Objective Obesity in pregnancy bears unique maternal and fetal risks. Obesity has also been associated with chronic inflammation, including elevated serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Higher serum lipopolysaccharide (LPS) levels have been implicated in driving this inflammation, a phenomenon called metabolic endotoxemia (ME). GLP-2, a proglucagon-derived peptide, is believed to be integral in maintaining the integrity of the intestine in the face of LPS-mediated endotoxemia. We hypothesized that obesity and/or excess weight gain in pregnancy would be associated with an increase in maternal and neonatal markers of ME, as well as GLP-2. Study Design Paired maternal and neonatal (cord blood) serum samples (n = 159) were obtained from our pregnancy biobank repository. Serum levels of LPS, endotoxin core antibody-immunoglobulin M (EndoCAb-IgM), and GLP-2 were measured by ELISA. IL-6 and TNF-α were measured using a Milliplex assay. Results were stratified by maternal body mass index (BMI), maternal diabetes, and gestational weight gain (GWG). Results Maternal IL-6 is significantly decreased in the obese, diabetic cohort compared with the nonobese, nondiabetic cohorts (95.28 vs. 99.48 pg/mL, p = 0.047), whereas GLP-2 is significantly increased (1.92 vs. 2.89 ng/mL, p = 0.026). Neonatal TNF-α is significantly decreased in the obese cohort compared with the nonobese cohort (12.43 vs. 13.93 pg/mL, p = 0.044). Maternal GLP-2 is significantly increased in women with excess GWG compared with those with normal GWG (2.27 vs. 1.48 ng/mL, p = 0.014). We further found that neonatal IL-6 and TNF-α are negatively correlated with maternal BMI (−0.186, p = 0.036 and –0.179, p = 0.044, respectively) and that maternal and neonatal IL-6 showed a positive correlation (0.348, p < 0.001). Conclusion Although we observed altered levels of markers of inflammation (IL-6 and TNF-α) with maternal obesity and diabetes, no changes in LPS or endoCAb-IgM were observed. We hypothesize that the increased GLP-2 levels in maternal serum in association with excess GWG may protect against ME in pregnancy. Key Points

Objective This study aimed to evaluate platelet counts at delivery in uncomplicated pregnancies between 37 and 41 weeks of gestation. Study Design Platelet counts in women 16 to 45 years of age from August 1, 2011, through May 15, 2018, with a singleton pregnancy that delivered from 370/7 to 416/7 weeks of gestation. Women with pregnancy-related complications, preexisting disorders, or on medications that could affect platelet counts were excluded. Results A total of 18,526 women had uncomplicated pregnancies with mean platelet count from 370/7 to 416/7 weeks of gestation of 220 × 109/L. The lower limit 95th percentile (2.5% quantile) was 120 × 109/L. Platelet counts decreased weekly from 37 to 41 weeks of gestation, becoming significant at 39 weeks of gestation and beyond, compared with 37 weeks (p < 0.01). Mean platelet counts: 225 × 109/L at 37 weeks, 223 × 109/L at 38 weeks, 219 × 109/L at 39 weeks, 218 × 109/L at 40 weeks, and 216 × 109/L at 41 weeks of gestation. Platelet counts of less than 150 × 109/L occurred in 9.7%. Conclusion Platelet counts in uncomplicated pregnancies decrease weekly from 37 to 41 weeks of gestation. This will be important to consider when serial platelet values are monitored for other indications.

INTRODUCTION: Strong evidence has linked perturbations of vitamin C levels and collagen integrity with risk for preterm premature rupture of membranes (PPROM). We sought to evaluate the literature and perform a meta-analysis using available data from randomized clinical trials (RCT) which evaluated the use of vitamin C supplementation to prevent PPROM and preterm birth (PTB). METHODS: A systematic literature review was conducted using PUBMED and MEDLINE 1966-2017 using relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCT were abstracted and meta-analysis performed using Mantel-Haenszel fixed effects model with test of heterogeneity (Comprehensive Meta-Analysis - Version 2.2.064). RESULTS: Ten randomized placebo controlled trials, conducted 2004-2013, assessing Vitamin C supplementation and relationship to PPROM or PTB were identified. These studies included at total cohort of 14291 women who received vitamin C supplementation and 14307 women who received placebo. PPROM and/or PTB were the primary outcome in 4 of the 10 studies. The remainder of studies evaluated PPROM and/or PTB as a secondary outcome. Eight studies included data for PPROM<37 weeks and/or PTB<37 weeks. Five studies included data for PTB<34 weeks. Vitamin C was not associated with reduction in risk of PPROM<37 weeks (OR 1.05, CI 0.91-1.21, p=0.55), PTB<37 weeks (OR 1.02, CI 0.95-1.10, p=0.62) or PTB<34 weeks (OR 1.15, CI 0.97-1.36, p= 0.10). CONCLUSION: Vitamin C supplementation during pregnancy is not associated with prevention of PPROM or PTB.

anomalies, which were also the least prevalent. Figure 1 shows probability of an anomaly with increasing hemoglobin A1c values. CONCLUSION: In women with pregestational diabetes, hgb A1c is strongly associated with fetal anomaly risk. Data from a contemporary cohort may facilitate counseling.

Background Patients with systemic lupus erythematosus (SLE) have an increased risk of preeclampsia (PE), which can be confused with lupus nephritis. Objectives Our objective was to evaluate the behaviour of mean pulsatility index in the uterine arteries (mPI-UtA), sFlt-1/PlGF ratio and endoglin levels in pregnant women with SLE and/or antiphospholipd syndrome (APS). Methods Pregnant women with SLE and/or APS attending our high-risk pregnancy unit were consecutively included. Clinical, analytical and sonographic evaluations were conducted at baseline, at different weeks (wk) of gestational age (10-13, 22, 28, 32), at delivery and postpartum. We collected demographic data, information regarding cardiovascular risk factors and toxic habits, the underlying disease, obstetrical history, last SLE flare, previous and current treatments, as well as usual blood tests including complement and a-dsDNA antibodies levels. Levels of sFlt-1, PlGF, and maternal serum endoglin were quantified by ELISA. PE and its severity were diagnosed according with the ISSSHP definition. Intrauterine growth restriction (IUGR) was defined as a small for gestational age newborn together with a Doppler PI in the umbilical artery above the 95th percentile. Results 34 consecutive patients were recruited, of whom 29 had SLE (4 with secondary APS), 3 had primary APS and 2 had antiphospholipid antibodies but without clinical criteria for APS. Five patients have not delivered at the time of writing and we missed 1 patient in the follow-up. Ten patients (36%) suffered an early pregnancy loss (<12 wks), being most frequent among patients with previous APS diagnosis (p=0.03), high blood pressure (p=0.01), arterial thrombosis related to APS (p=0.03), and the presence of lupus anticoagulant (p=0.004). In uneventful pregnancies the values of the studied markers were within normal limits for the gestational age throughout pregnancy. One SLE patient (5.6%) had mild PE after 32 wk together with IUGR. We observed a relationship between IUGR and higher SLEDAI both before and throughout pregnancy (baseline, p=0.01; 10-13 wks, p=0.04; 22 wk, p=0.02; 28 wk, p=0.05; 32 wk, p=0.01). IUGR was also associated with higher mPI-UtA at 22 wk (p=0.05). Endoglin levels (14.6 ng/ml vs <7.9, 26.9 vs <7.2, 49 vs <13.6, at 22 wk, 28 wk and 32 wk, respectively) and ratio curve sFlt1/PlGF (17 vs 14.8, 36.6 vs 16.9, 170.7 vs 86.4 at 22 wk, 28 wk and 32 wk, respectively) behaved abnormal in this case. Among remaining patients, 1 patient with SLE (5.6%) developed HBP before delivery, 1 SLE patient had premature rupture of membranes at term, and 3 SLE patients had a preterm delivery at 28, 32 and 36 wks, respectively. 12 patients (67%) had a mild exacerbation of SLE, and only 1 (8%) had moderate activity requiring high doses of corticosteroids and azathioprine. Conclusions Our preliminary results indicate that mPI-UtA, sFlt1/PlGF ratio and endoglin levels behave in patients with SLE and/or APS essentially as in the general population. Moreover, these markers may be useful to p...