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Introduction: Fetal growth restriction (FGR) in most instances is a consequence of primary placental dysfunction due to inadequate trophoblastic invasion. Maternal cardiac maladaptation to pregnancy has been proposed as a possible determinant of placental insufficiency and impaired fetal growth. This study aimed to compare the maternal hemodynamic parameters between normotensive women with small-for-gestational-age (SGA) and FGR fetuses and to evaluate their correlation with neonatal outcome., Material and Methods: An observational cohort study including singleton pregnancies referred to our tertiary care center due to fetal smallness. At the time of diagnosis, fetuses were classified as SGA or FGR according to the Delphi consensus criteria, and pregnant women underwent hemodynamic assessment using a cardiac output monitor. A group of women with singleton uncomplicated pregnancies ar ≥35 weeks of gestation were recruited as controls. Cardiac output, systemic vascular resistance, stroke volume, and heart rate were measured and compared among the three groups (controls vs FGR vs SGA). The correlation between antenatal findings and neonatal outcome was also evaluated by multivariate logistic regression analysis., Results: A total of 51 women with fetal smallness were assessed at 34.8 ± 2.6 weeks. SGA and FGR were diagnosed in 22 and 29 cases, respectively. The control group included 61 women assessed at 36.5 ± 0.8 weeks of gestation. Women with FGR had a lower cardiac output Z-score (respectively, -1.3 ± 1.2 vs -0.4 ± 0.8 vs -0.2 ± 1.0; P < .001) and a higher systemic vascular resistance Z-score (respectively, 1.2 ± 1.2 vs 0.2 ± 1.1 vs -0.02 ± 1.2; P < .001) compared with both SGA and controls, whereas no difference in the hemodynamic parameters was found between women with SGA and controls. The incidence of neonatal intensive care unit admission did not differ between SGA and FGR fetuses (18.2% vs 41.4%; P = .13), but FGR fetuses had a longer hospitalization compared with SGA fetuses (14.2 ± 17.7 vs 4.5 ± 1.6 days; P = .02). Multivariate analysis showed that the cardiac output Z-score at diagnosis (P = .012) and the birthweight Z-score (P = .007) were independent predictors of the length of neonatal hospitalization., Conclusions: Different maternal hemodynamic profiles characterize women with SGA or FGR fetuses. Furthermore, a negative correlation was found between the maternal cardiac output and the length of neonatal hospitalization., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.)

Introduction: Obesity and overweight are increasing worldwide and may compromise female sexual function. Our aim was to compare the sexual function of normal and overweight women in pregnancy., Material and Methods: A cross-sectional study involving 223 pregnant women: 105 overweight [pre-pregnancy body mass index (BMI) ≥ 25.0 kg/m(2) ] and 118 normal weight (BMI 18.5-24.9 kg/m(2) ), in the 2nd and 3rd trimester of pregnancy. These women were managed at an antenatal clinic of a public university hospital in São Paulo, Brazil, between 2011 and 2014. The Female Sexual Function Index (FSFI) was used. The characteristics of normal and overweight women were compared using two-tailed Student's t- or chi-squared tests. Differences in mean FSFI scores were assessed using the Kruskal-Wallis test. Pearson's correlation coefficient was used to assess the correlation between pre-pregnancy BMI and FSFI scores., Results: In the 2nd trimester, mean total FSFI scores were similar in overweight (n = 51) compared to normal weight (n = 67) women (21.9 ± 9.8 vs. 21.7 ± 10.4, p = 1.000). In the 3rd trimester, overweight women (n = 54) had significantly lower total FSFI scores than normal weight women (n = 51; 19.1 ± 10.3 vs. 24.5 ± 9.7, p = 0.0004). In the 3rd trimester, overweight women also had significantly lower mean scores in desire, arousal, lubrication, orgasm and dyspareunia domains. We found an inverse correlation between pre-pregnancy BMI and mean 3rd trimester total FSFI scores (r = -0.212, p = 0.030), desire (r = -0.216, p = 0.027) and orgasm (r = -0.222, p = 0.023)., Conclusion: Overweight women in the 3rd trimester of pregnancy had poorer sexual function compared with normal weight women., (© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.)

Unlabelled: Current exercise guidelines recommend pregnant women to exercise throughout pregnancy. However, a high percentage of pregnant women are sedentary, and there is an increasing decline of physical activity and exercise, especially in the third trimester., Objective: The aim of the present study was to compare demographic and health-related factors in pregnant women exercising and not exercising in the third trimester., Design: Cross-sectional design comparing exercisers and non-exercisers., Setting: Rikshospitalet University Hospital and Norwegian School of Sport Sciences, Oslo, Norway., Population: Healthy pregnant women (n = 467) were successively allocated from the application form for birth at Rikshospitalet University Hospital., Methods: A questionnaire, including questions about demographic variables, physical activity level, common pregnancy complaints, social modeling, attitudes and barriers towards exercise participation was answered between gestation-week 32 and 36., Main Outcome Measures: Demographic variables, pregnancy related health factors and social modeling, including exercise counseling by health care providers, were tested using binary logistic regression analysis., Results: Less than 11% were defined as regular exercisers in the third trimester. Having high gestational weight gain and no social role models with respect to exercise behavior during childhood were inversely associated with third trimester exercise. Pre-pregnancy exercise was the strongest predictor of regular exercise at late gestation. Not receiving advice about exercise from health professionals was borderline significant. Pelvic girdle pain and sick-leave were not statistically significant factors., Conclusions: Pre-pregnancy exercise was strongly related to exercise at late gestation. This study indicates a need for more information and motivation for moderate exercise before and throughout pregnancy.

Objectives: To characterise the changes in serum visfatin levels in late normal pregnancy and pre-eclampsia., Methods: Twenty-seven women with pre-eclampsia were recruited. Twenty-eight women in the third trimester of normal pregnancy served as pregnant control and 28 healthy non-pregnant women as non-pregnant control. Serum levels of visfatin were measured with an enzyme-linked immunosorbent assay., Results: The means of serum visfatin were 626.4+/-45.5 ng/ml (mean+/-SEM) in non-pregnant control, 695.9+/-92.5 ng/ml in pregnant control, and 308.3+/-80.0 ng/ml in pre-eclampsia, respectively, and were significantly different among the groups (p<0.001). Visfatin level was significantly lower in pre-eclampsia compared to non-pregnant control (p=0.004) and pregnant control (p<0.001). Women with severe pre-eclampsia had a significantly lower serum visfatin level than those with mild pre-eclampsia (114.6+/-80.9 versus 425.2+/-122.1 ng/ml, p=0.037)., Conclusions: A decrease in visfatin level was demonstrated in pre-eclampsia, suggesting that visfatin and adipokine-associated metabolic abnormalities are involved in the pathogenesis of the disease.

Objectives: To establish a curve of amniotic fluid index [AFI] measurements from the 20th to the 42nd week of pregnancy., Methods: A prospective and descriptive study was performed, in which an independent sample of 2,868 low-risk pregnant women were studied using routine ultrasound, including fetal biometry and measurement of AFI. Data were analysed using multiple linear regression, and constructing a curve using 2.5th, 10th, 50th, 90th and 97.5th percentiles of the AFI measurements, according to gestational age, and after submitting values to smoothing process using quadratic polynomial adjustment., Results: There was a significant variation in AFI measurements at the different gestational ages. The 50th percentile remained practically constant at approximately 150 mm between the 20th and 33rd week, after which there was a decline in volume, which became evident after the 38th week. At the 40th week, the 10th percentile was around 62 mm and the 2.5th percentile around 33 mm., Conclusions: The curve of percentiles of AFI measurements in low-risk pregnant women showed significant decrease with gestational age, especially after the 33rd week. These data should be validated for a diagnosis of increased or decreased volumes of amniotic fluid at specific gestational ages.

Objective: The impact of pregnancy on maternal bone density remains unclear. As a prerequisite to investigate the pathophysiology of gestational bone metabolism, we sought to document the changes in bone metabolism biochemistry in conjunction with those in selective trabecular/cortical osteodensitometry between early and late pregnancy., Methods: A prospective, controlled study in a university hospital was conducted with 43 healthy women, 34 of them during uneventful pregnancy. The main outcome measures are trabecular and cortical bone density measured in the first and third trimesters using peripheral quantitative computed tomography in conjunction with a panel of bone metabolism parameters, including blood parathyroid hormone, calcitonin, osteocalcin, skeletal alkaline phosphatase, and the urinary desoxypyridinoline/creatinine ratio., Results: Cortical bone density was unaffected by pregnancy. Trabecular bone density changes showed wide interindividual variation, ranging from +1.3 to -20.7% per year, identified as fast losers (less than -3%) and slow losers (more than -3%). Serum osteocalcin levels were lower in slow versus fast bone losers in both trimesters (first: P=0.02, third: P=0.02) and were the only independent parameter to differentiate between fast and slow losers., Conclusions: Our data suggest that wide interindividual variation and the failure to provide a separate measure of trabecular bone density account for the conflicting evidence in earlier reports. Serum osteocalcin concentration during the first trimester distinguishes between fast and slow losers of trabecular bone and should be evaluated in future studies as predictor for later bone loss (osteoporosis).

Purpose: To evaluate the endothelial cell state and the possible relation to placental function in the third trimester of normal pregnancy by an indirect assessment of endothelial cell function. STUDY-DESIGN. Twenty-six pregnant women entered the study in the 30th week of pregnancy. Von Willebrand Factor, urate and key hemostatic variables were quantified at entry, and during the 33rd and 37th weeks of pregnancy., Results: Levels of von Willebrand Factor, PAI-1 antigen, t-PA antigen; variables produced by the endothelial cell, increased during the third trimester of pregnancy. Serum urate, which is correlated with clinical outcome of pregnancy, increased during the study period and correlated directly with von Willebrand Factor and PAI-1 antigen, respectively. There was an inverse correlation between the concentrations of placenta-derived PAI-2 antigen and urate., Conclusions: In healthy human pregnancy the markers of endothelial related processes of coagulation and fibrinolysis pointed towards a procoagulatory state of the endothelial cell. However, the balance between fibrin formation and resolution seemed to be maintained in uncomplicated pregnancy. Our study indicated an association between this change of endothelial cell function and placental function.