The Association between Gestational Diabetes Mellitus and Infections in Pregnancy-Systematic Review and Meta-Analysis

We conducted a systematic review and meta-analysis to evaluate the association between gestational diabetes mellitus and infections during pregnancy. We included cross-sectional, case-control, cohort studies and clinical trials, evaluating the frequency of infections in women with and without gestational diabetes mellitus. A search was conducted in Embase, PubMed, and Web of Science electronic databases and by manually searching references, until 23 March 2022, resulting in 16 studies being selected for review, with 111,649 women in the gestational diabetes mellitus group, and 1,429,659 in the controls. Cochrane's Q test of heterogeneity and I² were used to assess heterogeneity. Pooled odds ratio (OR) was calculated. Funnel plots and Egger test were used for assessment of publication bias. The results showed a significant association between gestational diabetes mellitus and infections (pooled-OR 1.3 95% CI [1.2-1.5]). Sub-analyses showed a significant association for urinary tract infections (pooled-OR of 1.2 95% CI [1.1-1.3]), bacterial infections (pooled-OR were 1.2 95% CI [1.1-1.4]), and SARS-CoV-2 (pooled-OR 1.5 95% CI [1.2-2.0]) but not to gingivitis or vaginal candidiasis. The results underscore the significance of acknowledging gestational diabetes mellitus as a risk factor for infections.

Effects of Probiotics on Glycemic Control and Metabolic Parameters in Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis

Objectives: To assess the effects of probiotic supplements on glycemic control and metabolic parameters in women with gestational diabetes mellitus (GDM) by performing a systematic review and meta-analysis of randomized controlled trials. The primary outcome was glycemic control, i.e., serum glucose and insulin levels. Secondary outcomes were maternal weight gain, neonatal birth weight, and lipid parameters. Weighted mean difference (WMD) was used. Cochrane’s Q test of heterogeneity and I2 were used to assess heterogeneity. Results: Of the 843 papers retrieved, 14 (n = 854 women) met the inclusion criteria and were analyzed. When compared with placebo, women receiving probiotic supplements had significantly lower mean fasting serum glucose, fasting serum insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, and VLDL levels. Decreased neonatal birth weight was witnessed in supplements containing Lactobacillus acidophilus. Conclusion: Probiotic supplements may improve glycemic control and lipid profile and reduce neonatal birth weight in women with GDM.

Should pregnant women be screened for SARS-CoV-2 infection? A prospective multicenter cohort study

OBJECTIVE

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranges from asymptomatic to severe infection. We aimed to compare the prevalence of COVID-19 in asymptomatic pregnant versus nonpregnant women in order to establish recommendations for a COVID-19 screening strategy.

METHODS

A prospective multicenter cohort study was conducted. Asymptomatic pregnant or nonpregnant women after March 2020 (the time when COVID-19 was first detected in north Israel) were tested for SARS-CoV-2 using nasopharyngeal reverse transcription polymerase chain reaction test, anti-nucleocapsid IgG, and anti-spike IgG. Diagnosis was made if at least one test result was positive. Pregnant women were tested between 34 and 42 weeks, mostly at birth.

RESULTS

Among the 297 participating women, 152 were pregnant and 145 were nonpregnant. The prevalence of asymptomatic COVID-19 was similar between the groups (4 [2.6%] and 8 [5.5%], respectively; P = 0.2). All women with COVID-19 delivered healthy appropriate-for-gestational-age babies without malformations, at term.

CONCLUSIONS

The rate of asymptomatic COVID-19 in pregnant women is low and comparable to the rate among nonpregnant women. Pregnancy outcomes are favorable. Future screening programs should consider that one of 25 screened asymptomatic women will be positive.

Effect of nitrous oxide use on external cephalic version success rate; a systematic review and meta-analysis

INTRODUCTION

Several adjuvant interventions have been evaluated for improving the success rate of the external cephalic version (ECV) and reducing the rate of cesarean delivery (CD). Evidence regarding the effect of Nitrous oxide is limited to a small number of participants with inconsistent results on pain score and success rate. This study aims to examine the effect of inhaled nitrous oxide on the success rate and pain score for women undergoing ECV.

MATERIAL AND METHODS

Survey on ECV reports from inception till June 2020 were made from MEDLINE, EMBASE, PubMed, Ovid Medline, ClinicalTrials.gov, the Cochrane Library and Google Scholars. Peer-review studies that examined the success rate of ECV from the application of nitrous oxide during ECV attempts compared with or without the use of other analgesic agents were obtained. The study population comprising women with singleton pregnancies having a non-vertex presentation at least 36 weeks, were categorized into one of two treatment groups: ECV attempt with nitrous oxide (nitrous oxide group) and ECV attempt with or without another analgesia (control group). The primary outcome was the ECV success rate, defined by conversion to vertex-presentation following the procedure. The secondary outcomes were pain scores during ECV attempt and CD rate. The study quality scores were evaluated as a source of heterogeneity by fitting meta-regression models to the individual study effect sizes.

RESULTS

Of the 26 records identified, two randomized trials and one prospective cohort study (720 women; 434 in the nitrous oxide group and 286 controls) were deemed adequate for meta-analysis. ECV success rate did not differ significantly between the nitrous oxide group and the control group (p = .825; OR 1.036; 95% CI, 0.756, 1.419). In addition, the use of nitrous oxide did not affect pain scores during ECV attempt (p = .457; OR 0.759; 95% CI, -1.240, 2.759) and there was no difference in the incidence of CD as well (p = .943; OR 1.013; 95% CI, 0.703, 1.46).

CONCLUSION

The use of nitrous oxide during ECV attempts was not associated with an increase in ECV success rate and does not affect pain scores. PROSPERO Registration No. CRD42020197933.

Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis

BACKGROUND

Regular menstrual cycling during the reproductive years is an indicator of spontaneous ovulation but sometimes falsely perceived as an indicator of preserved fertility. In contrast, menstrual cycle shortening, a physiologic occurrence preceding the menopausal transition, is not usually perceived as an indicator of decreased ovarian reserve in the general population.

OBJECTIVE AND RATIONALE

The individual decrease in menstrual cycle length (MCL) might represent a sensitive biomarker of diminishing ovarian reserve. The aim of this systematic review and meta-analysis is to examine the possible association between MCL in regularly cycling women (21-35 days) and ovarian reserve tests (ORT), fecundability in natural cycles and IVF outcomes.

SEARCH METHODS

An electronic database search employing PubMed, Web of Science, Trip, EBSCO, ClinicalTrials.gov and the Cochrane library was performed to identify research articles, only on human, published between January 1978 and August 2019. Search terms were pregnancy OR fertility OR fecundity OR fecundability, anti-Müllerian hormone OR AMH OR antral follicle count OR AFC OR ovarian reserve OR ovarian reserve test, in vitro fertilization OR ART OR assisted reproductive therapy OR assisted reproductive treatment OR assisted reproductive technology OR IVF OR ICSI, menstrual cycle length OR menstrual cycle characteristics. We combined these terms to complete the search. All prospective and retrospective studies exploring an association between MCL and proxies of ovarian reserve were included. The exclusions included studies of PCOS, ovarian failure, oral contraception treatment, prior chemotherapy and/or radiotherapy or ovarian surgery. The Newcastle-Ottawa scale was used to assess the quality of studies that were eligible for meta-analysis.

OUTCOMES

Eleven studies were eligible for meta-analysis, including 12 031 women. The included studies had a low risk of bias. Short MCL (21-27 days) was associated with lower ORT values as compared to normal (28-31 days), long (32-35 days) and all other (28-35 days) MCL sets. The estimated weighted mean difference (WMD) of AMH level was -1.3 ng/mL (95% CI: -1.75 to -0.86, P < 0.001) between the short and normal MCL sets. The estimated WMD of AFC values was -5.17 (95% CI: -5.96 to -4.37, P < 0.001) between the short and normal MCL sets. The weighted overall odds ratio (OR) of fecundability in natural cycles between women with short versus normal MCL sets was statistically significant (overall OR 0.81; 95% CI 0.72-0.91, P < 0.001). In the IVF setting, fewer oocytes were retrieved in short MCL in comparison to normal, long and all other MCL sets, with an estimated WMD of -1.8 oocytes (95% CI: -2.5 to -1.1, P < 0.001) in the short versus normal MCL sets. The weighted overall OR of clinical pregnancy rate between women with short versus all other MCL sets was statistically significant (overall OR 0.76; 95% CI: 0.60 to 0.96, P = 0.02). Low levels of heterogeneity were found in most meta-analyses of MCL and qualitative ovarian reserve biomarkers, while heterogeneity was high in meta-analyses performed for quantitative measures.

WIDER IMPLICATIONS

MCL in regularly cycling women is closely related to ovarian reserve biomarkers during the reproductive years. A short MCL, as compared to normal, is significantly associated with lower ORT values, reduced fecundability and inferior IVF outcomes, independent of age. The results imply that short MCL may be a sign of ovarian aging, combining the quantitative and qualitative facets of ovarian reserve. Educational efforts ought to be designed to guide women with short MCL at a young age, who desire children in the future, to seek professional counselling.

Impact of breast cancer risk assessment in primary care: Modeling clinical outcomes and effectiveness

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Background: Breast cancer risk assessment (RA) is rarely performed in the primary care setting due to uncertainty regarding the balance of harms and benefits in high risk women subsequently offered chemoprevention. We used a decision model to assess the potential clinical impact of several strategies involving use of routine RA in primary care. Methods: We developed a decision analytic model to compare routine breast cancer RA in primary care to usual care. The RA method was the Gail model, with a 5-year risk of >1.67% being designated as high risk (varied in sensitivity analyses). We assumed that high risk women would be offered 5 years of tamoxifen and that acceptance (70%) and compliance (68%) rates would be incomplete. For women receiving tamoxifen, the relative risk (RR) of incident estrogen-receptor positive invasive breast cancer was 0.31 over the 5 years of treatment, diminishing over the next 5 years after cessation of treatment. RR’s for the other health effects associated with tamoxifen were: vertebral fracture (0.74), endometrial cancer (2.41), stroke (1.6), pulmonary embolism (PE, 3.01), and deep vein thrombosis (DVT, 1.60). The non-breast cancer health effects of tamoxifen were assumed to pertain only to the 5 years of active therapy. All RR’s were applied to age-dependent population-based incidence rates; data sources included published epidemiologic and clinical trial data; model duration was 40 years. Results: In agreement with recommended clinical use of tamoxifen, the results were sensitive to age and the Gail threshold above which chemoprevention was recommended ( Table ). The number of women needed to screen (NNS) to prevent 1 case of breast cancer is 7-fold higher among women aged 50 compared to 65 with a Gail risk of 1.67% (719 vs. 104). Conclusions: The number of women offered treatment, as well as the clinical outcomes and NNS, resulting from routine breast cancer risk assessment varies with the age at RA and treatment threshold selected.

[Table: see text]

No significant financial relationships to disclose.

Sperm antibodies in serum and semen in men with bilateral congenital absence of the vas deferens

Sperm antibodies were evaluated in serum and semen of 14 cases with bilateral congenital absence of the vas deferens, by agglutination and complement dependent tests. The level of the various immunoglobulin fractions were determined by the single radial immuno diffusion method. Sperm agglutinins were present in serum in 71% of cases and in 29% in semen. Immunoglobin (Ig) M was not detected in semen of both patient and control groups, while IgG and IgA were absent in the semen of patients.

IgG4 antibodies in Egyptian patients with schistosomiasis

Serum immunoglobulins were determined in 40 Egyptian patients with schistosomiasis. In addition to the well-established elevation in total IgE, a striking imbalance in the IgG subclass levels was found: IgG3 and IgG4 levels were markedly elevated, whereas IgG2 levels were normal. The IgG4 level did not correlate with the IgG3 level, but a weak correlation between the IgG4 levels and the logarithmic value of the IgE levels was observed (r = 0.49). We determined anti-schistosome antibodies in the IgE and IgG classes and in the IgG4 subclass by a RAST-type of assay. As test antigens an adult worm antigen preparation (AWA) and a soluble egg antigen preparation (SEA) were used. IgE antibodies reacted predominantly with AWA, whereas IgG4 antibodies, especially in patients with recent infections, were directed mainly against SEA. The hypothesis is put forward that the IgG4 antibodies interfere with the effector activities of anti-schistosome antibodies, and thus inhibit complement activation and mast cell triggering.