard treatment (Sadamin, Partusisten, glucose i.v., amino acids i.v.) for 10 days. Ultrasound examination of the biometric parameters of the fetus (BPD, AC, FL) was performed and estimated fetal weight (EFW) calculated before and after treatment. The birthweight of infants in the two examined groups was compared.

RESULTS

The mean increase in EFW was higher in the aspirin-treated group compared to that receiving standard treatment (478 g vs 246 g, p < 0.05). In all the biometric parameters under study a higher increase was noted in the group with aspirin treatment; however, the difference was not statistically significant. The mean birthweight was found to be higher in the ASA group as well (2856 g vs 2511 g). The frequency of small-for-gestational-age (SGA) infants (birth weight below 10th percentile) was lower in the ASA group than in the controls (27% vs 55%). The low-dose aspirin therapy did not produce any adverse side-effects either among mothers of infants.

CONCLUSION

The treatment with low doses of aspirin reduces the proportion of SGA babies and increases birthweight in the case of a diagnosed fetal growth retardation. Since the number of subjects in this study was relatively small, further clinical trials are necessary to evaluate the effectiveness of IUGR treatment by low-dose aspirin.

Risk factors of intrauterine growth retardation: a study of an urban population in Poland

The main objective of the study was to examine the role of selected socio-occupational factors on the development of intrauterine growth retardation (IUGR) in the urban population of Lódź, Poland. An epidemiological model of the case-control study was employed. Both the cases and controls were recruited from the female population covered by obstetric services in district hospitals during 1 January-30 June 1992. A group of cases included 92 females who delivered IUGR children, the control group-438 mothers of term born eutrophic babies. The presence of the relationship between IUGR manifestation and selected variables was initially assessed using the unadjusted odds ratio (OR). The variables described as significant were considered in the logistic regressions models, separately for all women and those with previous pregnancies. A comparison of the groups of cases and controls has revealed a significant excess of risk of delivering an IUGR child by mothers with the following characteristics: marital status-single, low educational level, low height (less than 1.60 m) low prepregnancy weight and low maternal weight gain. An elevated risk of delivering an IUGR child was found in the group of women who reported to have their first contact with the physician after 12 weeks of pregnancy. An adverse effect of prolonged vaginal bleeding was observed. Women who recently lost their job, compared to those employed continuously during pregnancy, were at an increased risk of IUGR. Cigarette smoking appeared to be the most important variable affecting the evaluated pregnancy outcome. For the women smoking 6-10 and more than 10 cigarettes a day, the risk of delivering an IUGR child was found to be almost 4 and 7 times, respectively, higher than for non-smokers. A logistic regression covering all the above mentioned maternal characteristics was employed. Only four of them proved to be significant: low maternal weight gain, prolonged vaginal bleeding, smoking and the marital status-single. The process of preventing IUGR and its consequences requires more effective activities aimed at increasing the level of health education and stimulating the development of appropriate, health-oriented behaviour.

[Ovarian teratomas: some clinical and statistical factors based on 456 patients operated on in the Institute of Gynecology and Obstetrics Academy of Medicine in Lodz]

In the years 1977-1994 456 cases of teratomas located in one ovary and 47 in two ovaries were diagnosed. 88,8% of patients were between 16 and 50 years old, with the peak of occurrence between 25 and 30 years. In 5% malignant teratomas were diagnosed.

[Tobacco smoking--a risk factor for intrauterine growth retardation, preterm delivery and low birth weight]

The risk of intrauterine growth retardation (IUGR) and preterm delivery, in the group of 551 females from the area of Lódź, was related to the amount of cigarettes smoked per day. In subjects smoking more than 20 cigarettes, the risk of IUGR and preterm delivery was five times as high as in the nonsmoking females. The average weight of the newborns was found to be 510 g lower in the group of the most heavy smokers as compared with the nonsmoking subjects. The study has not provided any clear evidence for the pre-pregnancy smoking and the passive smoking as the risk factors for the pathologies under study.