Several amino acids were deficient in plasma on ICU admission but increased during EN. Taurine concentrations declined and were associated with longer periods of mechanical ventilation and ICU support. Fast taurine decline correlated with severity of organ failure. These findings support the role of taurine during ischemia, reperfusion, and inflammation. Taurine may be an essential candidate to enrich nutrition support for critically ill patients, although more research is required.

Objective To study the prevalence of metabolic syndrome in women after a pregnancy complicated by pre-eclampsia or smallfor-gestational-age (SGA), both epitomes of placental syndrome.Design A retrospective cohort study.Setting Single tertiary centre for maternal medicine in the Netherlands.Population Women with a history of pre-eclampsia in absence of SGA (n = 742) or pregnancy complicated by normotensive SGA (n = 147) between 1996 and 2010.Methods Women were routinely screened for underlying cardiometabolic and cardiovascular risk factors at least 6 months postpartum. Logistic regression analysis was used to calculate the odds ratio and adjusted odds ratio for each group. Adjustments were made for age, maternal height, smoking, parity, and interval between delivery and measurement.Main outcome measures Prevalence of the metabolic syndrome.Results The prevalence of the metabolic syndrome in our population was two-fold higher for women with a history of preeclampsia (13.9%) compared with women with a history of SGA (7.6%). Calculated odds ratios for metabolic syndrome, fasting insulin, HOMA, and microalbuminuria were all higher for women with a history of pre-eclampsia compared with women with SGA. This difference persisted after adjustment for confounding factors: metabolic syndrome (adjusted odds ratio, aOR 2.11; 95% confidence interval, 95% CI 1.00-4.47) and hyperinsulinaemia (aOR 1.78; 95% CI 1.13-2.81) insulin resistance (HOMA IR ; aOR 1.80; 95% CI 1.14-2.86). Microalbuminuria (aOR 1.58; 95% CI 0.85-2.93) did not reach the level of significance after adjustment for confounding factors.Conclusions A history of pre-eclampsia, rather than SGA, was associated with metabolic syndrome, suggesting that it relates to maternal rather than fetal etiology of placental syndrome.

Background: Satisfaction of pregnancy and childbirth is an important quality measure of maternity care. Satisfaction questionnaires generally result in high scores. However, it has been argued that dissatisfaction relies on a different construct. In response to a worldwide call for obstetric care that is more woman-centered, we identified and described the contributors to suboptimal satisfaction with pregnancy and childbirth. Methods: A prospective subcohort of 739 women from a larger cohort (Expect Study I, n ¼ 2614) received a pregnancy and childbirth satisfaction questionnaire. Scores were transformed to a binary outcome whereby a score <100 points corresponded with less satisfied women. We performed a multiple logistic regression analysis to define independent perinatal factors related to suboptimal satisfaction. Results: Decreased perceived personal well-being, antenatal anxiety, and obstetrician-led care during labor were all independently associated with suboptimal pregnancy and childbirth satisfaction. No difference in satisfaction was found between antenatal care led by a midwife or an obstetrician, but midwife-led antenatal care reduced the odds of suboptimal satisfaction compared to women who were transferred to an obstetrician in the antenatal period. Antenatal anxiety was experienced by 25% of all women and is associated with decreased satisfaction scores. Discussion: Screening and treatment of women suffering from anxiety might improve pregnancy and childbirth satisfaction, but further research is necessary. Women's birthing experience may improve by reducing unnecessary secondary obstetric care.

Background. Despite improved management, preeclampsia remains an important cause of maternal and neonatal mortality and morbidity. Low-dose aspirin (LDA) lowers the risk of preeclampsia. Although several guidelines recommend LDA prophylaxis in women at increased risk, they disagree about the definition of high risk. Recently, an externally validated prediction model for preeclampsia was implemented in a Dutch region combined with risk-based obstetric care paths. Objectives. To demonstrate the selection of a risk threshold and to evaluate the adherence of obstetric health care professionals to the prediction tool. Study Design. Using a survey (n = 136) and structured meetings among health care professionals, possible cutoff values at which LDA should be discussed were proposed. The prediction model, with chosen cutoff and corresponding risk-based care paths, was embedded in an online tool. Subsequently, a prospective multicenter cohort study (n = 850) was performed to analyze the adherence of health care professionals. Patient questionnaires, linked to the individual risk profiles calculated by the online tool, were used to evaluate adherence. Results. Health care professionals agreed upon employing a tool with a high detection rate (cutoff: 3.0%; sensitivity 75%, specificity 64%) followed by shared decision between patients and health care professionals on LDA prophylaxis. Of the 850 enrolled women, 364 women had an increased risk of preeclampsia. LDA was discussed with 273 of these women, resulting in an 81% adherence rate. Conclusion. Consensus regarding a suitable risk cutoff threshold was reached. The adherence to this recommendation was 81%, indicating adequate implementation.

Background Clinical guidelines are developed to lower risks, mostly viewed upon as probability. However, in daily practice, risk is perceived as the combination of probability and the impact of desired and adverse events. This combination of probability and impact can be visualized in a risk matrix. We evaluated the effect of interventions and diagnostic thresholds on modeled risk, by using the risk matrix approach (RMA) in a clinical guideline development process, and investigated which additional factors affected choices. Methods To improve care outcomes, we developed new guidelines in which care professionals had to decide upon novel interventions and diagnostic thresholds. A risk matrix showed the probability and impact of an intervention, together with the corresponding risk category. First, professionals’ opinion on required performance characteristics on risk were evaluated by a qualitative online survey. Second, qualitative assessment of possible additional factors affecting final decisions, that followed from group discussion and guideline development were evaluated. Results Upfront, professionals opinioned that non-invasive interventions should decrease the general population risk, whereas invasive interventions should decrease the risk in high-risk groups. Nonetheless, when making guidelines, interventions were introduced without reaching the predefined threshold of desired risk reduction. Professionals weighed other aspects besides risk reduction, as financial aspects and practical consequences for daily practice in this guideline-making process. Conclusion Professionals are willing to change policies at much lower level of anticipated effectiveness than defined upfront. Although objectively presented data structured group discussions, decisions in guideline development are affected by several other factors than risk reduction alone.