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The Role of Metformin in Treating Preeclampsia

Maternal-Fetal Medicine.2021;03(3):203-207. doi:10.1097/FM9.0000000000000086

Preeclampsia (PE) is a principal cause of maternal and newborn mortality that poses financial and physical burdens to tens of thousands of families each year. Unfortunately, there is no effective management to arrest the progression of this disease unless delivery. Therefore, standardized management or preventive treatments are needed urgently. PE is closely associated with placental hypoxia, which increases the secretion of soluble fms-like tyrosine kinase 1 (sFlt-1) as well as soluble endoglin (sEng) into the maternal circulation. Metformin has been found to inhibit those anti-angiogenic factors so it might be a candidate to prevent or treat PE. Women who are diagnosed with gestational diabetes mellitus (GDM) are more likely to have complications of hypertension or PE, so this review aims to demonstrate that the application of metformin in GDM might prevent the onset or progression of PE complicated with GDM.

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Cervical Assessment by Transvaginal Ultrasound for Predicting Preterm Birth in Asymptomatic Women

Jie LI

Maternal-Fetal Medicine.2020;02(2):95-99. doi:10.1097/FM9.0000000000000043

Preterm birth (PTB) is defined as delivery before completing 37 weeks of gestation. It is the main cause of neonatal morbidity and mortality in the most countries. The inherent cervical length and strength are two main features of the cervix that determine whether or not a pregnant woman is at risk for PTB. Routine transvaginal cervical length screening was recommended for women with singleton pregnancy and history of prior spontaneous PTB, while the issue of universal cervical length screening and the screening in multiple gestations remain an object of debate. Strain sonoelastography and shear-wave sonoelastography have been used to evaluate the cervical stiffness in pregnant women, but the predictive value for PTB still requires further investigations. In this review, we will discuss the measurement methods of cervical length and cervical stiffness, and compare the value of cervical assessment by transvaginal ultrasound for predicting PTB in asymptomatic women.

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Maternal-Fetal Medicine in China

Zheng Thomas Q. ; Hui-Xia YANG

Maternal-Fetal Medicine.2020;02(1):48-55. doi:10.1097/FM9.0000000000000029

The obstetric issues and management styles in China are different from that in Western countries. Chinese medical education, residency training, obstetric care structure, and management of common obstetric complications are briefly reviewed and compared to the United States. Maternal-fetal medicine (MFM) is rapidly developing in China, but the development of MFM may not follow the same trajectory as in the West. Understanding the difference between China and the West may facilitate communication and foster mutual development.

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Prior Preterm Birth and Birthweight Below the 5 th Percentile are Independent Risk Factors for Recurrence of a Small for Gestational Age Neonate

Mor SVORAI ; Barak ARICHA ; Offer EREZ

Maternal-Fetal Medicine.2020;02(1):28-33. doi:10.1097/FM9.0000000000000034

Objective::This study aimed to determine: (1) whether recurrent deliveries of a small for gestational age (SGA) neonate are associated with increased obstetrical or neonatal complications; (2) whether the risk factors that can predict small for gestational age (SGA) recurrence.Methods::This study was based on Soroka Medical Center' s Obstetrics electronic database. The database consisted of 109 022 women who had 320 932 deliveries between the year 1988-2014.The study cohort included 6.8% (7 368/109 022) of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery. The study population was divided into two groups according to the outcome of the subsequent delivery: (1) women with sporadic SGA who delivered a non-SGA neonate ( n= 5 416); (2) women with recurrent SGA ( n = 1 952). SGA defined as birthweight <10 th percentile. Maternal and neonatal complications were compared between the two groups. Logistic regression was used to determine independent risk factors for SGA recurrence. Results::The prevalence of birthweight <5 th percentile was higher among the recurrent SGA group in the first delivery ( P < 0.001). Bedouin ethnicity was more prevalent in the recurrent SGA group ( P < 0.001). The rate of preterm delivery was higher in the first delivery of the recurrent SGA group ( P = 0.015). The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy ( P= 0.017). The rate of severe hypertension ( P= 0.005), polyhydramnios, meconium-stained amniotic fluid, nonreassuring fetal heart rate and total perinatal mortality ( P < 0.001) were higher in the second delivery of the recurrent SGA group. In a logistic regression model, preterm delivery and birthweight <5 th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth (relative risks:1.530, confidence interval: 1.249-1.875; relative risks:1.826, confidence interval: 1.641-2.030, respectively). Conclusion::Women with recurrent SGA neonates have specific clinical characteristics. Among women who deliver an SGA neonate, preterm delivery, and birthweight <5 th percentile are independent predictors for its recurrence.

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Current Practice and Protocols: Endoscopic Laser Therapy for Twin-Twin Transfusion Syndrome

Pandya Viral M. ; Julien STIRNEMANN ; Claire COLMANT ; Yves VILLE

Maternal-Fetal Medicine.2020;02(1):34-47. doi:10.1097/FM9.0000000000000035

The pathophysiology of twin-to-twin transfusion syndrome (TTTS) is complex, and its understanding has evolved along with the evolution and revolution of fetal diagnostic and therapeutic techniques. Over the last few decades, several therapeutic interventions have been researched for improving the outcomes in TTTS. We present a summary of the current protocols for surveillance, diagnosis, and staging of TTTS in monochorionic pregnancies. We also describe in detail the technique for treatment of TTTS by endoscopic laser photocoagulation.

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Metformin in Pregnancy with Diabetes—Opinions from Several Latest Guidelines

Ye FENG ; Hui-Xia YANG

Maternal-Fetal Medicine.2020;02(1):10-11. doi:10.1097/FM9.0000000000000036

Pregnancy complicated with diabetes is associated with adverse maternal and fetal outcomes. Good control of glucose level during pregnancy contributes to improve maternal and fetal outcomes and break the vicious cycle of "diabetes begetting diabetes". The first line antidiabetic drug in pregnancy is insulin, which is expensive and inconvenient to use. Lots of clinical trials and meta-analyses have constantly confirmed the safety and efficacy of metformin in pregnancy. Several guidelines across the world have been discussing metformin as an alternative to insulin in pregnancy. This article summarizes the opinions about metformin from several latest guidelines.

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Risk Assessment and Prevention of Spontaneous Preterm Birth

Chao LI

Maternal-Fetal Medicine.2020;02(2):89-94. doi:10.1097/FM9.0000000000000042

Preterm parturition is the consequence of pathological signals that activate the common pathway of parturition and considered as a syndrome. Many risk factors for spontaneous preterm birth (sPTB) have been identified. Two significant risk factors for sPTB are history of prior sPTB and short cervical length at midtrimester. 17 hydroxyprogesterone caproate, vaginal progesterone, cerclage, and pessary have all been studied for prevention of sPTB. Difference in patient populations likely contributes to the conflicting study results. Further studies are needed to establish strategies in prevention of sPTB in singleton as well as multiple pregnancies.

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The Relationship Between the Expression of Resistin and Apoptosis Factors in Placenta and the Pathogenesis of Gestational Diabetes Mellitus

Jun YU ; Xiao-Ling SU ; Jing JIA ; Yu ZENG ; Jing-Yi ZHANG ; Shao-Shuai WANG ; Ling FENG

Maternal-Fetal Medicine.2020;02(2):80-83. doi:10.1097/FM9.0000000000000040

Objective::To detect the expression of caspase-3, baculoviral inhibitor of apoptosis repeat containing 5 (BIRC-5), vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), and the concentration of resistin protein in placental of patients with gestational diabetes mellitus (GDM) and normal pregnant women, and to explore its correlation with the pathogenesis of GDM and its significance.Methods::This study includes 30 pregnant women who chose cesarean section at Tongji Hospital of Tongji Medical College during May 2013 to February 2014: 15 GDM patients and 15 normal glucose tolerance patients, 26-36 years old. The expression of caspase-3, VEGF, HIF, and BIRC-5 in placenta of 15 patients with GDM (GDM group) and 15 normal late pregnancy (control group) was detected by real-time fluorescence quantitative polymerase chain reaction. The concentration of resistin protein in the placenta was detected by enzyme-linked immunosorbent assay.Results::Compared with the control group, the expression of caspase-3, HIF, VEGF, resistin in placenta of GDM group increased significantly ( P < 0.05); the expression of BIRC-5 in placenta of GDM group decreased significantly ( P < 0.05). Conclusion::The expression of caspase-3, BIRC-5, VEGF, HIF, and resistin in placenta of GDM patients and normal pregnant women are significantly different, which may be involved in the pathogenesis of GDM disease.

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Positive Rate of Noninvasive Prenatal Screening for Pregnancies with Fetal Congenital Heart Disease and Its Impact on Pregnancy Outcome

Yun CHEN ; Yun-Li LAI ; Yi-Ping SHEN ; Xiao-Xian TIAN ; Chen-Guang ZHENG ; Hong-Wei WEI

Maternal-Fetal Medicine.2020;02(2):84-88. doi:10.1097/FM9.0000000000000028

Objective::To evaluate the clinical utility of noninvasive prenatal screening (NIPS) for fetuses with congenital heart disease (CHD) and impact of NIPS results on pregnancy outcome.Methods::This was a retrospective study of pregnant women with fetuses diagnosed with CHDs by sonographic examination, who willing to underwent NIPS as a side-test for fetal aneuploidies. From August 2016 to October 2017, in the sonographic examination center of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. NIPS was offered to 117 women, 19-32 years old, who carried fetuses with CHD diagnosed by fetal ultrasound (mean gestational age= 24 weeks). The pregnancy outcomes were followed-up.Results::NIPS positive rate in our pregnancies with CHD fetuses’ cohort was 11.1% (13/117), and the positive predictive value for aneuploidies is 85.7% (6/7). In the NIPS positive group ( n = 13), all pregnancies terminated, 76.9% (10/13) of those decisions were made on ultrasound finding alone. In the NIPS negative group ( n= 104), 2 lost follow-up, 79 pregnancies terminated, among which 77.2% (61/79) of the decision was made by ultrasound results alone. Twenty-three pregnancies continued and 78.3% of those fetuses carried single type CHD. In terminated pregnancies that did not considered NIPS results (71/115), 73.2% (52/71) of those carried fetuses with two or more types of CHDs. Conclusion::NIPS can detect common aneuploidy associated with CHD with high positive predictive value and screening yield. The NIPS result played certain meaningful roles in determining pregnancy outcomes, particularly for fetus with simplex CHD; yet the parents’ decision of pregnancy was mainly made based on ultrasound findings.

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Challenges for Obstetricians and the Countermeasures of COVID-19 Epidemic

Yin ZHAO ; Li ZOU ; Ming-Hui DONG ; Xiao-Xia LIU ; Ya-Lan LIU ; Jian-Wen ZHU ; Qing-Qing LUO ; Hui GAO

Maternal-Fetal Medicine.2020;02(2):68-71. doi:10.1097/FM9.0000000000000046

Since the outbreak of the novel coronavirus in Wuhan, China, as obstetricians, we also face great challenges. We need to identify pregnant patients with 2019 coronavirus disease infection timely, and give them appropriate treatment in order to obtain a good maternal and infant prognosis. Here, we would like to share a case and provide some suggestions on how to screen, diagnose and treat pregnant women with 2019 coronavirus disease infection during the outbreak.

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