Chorionic Gonadotropin, beta Subunit, Human ; blood ; Down Syndrome ; blood ; diagnosis ; Female ; Humans ; Pregnancy ; Pregnancy, Twin ; Prenatal Diagnosis ; alpha-Fetoproteins ; metabolism

OBJECTIVE: To investigate the association between serum high sensitivity C-reaction protein (hsCRP) in early pregnancy and gestational diabetes mellitus (GDM) among twin pregnant women, and to explore the effects of the pre-pregnant body mass index (BMI) and gestational weight gain (GWG) status on such association. METHODS: Twin pregnant women with pre-pregnant BMI greater than or equal to 18.5 kg/m² were recruited at Department of Obstetrics and Gynecology of Peking University Third Hospital from March 2017 to December 2020. Serum samples collected in early pregnancy were analyzed for hsCRP using particle-enhanced immunoturbidimetric method. In the following visits, the information about GWG and GDM were prospectively collected in every trimester. The association effect between hsCRP tertiles and GDM were estimated using Logistic regression, and further converted into risk ratio (RR). Cochran-Mantel-Haenszel test and mediation analysis were used to explore the effects of BMI and GWG status on the association. RESULTS: Among the included 570 twin pregnant women, 31.6% deve-loped GDM, 26.1% were pre-pregnant overweight or obesity, and 49.5% with GWG out of referenced range. After adjustment for confounding factors, risk of developing GDM in twin gestations with the middle tertile and highest tertile of serum hsCRP in early pregnancy were 1.42 fold (95%CI: 1.02-1.89) and 1.54 fold (95%CI: 1.12-2.02), respectively, compared with the lowest tertile of serum hsCRP, and there existed significantly linear trend (P=0.022). Findings from mediation analysis illustrated that pre-pregnant BMI had partial mediating effect on the association, and BMI accounted for 23.84% (P < 0.001) of the increasing GDM risks with elevated hsCRP. Joint analysis with hsCRP and GWG found that those who were with GWG out of referenced range accompanied with the higher hsCRP tertiles (>1.21 mg/L) had significantly 2.31 fold increased risk according to those who were with GWG in the referenced range accompanied with the lowest hsCRP tertile (≤1.21 mg/L, P < 0.01). CONCLUSION Elevated hsCRP in early pregnancy significantly increased GDM risk among twin pregnant women. The hsCRP-GDM association was dependent on GWG status, and pre-pregnant BMI had partial mediating effect on such association. It is suggested that twin pregnant women should consider systemic inflammation and gestational weight at the same time to reduce GDM risk.
Body Mass Index ; C-Reactive Protein/metabolism* ; Cohort Studies ; Diabetes, Gestational/blood* ; Female ; Gestational Weight Gain ; Humans ; Pregnancy ; Pregnancy, Twin/blood* ; Weight Gain

Pregnancies consisting of complete hydatidiform mole with a coexisting fetus are relatively rare and associated with a risk of persistent gestational trophoblastic tumor. Recently, hydatidiform moles with a fetus have become more and more common due to utilization of induction agents for ovulation, and many clinicians have been confronted with the difficulty of determining whether to undergo immediate intervention or expectant management. However, there are limited data to guide the antenatal management of complete hydatidiform mole coexisting with a fetus. We experienced a case of complete hydatidiform mole with a coexistent live fetus, which was diagnosed by ultrasonography at 19 gestational weeks, showing a molar pattern and normal fetal structure, and confirmed normal karyotype of the coexistent fetus. Antenatal management was done with an additional serial check of beta-hCG levels and blood pressure. The levels of serum beta-hCG in serum level were progressively decreased after 19 gestational weeks and fell within normal range during advancing gestation. Pregnancy was terminated at 30 gestational weeks due to fetal hypoxia resulting from severe pre-eclampsia with a live small for gestational age infant. We report our case with a literature review to provide a guideline of management about complete hydatidiform mole with a coexisting fetus. Our result suggest that the pregnancy of complete mole with a coexisting live fetus may be allowed to continue when the fetal karyotype and development are normal and serum beta-hCG titers are falling with advancing gestational age.
Blood Pressure ; Female ; Fetal Hypoxia ; Fetus* ; Gestational Age ; Humans ; Hydatidiform Mole* ; Infant ; Karyotype ; Molar ; Ovulation ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Reference Values ; Trophoblastic Neoplasms ; Ultrasonography

To evaluate the risk factors and clinical characteristics of acute renal failure(ARF) in patients with severe preeclampsia, we retrospectively investigated medical and obstetric histories, clinical and laboratory findings, maternal morbidity, and perinatal outcome between renal insufficiency and normal groups in patients with severe preeclampsia. Of the total 307 patients with severe preeclampsia, ARF occurred in 36 patients and its incidence was 11.7%. ARF developed before labor in 17 patients and postpartum in 19 patients. Oliguria occurred in 13 patients(36.1%) and 3 out of these patients required hemodialysis. Of the 31 patients who was observed for 3 months, renal function did not recover in 3 patients(9.7%). The systolic and diastolic blood pressures in renal insufficiency group(n=36) were higher than those in normal group(systolic:173+/-22 vs 164+/-19mmHg, p<0.02, diastolic:119+/-17 vs 108+/-14mmHg, p<0.01). In addition to degree of blood pressure, this study demonstrated that the risk factors of acute renal failure at admission were history of chronic hypertension, twin pregnancy, hypoalbuminemia, and thrombocytopenia. The incidences of maternal complications such as syndrome of hemolysis, elevated liver enzymes, and low platelets(HELLP syndrome), abruptio placenta, pulmonary edema and perinatal morbidity in renal insufficiency group were higher than those in normal group, respectively. In conclusion, acute renal failure in severe preeclampsia occur frequently in patients with history of chronic hypertension, twin pregnancy, severe hypertension, severe hypoalbuminemia, and thrombocytopenia.
Acute Kidney Injury* ; Blood Pressure ; Hemolysis ; Humans ; Hypertension ; Hypoalbuminemia ; Incidence ; Liver ; Oliguria ; Placenta ; Postpartum Period ; Pre-Eclampsia* ; Pregnancy ; Pregnancy, Twin ; Pulmonary Edema ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Thrombocytopenia