Veli Mihmanlı

Objective: To evaluate whether the admission blood urea nitrogen to albumin ratio (BAR) predicts adverse maternal and perinatal outcomes in preeclampsia, and to compare its performance against six other laboratory‐derived ratios. Methods: Records of 252 preeclamptic pregnancies were reviewed and dichotomised at a BAR cut‐off of 3.0: low (< 3.0, n = 135) and high (≥ 3.0, n = 117). Composite adverse maternal outcomes included severe complication, intensive‐care admission, or transfusion; composite adverse perinatal outcomes included growth restriction, stillbirth, neonatal death, neonatal‐unit admission, or 5‐min Apgar below 7. BAR was benchmarked against six other ratios: uric acid/albumin ratio (UAR), lactate dehydrogenase/albumin ratio (LAR), C‐reactive protein/albumin ratio (CAR), fibrinogen/CRP ratio, fibrinogen/albumin ratio (FAR), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (De Ritis) by ROC analysis. Independent predictors were sought through multivariable logistic regression. Results: Patients in the high‐BAR stratum showed substantially higher rates of composite adverse obstetric outcome (78.6% vs. 54.1%; p < 0.001), composite adverse maternal outcome (28.2% vs. 6.7%; p < 0.001), maternal intensive‐care admission (16.2% vs. 3.7%; p = 0.001), and transfusion (12.0% vs. 2.2%; p = 0.002). BAR yielded the most balanced discrimination across endpoints, with AUCs of 0.68 (95% CI: 0.61–0.75) for the obstetric composite, 0.74 (95% CI: 0.65–0.83) for the maternal composite, and 0.66 (95% CI: 0.59–0.73) for the perinatal composite (all p < 0.01); fibrinogen/albumin and AST/ALT ratios were not predictive. BAR did not differ significantly from UAR or LAR by DeLong test (all p > 0.05) and retained independent association with adverse perinatal outcome after adjustment (adjusted OR 1.32; 95% CI: 1.03–1.70; p = 0.03). Sensitivity analyses showed that UAR retained independent significance for all three composite endpoints, positioning BAR and UAR as complementary bedside markers. Conclusion: An elevated admission BAR identifies preeclamptic women at higher risk of severe maternal and perinatal events, with performance comparable to that of UAR. Both BAR and UAR may serve as simple complementary bedside adjuncts to existing risk stratification tools in preeclampsia.

Objectives: To investigate the association between Doppler ultrasonographic parameters and maternal serum bile acid levels in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP) and to evaluate their potential role in fetal monitoring. Methods: In this prospective observational study, 59 pregnant women diagnosed with ICP and 59 healthy controls were included. The diagnosis of ICP was based on pruritus and serum bile acid levels >10 μmol/L. Doppler assessments – performed by a blinded perinatologist – included the uterine artery pulsatility index (PI), middle cerebral artery (MCA) PI, umbilical artery (UA) PI, and cerebroplacental ratio (CPR). Participants were further stratified by bile acid levels (40 μmol/L), and intergroup comparisons and correlation analyses were performed. Results: The ICP cases had significantly higher uterine artery PI and lower MCA PI and CPR values compared to controls (p<0.05). Bile acid levels were positively correlated with uterine artery PI and inversely correlated with MCA PI and CPR. ICP pregnancies also demonstrated increased rates of preterm delivery, low birth weight, and neonatal intensive care unit (NICU) admissions. Conclusions: Alterations in uterine and fetal Doppler indices in ICP pregnancies suggest underlying placental dysfunction. These findings support the clinical utility of Doppler ultrasound in the risk stratification and perinatal surveillance of patients with ICP.

Our aim in our study was to evaluate folic acid use and awareness among pregnant women with NTD risk factors. The prospective cohort study encompassed singleton pregnant women in their first trimester at a tertiary hospital in Turkey. The study group consisted of 132 pregnant women with at least one NTD risk factor and equal number without any risk factors, forming the control group. Demographic data were collected via responses to a 10-question survey developed through a literature review. The survey explored participants' knowledge of folic acid and awareness of NTDs. It was conducted face to face and categorized by outcome. The high-risk group exhibited better folate awareness and use. Although there was a significant increase in pre-pregnancy folate use in the high-risk group, only 18.35% had used pre-pregnancy folate. The study showed that folate awareness was higher among participants with at least a university degree. In conclusion, despite recommendations for pre-conceptional folate use, the study reveals that awareness and use are low and emphasizes the need to increase social awareness, especially by targeting women with NTD risk factors.

Background. Vitamin B12, an indispensable micronutrient, is pivotal in numerous physiological processes, with particular significance during pregnancy and fetal development. The increasing adoption of vegetarian diets and the economic challenges associated with accessing animal-based food sources contribute to the prevalence of vitamin B12 deficiency. This study aims to examine the levels of vitamin B12 and homocysteine in pregnant women upon admission for delivery and to analyze corresponding cord blood samples from their newborn infants in a substantial sample within the Istanbul metropolitan area. Materials and Methods. This cross-sectional multicenter study included women aged ≥16 years admitted for delivery and their newborns ≥34 weeks. The demographic data and the results of complete blood counts within the previous 24 hours before birth were recorded. Vitamin B12 and homocysteine levels were measured in maternal and cord blood samples. The study parameters were compared between the groups based on the mothers’ and babies’ homocysteine and vitamin B12 levels. Results. The study included 832 pregnant women and 832 neonates. Anemia affected 36% of pregnant women, with a higher frequency in mothers with vitamin B12 deficiency. Seventy-eight mothers and 48.9% of neonates showed Vitamin B12 levels below 200 pg/mL, while elevated homocysteine levels were observed in 30% of mothers and 26% of neonates. Maternal vitamin B12 deficiency was significantly correlated with cord blood B12 deficiency and elevated homocysteine. The median cord blood vitamin B12 level was inversely correlated with the number of previous pregnancies. Conclusion. Vitamin B12 deficiency is extremely common in pregnant women before delivery, significantly correlating to cord blood homocysteine and vitamin B12 levels. However, homocysteine alone is not a reliable marker for maternal vitamin B12 status. Implementing strategies to detect vitamin B12 deficiency and supplying adequate vitamin B12 supplementation during pregnancy holds the potential to enhance maternal and neonatal health in Türkiye.

Effectiveness of first trimester maternal fat tissue measurement in prediction of gestational diabetes: a prospective cohort study - Journal of the Turkish-German Gynecological Association

Background: Carpal tunnel syndrome (CTS) is a prevalent condition during gestation. The recent ability of ultrasound to provide comparable results with electrodiagnostic tests (EDx) has opened the door for investigating new parameters. The objective of this investigation is to explore the clinical importance of a new anthropometric independent parameter called the nerve/tendon ratio (NTR) when compared to EDx and to determine whether it has the utility to be used in clinical practice. Methods: In this prospective case-control study conducted between April 2023 and September 2023, 160 pregnant women displaying clinical symptoms of CTS who presented to the outpatient clinic underwent evaluation employing the Boston Carpal Tunnel Questionnaire, Visual Analog Scale, and provocative tests (Phalen and Tinnel). The pregnant women with clinical symptoms were divided into two groups: those with positive CTS in the EDx results (mild/moderate/severe) and those without EDx findings (control group). All pregnant women participating in the study had their median nerve cross-sectional area (MN-CSA), flexor carpi radialis (FCR), and MN-CSA/FCR ratio (expressed as a percentage called NTR) values examined. The sonographers were unaware of the clinical and EDx results. Subsequently, the data were examined utilizing logistic regression models, with a significance threshold established at p < 0.05. Results: In pregnant women with CTS, the MN-CSA values were observed to surpass those in the control cohort (10.03 ± 3.28 vs. 7.80 ± 2.50) (p < 0.001). The NTR values in the pregnant women with CTS were also higher than those in the control group (0.94 ± 0.39 vs. 0.81 ± 0.28) (p = 0.045). The best cut-off for MN-CSA values was calculated to be >8.5 mm2. The best cut-off point for MN-CSA/FCR values was found to be >0.82%. A receiver operating characteristic curve was generated, and the NTR cut-off point of 0.82% showed a sensitivity of 51.9% and a specificity of 67.9%. The positive predictive value and the negative predictive value were 61.2% and 59.1%, respectively, with the mentioned point as the diagnostic threshold (area under the curve 0.592 (95% confidence interval [CI]: 0.503–0.680)). Among ultrasound-related factors, patients with symptoms of CTS exhibited an association with MN-CSA (odds ratio [OR] of 6.396, 95% CI: 2.981–13.722). NTR was not identified as a risk factor for CTS (p > 0.05). Conclusions: Ultrasonography of the wrist may serve as an alternative diagnostic tool for CTS in pregnant women due to its rapid, non-invasive, and reproducible characteristics. Further research should focus on investigating the response to treatment. Clinical Trial Registration: the study was registered at https://clinicaltrials.gov (registration number NCT05839769).