Publications by authors named "Bozena Leszczynska-Gorzelak"

82 Publications

Emergency Cervical Cerclage.

J Clin Med 2021 Mar 18;10(6). Epub 2021 Mar 18.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.

Despite the progress of medicine in the last decades, recurrent pregnancy loss, premature birth, and related complications are still a vast problem. The reasons for recurrent pregnancy loss and preterm delivery are diverse and multifactorial. One of the main reasons for these complications is cervical insufficiency, which means that the cervix is weak and unable to remain closed until the date of delivery. It manifests as painless softening and shortening of the cervix without contractions. The aim of the study was to review the available literature on rescue sutures, which are an emergency treatment in pregnancies with premature cervical dilatation and protrusion of the fetal membranes in the second trimester of pregnancy. This review confirms that emergency cerclage reduces the rate of preterm birth in patients with advanced cervical insufficiency. This procedure prolongs gestational age and improves the chances of survival of the newborn without increasing the risk of chorioamnionitis and preterm premature rupture of membranes.
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http://dx.doi.org/10.3390/jcm10061270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003203PMC
March 2021

COVID-19 impact on perinatal care: risk factors, clinical manifestation and prophylaxis. Polish experts' opinion for December 2020.

Ginekol Pol 2021 ;92(1):57-63

Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland.

Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 (COVID-19). Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.
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http://dx.doi.org/10.5603/GP.a2021.0023DOI Listing
February 2021

Ovarian Cancer and Pregnancy-A Current Problem in Perinatal Medicine: A Comprehensive Review.

Cancers (Basel) 2020 Dec 16;12(12). Epub 2020 Dec 16.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Lubelskie Region, Poland.

The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15-5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords "ovarian cancer", "ovarian malignancy", "adnexal masses", "ovarian tumor" and "pregnancy" was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother's decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes.
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http://dx.doi.org/10.3390/cancers12123795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765590PMC
December 2020

The pregnancy rate of infertile patients with proximal tubal obstruction 12 months following selective salpingography and tubal catheterization.

Eur J Obstet Gynecol Reprod Biol 2020 Nov 16;254:164-169. Epub 2020 Sep 16.

Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8 Str., 20-954, Lublin, Poland. Electronic address:

Objective: To assess the efficacy of selective salpingography (SSG) with additional tubal catheterization (TC) among infertile patients diagnosed with PTO and analysis of reproductive outcome.

Study Design: Retrospective cohort study.

Results: Of a total of 399 tubes with confirmed proximal tubal occlusion, 383 successfully restored their patency resulting in 96 % technical success rate. Thirty-five percent of oviducts that had their patency restored was treated with SSG and 65% required additional TC. Reproductive outcomes at minimum 12 months following the treatment were collected by a telephone survey. 21/221 women were lost to follow up. Out of remaining 200 patients with at least one patent tube, 80 patients conceived which resulted in 40 % overall pregnancy rate.

Conclusion: Selective salpingography and tubal canalization offer patient-friendly, minimally invasive and cost-effective alternatives to tubal microsurgery and IVF-ET in women with tubal occlusion with very high technical success rate and promising clinical results which depend also on the complexity of couple infertility. Specific indications and limitations make a careful assessment of fallopian tubes and comprehensive evaluation of partners' reproductive situation prior to therapy an absolute requirement.
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http://dx.doi.org/10.1016/j.ejogrb.2020.08.008DOI Listing
November 2020

Adipokines and Endothelium Dysfunction Markers in Pregnant Women with Gestational Hypertension.

Int J Hypertens 2019 13;2019:7541846. Epub 2019 Oct 13.

Department of Obstetrics and Perinatology, Medical University of Lublin, ul. Jaczewskiego 8, 20-094 Lublin, Poland.

Objective: The aim of the study was to evaluate the levels of adipokines such as adiponectin and leptin as well as soluble intercellular adhesion molecule-1 (sICAM-1) and endogenous NOS inhibitor-asymmetric dimethylarginine (ADMA), as the endothelium dysfunction markers in pregnant women with gestational hypertension (GH).

Patients And Methods: Adiponectin, leptin, sICAM-1, and ADMA concentrations were measured in a group of 34 patients with GH and in 32 healthy pregnant women between the 24 and 34 week of gestation with ELISA tests.

Results: The patients with GH compared with healthy ones were characterized by significantly higher BMI (28.09 ± 7.90 vs. 22.34 ± 4.21 kg/m, =0.016) and higher concentrations of leptin (45.89 ± 35.91 vs. 24.09 ± 24.40 ng/mL, =0.006). sICAM-1 levels were also higher in the GH group but without the statistical significance (264.51 ± 50.99 vs. 232.56 ± 43.3 ng/ml, =0.057). There were no significant differences between groups in adiponectin (8.79 ± 8.67 vs. 7.90 ± 3.71 g/mL, =0.46, NS) and ADMA (0.57 ± 0.26 vs. 0.60 ± 0.24 mol/L, =0.68, NS) levels. The significant correlation between leptin levels and BMI value was observed only in patients with GH ( = 0.56, =0.02).

Conclusions: The higher levels of leptin in pregnant women with gestational hypertension may be suggestive of the role of leptin in GH development. As the patients in the GH group had higher BMI, hyperleptinemia may link obesity with gestational hypertension. The significance of leptin as the predictive marker of GH development could be implied. It could be postulated that the higher levels of sICAM-1 in the GH patients, although not statistically significant, could reflect some impairment of the endothelium function occurring in GH regardless of BMI. The comparable adiponectin levels in GH and healthy pregnant patients and the lack of its correlation with BMI may indicate the occurrence of a protective mechanism in pregnancy maintaining its concentration and preserving from the consequences of the decrease in its levels in overweight and obese patients. Since ADMA levels were similar in GH and healthy pregnant women, ADMA seems not to be involved in GH pathogenesis, suggesting that NO synthesis is not impaired in this pregnancy complication. As the data on the gestational hypertension pathogenesis and its correlations with adipokines and markers of the endothelium dysfunction are limited, further studies on this issue are warranted.
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http://dx.doi.org/10.1155/2019/7541846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815564PMC
October 2019

Aortic dissection during pregnancy - obstetric perspective.

Ginekol Pol 2019 ;90(6):346-350

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland.

The risk of vascular events during pregnancy is substantially increased. Beyond comparatively frequent vascular diseases, pregnancy may lead also to the development of exceptionally rare vascular events such as the aortic dissection and aortic rupture which are conceivably endangering life conditions. Women with the connective tissue disorders and with a family history of the aorta diseases are especially prone to the aortic complications which may also develop in the absence of these risk factors due to the pregnancy-induced structural changes of the aortic wall. The preconception counselling is vital for patients with aortopathies to assess the risk of the aortic dissection and to establish the most appropriate care plan including the surgical intervention. This review presents the management guidelines in patients with the aortic dissection risk during pregnancy.
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http://dx.doi.org/10.5603/GP.2019.0052DOI Listing
March 2020

Leptin and Ghrelin in Excessive Gestational Weight Gain-Association between Mothers and Offspring.

Int J Mol Sci 2019 May 15;20(10). Epub 2019 May 15.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin 20-090, Poland.

Two-thirds of pregnant women exceed gestational weight gain recommendations. Excessive gestational weight gain (EGWG) appears to be associated with offspring's complications induced by mechanisms that are still unclear. The aim of this study was to investigate whether umbilical cord leptin (UCL) and ghrelin (UCG) concentrations are altered in full-term neonates born to EGWG mothers and whether neonatal anthropometric measurements correlate with UCL and UCG levels and maternal serum ghrelin and leptin as well as urine ghrelin concentrations. The study subjects were divided into two groups, 28 healthy controls and 38 patients with EGWG. Lower UCL and UCG levels were observed in neonates born to healthy mothers but only in male newborns. In the control group UCG concentrations correlated positively with neonatal birth weight, body length and head circumference. In the control group maternal serum ghrelin levels correlated negatively with neonatal birth weight, body length and head circumference as well as positively with chest circumference. In the EGWG group UCG concentrations correlated negatively with neonatal birth weight and birth body length. UCL correlated positively with birth body length in EGWG group and negatively with head circumference in the control group. In conclusion, EGWG is associated with disturbances in UCL and UCG concentrations.
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http://dx.doi.org/10.3390/ijms20102398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566238PMC
May 2019

Vaspin in Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain.

Medicina (Kaunas) 2019 Mar 23;55(3). Epub 2019 Mar 23.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.

: Data concerning vaspin in obstetric aspects are limited and conflicting. The aim of the study was to evaluate vaspin concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) in the early post-partum period (i.e., 48 h after delivery), when placental function no longer influences the results. : The study subjects were divided into two groups of 28 healthy controls and 38 mothers with EGWG. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of vaspin, fatty acid-binding protein 4 (FABP4), leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). : Serum vaspin levels were lower in the EGWG group, whereas no significant differences were noted between the groups, with regard to the urine vaspin concentrations. In both studied groups, the serum vaspin concentrations correlated positively with the urine FABP4 levels and negatively with gestational weight gain, body mass index gain in the period from pre-pregnancy to 48 h after delivery (ΔBMI), and fat tissue index (FTI). In the multiple linear regression models, the serum vaspin concentrations were positively dependent on the serum FABP4 levels, as well as negatively dependent on triglycerides, FTI, and ΔBMI. : Our study revealed that the EGWG mothers were characterized by significantly lower serum vaspin concentrations in the early post-partum period compared with the subjects that had appropriate gestational weight gain. Our observation supports previous hypotheses that vaspin might be used as a marker of lipid metabolism in pregnancy and maternal adipose tissue. Considering the fact that FABP4 is widely referred to as a pro-inflammatory adipokine, further research on the protective role of vaspin seems crucial, especially in the context of its relationship to FABP4.
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http://dx.doi.org/10.3390/medicina55030076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473861PMC
March 2019

Associations between Fatty Acid-Binding Protein 4⁻A Proinflammatory Adipokine and Insulin Resistance, Gestational and Type 2 Diabetes Mellitus.

Cells 2019 03 8;8(3). Epub 2019 Mar 8.

Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.

There is ample scientific evidence to suggest a link between the fatty acid-binding protein 4 (FABP4) and insulin resistance, gestational (GDM), and type 2 (T2DM) diabetes mellitus. This novel proinflammatory adipokine is engaged in the regulation of lipid metabolism at the cellular level. The molecule takes part in lipid oxidation, the regulation of transcription as well as the synthesis of membranes. An involvement of FABP4 in the pathogenesis of obesity and insulin resistance seems to be mediated via FABP4-dependent peroxisome proliferator-activated receptor γ (PPARγ) inhibition. A considerable number of studies have shown that plasma concentrations of FABP4 is increased in obesity and T2DM, and that circulating FABP4 levels are correlated with certain clinical parameters, such as body mass index, insulin resistance, and dyslipidemia. Since plasma-circulating FABP4 has the potential to modulate the function of several types of cells, it appears to be of extreme interest to try to develop potential therapeutic strategies targeting the pathogenesis of metabolic diseases in this respect. In this manuscript, representing a detailed review of the literature on FABP4 and the abovementioned metabolic disorders, various mechanisms of the interaction of FABP4 with insulin signaling pathways are thoroughly discussed. Clinical aspects of insulin resistance in diabetic patients, including women diagnosed with GDM, are analyzed as well.
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http://dx.doi.org/10.3390/cells8030227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468522PMC
March 2019

FABP4 in Gestational Diabetes-Association between Mothers and Offspring.

J Clin Med 2019 Feb 27;8(3). Epub 2019 Feb 27.

Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.

Fetuses exposed to gestational diabetes mellitus (GDM) have a higher risk of abnormal glucose homeostasis in later life. The molecular mechanisms of this phenomenon are still not fully understood. Fatty acid binding protein 4 (FABP4) appears to be one of the most probable candidates involved in the pathophysiology of GDM. The main aim of the study was to investigate whether umbilical cord serum FABP4 concentrations are altered in term neonates born to GDM mothers. Two groups of subjects were selected-28 healthy controls and 26 patients with GDM. FABP4, leptin, and ghrelin concentrations in the umbilical cord serum, maternal serum, and maternal urine were determined via an enzyme-linked immunosorbent assay. The umbilical cord serum FABP4 levels were higher in the GDM offspring and were directly associated with the maternal serum FABP4 and leptin levels, as well as the prepregnancy body mass index (BMI) and the BMI at and after delivery; however, they correlated negatively with birth weight and lipid parameters. In the multiple linear regression models, the umbilical cord serum FABP4 concentrations depended positively on the maternal serum FABP4 and negatively on the umbilical cord serum ghrelin levels and the high-density lipoprotein cholesterol. There are many maternal variables that can affect the level of FABP4 in the umbilical cord serum, thus, their evaluation requires further investigation.
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http://dx.doi.org/10.3390/jcm8030285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462903PMC
February 2019

Umbilical Cord SFRP5 Levels of Term Newborns in Relation to Normal and Excessive Gestational Weight Gain.

Int J Mol Sci 2019 Jan 30;20(3). Epub 2019 Jan 30.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin 20-090, Poland.

Among the new adipokines, secreted frizzled-related protein 5 (SFRP5) is considered to prevent obesity and insulin resistance. The umbilical cord SFRP5 levels have not yet been investigated. The main aim of the study was to investigate whether the umbilical cord SFRP5 concentrations are altered in term neonates born to mothers with excessive gestational weight gain (EGWG). Two groups of subjects were selected depending on their gestational weight gain, i.e. 28 controls and 38 patients with EGWG. Umbilical cord and maternal serum SFRP5 levels were lower in the EGWG group. Umbilical cord SFRP5 concentrations were directly associated with the maternal serum SFRP5, hemoglobin A1c and lean tissue index, umbilical cord leptin levels, as well as newborns' anthropometric measurements in the EGWG subjects. In multiple linear regression models performed in all the study participants, umbilical cord SFRP5 concentrations depended positively on the maternal serum SFRP5, ghrelin, and leptin levels and negatively on the umbilical cord ghrelin levels, low-density lipoprotein cholesterol, pre-pregnancy body mass index, and gestational weight gain. EGWG is associated with disturbances in SFRP5 concentrations. Obstetricians and midwives should pay attention to nutrition and weight management during pregnancy.
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http://dx.doi.org/10.3390/ijms20030595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387116PMC
January 2019

Nesfatin-1 and Vaspin as Potential Novel Biomarkers for the Prediction and Early Diagnosis of Gestational Diabetes Mellitus.

Int J Mol Sci 2019 Jan 4;20(1). Epub 2019 Jan 4.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland, ul. Jaczewskiego 8, 20-954 Lublin, Poland.

Gestational diabetes mellitus (GDM) is considered to be one of the most frequent medical complication observed among pregnant women. The role of adipokines in the pathogenesis of GDM remains strictly unknown. Different adipokines have been studied throughout gestation, and they have been proposed as biomarkers of GDM and other pregnancy-related complications; however, there is no biomarker reported for GDM screening at present. The aim of this study was to evaluate serum nesfatin-1 and vaspin levels in GDM and non-GDM women, to characterize the correlation between these adipokines, and to assess the potential role of circulating adipokines in the prediction of risk of gestational diabetes mellitus. Serum concentrations of nesfatin-1 and vaspin were measured in 153 women with GDM, and in 84 patients with uncomplicated pregnancy by enzyme-linked immunosorbent assay (ELISA) kits, according to the manufacturer's instructions. Circulating levels of nesfatin-1 and vaspin were significantly lower in the GDM group than in the control group. Nesfatin-1 levels were negatively correlated with vaspin levels. The results of this study point out the possible role of nesfatin-1 and vaspin as potential novel biomarkers for the prediction and early diagnosis of GDM. Further studies are necessary to evaluate the influence of nesfatin-1 and vaspin on glucose metabolism in the early stages of GDM.
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http://dx.doi.org/10.3390/ijms20010159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337752PMC
January 2019

Fatty Acid-Binding Protein 4-An "Inauspicious" Adipokine-In Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain and Gestational Diabetes Mellitus.

J Clin Med 2018 Dec 2;7(12). Epub 2018 Dec 2.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.

The exact roles of adipokines in the pathogenesis of type 2 diabetes and obesity are still unclear. The aim of the study was to evaluate fatty acid binding protein 4 (FABP4) concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) and gestational diabetes mellitus (GDM) in the early post-partum period, with reference to their laboratory test results, body composition, and hydration status. The study subjects were divided into three groups: 24 healthy controls, 24 mothers with EGWG, and 22 GDM patients. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of FABP4, leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Healthy women were characterized by the lowest serum leptin concentrations and by a negative correlation between the serum and urine FABP4 levels. Serum FABP4 levels were the highest in the GDM group. Serum FABP4 and leptin concentrations correlated positively in the GDM group. The EGWG group had the highest degree of BIA disturbances in the early puerperium and positive correlations between the urine FABP4 and serum leptin and ghrelin concentrations. The physiological and pathological significance of these findings requires further elucidation.
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http://dx.doi.org/10.3390/jcm7120505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306707PMC
December 2018

Heat Shock Proteins as a Potential Therapeutic Target in the Treatment of Gestational Diabetes Mellitus: What We Know so Far.

Int J Mol Sci 2018 Oct 17;19(10). Epub 2018 Oct 17.

Department of Obstetrics and Perinatology, Medical University of Lublin, K. Jaczewskiego 8 Street, 20-954 Lublin, Poland.

Gestational diabetes mellitus (GDM) is a complex condition that involves a variety of pathological mechanisms, including pancreatic β-cell failure, insulin resistance, and inflammation. There is an increasing body of literature suggesting that these interrelated phenomena may arise from the common mechanism of endoplasmic reticulum (ER) stress. Both obesity-associated nutrient excess and hyperglycemia disturb ER function in protein folding and transport. This results in the accumulation of polypeptides in the ER lumen and impairs insulin secretion and signaling. Exercise elicits metabolic adaptive responses, which may help to restore normal chaperone expression in insulin-resistant tissues. Pharmacological induction of chaperones, mimicking the metabolic effect of exercise, is a promising therapeutic tool for preventing GDM by maintaining the body's natural stress response. Metformin, a commonly used diabetes medication, has recently been identified as a modulator of ER-stress-associated inflammation. The results of recent studies suggest the potential use of chemical ER chaperones and antioxidant vitamins as therapeutic interventions that can prevent glucose-induced ER stress in GDM placentas. In this review, we discuss whether chaperones may significantly contribute to the pathogenesis of GDM, as well as whether they can be a potential therapeutic target in GDM treatment.
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http://dx.doi.org/10.3390/ijms19103205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213996PMC
October 2018

Adiponectin and Omentin Levels as Predictive Biomarkers of Preterm Birth in Patients with Gestational Diabetes Mellitus.

Biomed Res Int 2018 18;2018:7154216. Epub 2018 Sep 18.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland.

Objective: The aim of this study was to determine any changes in adiponectin and omentin levels in GDM patients who delivered at term and preterm and to evaluate whether adipokines can be useful as a clinical biomarker to predict subsequent preterm delivery.

Patients And Methods: The levels of adiponectin and omentin were measured in four groups: (1) women with GDM who delivered at term (n=63); (2) women with GDM who had the symptoms of threatened preterm labor and delivered at term (n=23); (3) women with GDM and spontaneous preterm birth (before 37 completed weeks of gestation) (n=19); (4) women with physiological pregnancy (n=55).

Results: In comparison with control group the median adiponectin concentrations were significantly lower in all GDM groups (10737 versus 8879; 7057; 6253 ng/ml, respectively; p<0.01). The median omentin concentrations were also significantly lower in all GDM groups in comparison with control group (469 versus 432; 357; 308 ng/ml, respectively; p<0.01). No significant differences in adiponectin and omentin levels between the GDM, preterm labor, and preterm birth groups were observed. However, there was a trend towards lower adiponectin and omentin levels in preterm birth group. The strong correlations between adiponectin and omentin levels were observed in all groups (R=0.801, p<0.001; R=0.824, p<0.001; R=0.705, p<0.001; R=0.764, respectively; p<0.001). In the univariable logistic regression model, significant correlation between omentin concentrations and preterm birth occurrence was found.

Conclusions: Our findings suggest that omentin-1, rather than adiponectin, could be useful as a predictor of preterm birth in patients with gestational diabetes mellitus.
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http://dx.doi.org/10.1155/2018/7154216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167585PMC
January 2019

Ghrelin in Serum and Urine of Post-Partum Women with Gestational Diabetes Mellitus.

Int J Mol Sci 2018 Oct 1;19(10). Epub 2018 Oct 1.

Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin 20-090, Poland.

Women with a previous history of gestational diabetes mellitus (GDM) have a significantly increased risk of developing type 2 diabetes, obesity, and cardiovascular diseases in the future. The aim of the study was to evaluate ghrelin concentrations in serum and urine in the GDM group in the early post-partum period, with reference to laboratory results, body composition, and hydration status. The study subjects were divided into two groups, that is, 28 healthy controls and 26 patients with diagnosed GDM. The maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. The concentrations of ghrelin in the maternal serum and urine were determined via enzyme-linked immunosorbent assay (ELISA). The laboratory and BIA results of the mothers with GDM were different from those without GDM. Urine ghrelin positively correlated with serum ghrelin and high-density lipoprotein cholesterol (HDL) levels in healthy mothers. There were direct correlations between urine ghrelin and HDL as well as triglycerides levels in the GDM group. Neither the lean tissue index nor body cell mass index were related to the serum ghrelin concentrations in this group. Only the urine ghrelin of healthy mothers correlated with the fat tissue index. Our results draw attention to urine as an easily available and appropriable biological material for further studies.
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http://dx.doi.org/10.3390/ijms19103001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213416PMC
October 2018

Pregnancy complicated by ovarian planoepithelial carcinoma arising in mature cystic teratoma.

J Obstet Gynaecol 2019 Apr 22;39(3):408-409. Epub 2018 Sep 22.

a Department of Obstetrics and Perinatology , Medical University of Lublin , Lublin , Poland.

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http://dx.doi.org/10.1080/01443615.2018.1465899DOI Listing
April 2019

Adipokines and C-peptide in overweight and obese pregnant women.

Ginekol Pol 2018 ;89(8):442-48

Klinika Położnictwa i Perinatologii Samodzielnego Publicznego Szpitala Klinicznego nr 4 w Lublinie.

Objectives: The aim of the study was to evaluate the levels of adipokines such as adiponectin, resistin, leptin as well as C-peptide in overweight and obese pregnant women.

Material And Methods: The adipokines and C-peptide concentrations were measured in the group of 38 overweight/obese pregnant women (BMI > 25 kg/m2) and in 42 pregnant women of normal weight (BMI < 25 kg/m2) with ELISA tests between 24th and 34th weeks of gestation.

Results: The overweight/obese women compared to lean ones were characterized by significantly higher concentrations of leptin (43.44 ± 31.41 vs. 21.29 ± 12.67 ng/mL, p = 0.0001) and C-peptide (2.77 ± 1.88 vs. 2.25 ± 1.42 ng/mL, p = 0.034). There were no significant differences between groups in resistin (17.39 ± 7.59 vs. 15.76 ± 6.64 ng/mL, NS) and adiponectin (6.93 ± 3.52 vs. 8.07 ± 6.53 μg/mL, NS) levels. In the overweight/obese patients, no relationships between the adipokines, C-peptide and CRP concentrations were found. BMI was negatively correlated with the resistin levels (R = -0.406, p = 0.011). The significant correlation between leptin and C-peptide concentrations was observed in the study group (R = 0.517, p = 0.012). In the control group, the negative correlation between adiponectin concentrations and BMI was shown (R = -0.446, p = 0.003).

Conclusions: The higher levels of leptin in the overweight and obese pregnant women seem to reflect the leptin resistance condition and the higher levels of C-peptide in this group is suggestive for hyperinsulinemia. The positive correlation between C-peptide and leptin levels but not with resistin and adiponectin might confirm the role of leptin in the hyperinsulinemia development in overweight and obesity during pregnancy.
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http://dx.doi.org/10.5603/GP.a2018.0076DOI Listing
April 2019

An Unusual Coexistence of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with Endometrioid-Type Endometrial Cancer in a 58-Year-Old Woman: A Case Study with Literature Review.

Case Rep Oncol 2018 May-Aug;11(2):347-352. Epub 2018 May 31.

2nd Department of Gynecology, Lublin Medical University, Lublin, Poland.

Introduction: The coexistence of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with different gynecologic neoplasms is a rare phenomenon. Here, we report a case of simultaneously developed CLL/SLL with endometrioid-type uterine cancer.

Case Report: A 58-year-old woman was admitted to the 2nd Department of Gynecology, Lublin Medical University, Lublin, Poland, in June 2017, where the uterine cancer was diagnosed. After the surgery, pathological examination revealed a uterine moderately differentiated adenocarcinoma of endometrioid subtype (subtype I according to Bokhman) deeply infiltrating the myometrium as well as the uterine cervix. Surprisingly, CLL/SLL was subsequently diagnosed in all removed pelvic as well as para-aortic lymph nodes. Immunohistochemical analysis showed CD45 (++), CD20 (+), CD3 (-/+), CD19 (+), CD23 (+), CD5 (+), and CD34 (+). Proliferative activity, assessed by MIB-1 proliferative index immunostaining, reached 18%. The patient was admitted to radiotherapy and chemotherapy at the Oncology Hospital, Lublin, Poland, and is still on follow-up.

Conclusions: The coexistence of CLL/SLL with various gynecological malignancies, especially primary human endometrial cancer, is a rare entity. The detection of both tumors simultaneously, in general, is accidental, and the management should not be different from the situation in which malignancy appears de novo.
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http://dx.doi.org/10.1159/000489662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006626PMC
May 2018

Predictors of cesarean delivery in cervical ripening and labor induction with Foley catheter.

J Matern Fetal Neonatal Med 2020 Jan 18;33(1):62-67. Epub 2018 Jul 18.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland.

The aim of this paper is to identify predictors of cesarean delivery (CD) in patients with an unfavorable cervix undergoing cervical ripening and labor induction with Foley catheter. A retrospective cohort study of singleton pregnancies induced using Foley catheter was performed to evaluate whether factors in the maternal history and during the process of labor induction are useful in predicting the risk of CD. During the study period there were 2221 births in the Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland. From a cohort of 402 women with Foley catheter induction (FCI), 327 met inclusion criteria. There were 236 vaginal labors (72.2%) and 91 CDs (27.8%). Nulliparity (OR 2.344), Bishop score of 1-2 points (OR 1.473), and meconium-stained amniotic fluid (OR 1.980) are linked to the risk of CD. In nulliparous patients, factors associated with an increased risk of CD included maternal age greater than 30 years (OR 3.200), meconium-stained amniotic fluid (OR 2.505), and birthweight ≥3400 g (OR 1.803). Among multiparous women none of the evaluated factors was significantly connected to CD. Nulliparity, low Bishop score, and meconium-stained amniotic fluid are important risk factors of CD after FCI.
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http://dx.doi.org/10.1080/14767058.2018.1486816DOI Listing
January 2020

The role of new adipokines in gestational diabetes mellitus pathogenesis.

Ginekol Pol 2018 ;89(4):221-26

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland, Jaczewskiego 8, 20-954 Lublin, Poland.

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition dur-ing pregnancy. Explanation of the GDM pathogenesis is important due to preventing gestational complications. During pregnancy there are significant changes in maternal metabolism. Many of these changes are influenced by different adi-pokines produced in the placenta and adipose tissue. The exact role of adipokines in the pathogenesis of GDM remains still unknown. Several adipokines have been analysed throughout gestation and their levels have been suggested as biomarkers of maternal-perinatal outcomes. Some of them have been postulated as significant in the pathogenesis of pregnancy complications like GDM. This report aims to review some of the recent topics of adipokine research that may be of particular importance in patho-physiology and diagnosis of gestational diabetes mellitus. Because of manuscript length limitations, after thorough literature review and in view of the recent evidence, we focus on the one of the most well-known adipokine: adiponectin, and not so well-studied: nesfatin-1, chemerin, ghrelin, and CTRP 1.
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http://dx.doi.org/10.5603/GP.a2018.0038DOI Listing
July 2018

Adverse pregnancy outcomes and inherited thrombophilia.

J Perinat Med 2018 May;46(4):411-417

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland.

Aim: (1) To evaluate the prevalence of inherited thrombophilia in pregnant women with adverse pregnancy outcomes: intrauterine growth retardation (IUGR), preeclampsia (PE) and placental abruption. (2) To assess the impact of inherited thrombophilia on the nature of obstetric complications. (3) To assess levels of protein S, protein C, antithrombin III and homocysteine in pregnant women with adverse pregnancy outcomes.

Subjects And Methods: The study comprised 162 pregnant women. The patients were divided into three test groups and one control group. In all 162 patients the following tests were completed: activated protein C resistance (APC-R), the level of free protein S, activity of protein C, antithrombin III and the level of homocysteine. The data were statistically analyzed via χ2 of independence or homogeneity test.

Results: In 32 of 162 patients participating in clinical research thrombophilia was diagnosed (10 patients with APC-R, 21 patients with protein S deficiency, one patient with hyperhomocysteinemia): seven patients belonged to the control group and 25 patients had diagnosed adverse pregnancy outcomes (P=0.04). In 32 patients with diagnosed thrombophilia, level of protein S was decreased (P=0.04). Protein S deficiency was diagnosed, when level of protein S was lower than 30% in the second trimester and lower than 24% in the third trimester. The incidence of activated protein C resistance caused by the mutation of factor V Leiden was in six patients (5.9%) with adverse pregnancy outcomes, and in four patients (6.6%) from the control group. Results were not statistically significant. No protein C deficiency was diagnosed (diagnosis: level<60%), but in 50% of patients with thrombophilia level of protein C was over the norm (P=0.02). The level of antithrombin III was often decreased in patients with preeclampsia - (32.4%), then in the other patients - (17.2%) (P=0.04), but no patient was diagnosed with antithrombin III deficiency (diagnosis: level<60%).

Conclusions: Tests for thrombophilia should be carried out in women with adverse pregnancy outcomes in their history, who are planning pregnancy, to start anticoagulant prophylaxis. Our study supports the thesis that tests for thrombophilia should be carried out in women with a history of adverse pregnancy outcomes and who are planning a pregnancy to start anticoagulant prophylaxis.
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http://dx.doi.org/10.1515/jpm-2017-0059DOI Listing
May 2018

Fetal programming of the metabolic syndrome.

Taiwan J Obstet Gynecol 2017 Apr;56(2):133-138

Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland.

Prenatal development is currently recognized as a critical period in the etiology of human diseases. This is particularly so when an unfavorable environment interacts with a genetic predisposition. The fetal programming concept suggests that maternal nutritional imbalance and metabolic disturbances may have a persistent and intergenerational effect on the health of offspring and on the risk of diseases such as obesity, diabetes, and cardiovascular diseases.
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http://dx.doi.org/10.1016/j.tjog.2017.01.001DOI Listing
April 2017

Stress experienced by women after premature labor is conditioned by their personality.

Ginekol Pol 2016 ;87(5):353-9

Department of Obstetrics and Perinatology, Medical University of Lublin, Poland.

Objectives: The aim of the study was to analyze a possible correlation between personality traits and the level of stress experienced by women after premature labor.

Material And Methods: The analysis was carried out on the basis of a study conducted in 96 women after premature labor. The following tools were used: Personality Inventory NEO-FFI, Parental Stressor Scale: NICU (SSR:OITN), and personal data questionnaire. It was an exploratory study since the SSR:OITN method is only applied to find out the characteristic features of stress induced by prematurity, and, therefore, it cannot be applied to study the control sample (i.e. women who delivered at term).

Results: The obtained results revealed significant correlations between the level and structure of stress connected with premature labor and personality traits. The general level of stress and all its components (infant's clinical characteristics and medical procedures, personal and interpersonal problems as well as parental competence) correlated positively with Neuroticism. Negative correlations between the general level of stress together with its parental competence factor and Extraversion and Openness to experience were found. Agreeableness correlated negatively with parental competence stress. No correlation between the level of stress and Conscientiousness was observed.

Conclusions: Our findings shed new light on how women after premature labor experience stress, and suggested an ef-fective medical-psychological-therapeutic support aiming at reducing the level of trauma. The SSR:OITN Scale is proposed as one of the basic methods used to diagnose difficulties experienced by the investigated women.
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http://dx.doi.org/10.5603/GP.2016.0004DOI Listing
July 2018

Intercellular Adhesion Molecule and Endogenous NOS Inhibitor: Asymmetric Dimethylarginine in Pregnant Women with Gestational Diabetes Mellitus.

J Diabetes Res 2016 11;2016:1342643. Epub 2016 Feb 11.

Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland.

Objective: The aim of the study was to evaluate the concentrations of soluble intercellular adhesion molecule-1 (s-ICAM-1) and endogenous NOS inhibitor, asymmetric dimethylarginine (ADMA), as markers of endothelium dysfunction in patients with gestational diabetes mellitus (GDM).

Patients And Methods: The levels of s-ICAM-1 and ADMA were analysed in the group of 56 patients with GDM and compared to 25 healthy pregnant women. The concentrations of s-ICAM-1 and ADMA were measured in serum using ELISA tests.

Results: The groups did not differ by baseline descriptors: age (30.75 ± 6.32 versus 28.50 ± 4.95 years, NS) and gestational age (28.96 ± 2.85 versus 29.12 ± 2.96 hbd, NS). The patients with GDM were more obese (BMI 27.93 ± 7.02 versus 22.34 ± 4.21 kg/m(2), p = 0.032) and had higher concentration of C-reactive protein (6.46 ± 6.03 versus 3.18 ± 3.83 mg/L, p = 0.029). In the GDM group the level of ADMA was lower (0.38 ± 0.17 versus 0.60 ± 0.28 μmol/L, p = 0.001) and the level of s-ICAM-1 was significantly higher (289.95 ± 118.12 versus 232.56 ± 43.31 ng/mL, p = 0.036) compared to controls.

Conclusions: The pregnant women with GDM are characterized by higher concentration of s-ICAM-1 that reflects the activation and dysfunction of the endothelial cells. The decreased ADMA level in GDM patients seems to be preventive in the limitation of NO synthesis caused by the impaired insulin action and the endothelial dysfunction.
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http://dx.doi.org/10.1155/2016/1342643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766337PMC
December 2016

Intra-uterine Growth Retardation as a Risk Factor of Postnatal Metabolic Disorders.

Curr Pharm Biotechnol 2016;17(7):587-96

Department of Obstetrics and Perinatology, Medical University of Lublin, Poland.

Intra-uterine growth retardation (IUGR) represents one of the major problems in perinatal medicine. IUGR is one of main causes of perinatal mortality and morbidity. A huge number and variety of established and possible causes of IUGR have been described. There are currently no data about effective treatment of this fetal condition. IUGR has been described to be strictly involved in fetal programming. Fetal programming is the general idea, which tells us how during development of the embryo and fetus significant physiological parameters can be shaped by environmental events. A link between the intra-uterine growth retardation and the risk of developing type 2 diabetes, obesity and cardiovascular disease postnatally has been well documented. The aim of this paper is to present an overview of the current knowledge of IUGR effects on development of hypertension and cardiovascular diseases, impact on insulin secretion and resistance, diabetes mellitus and metabolic syndrome. The influence of intrauterine growth retardation on predisposition to obesity and adipose dysfunction was also described.
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http://dx.doi.org/10.2174/1389201017666160301104323DOI Listing
December 2016

Effect of Docosahexaenoic Acid on Apoptosis and Proliferation in the Placenta: Preliminary Report.

Biomed Res Int 2015 3;2015:482875. Epub 2015 Aug 3.

Department of Obstetrics and Gynecology, Medical University of Lublin, Jaczewskiego 8 Street, 20-954 Lublin, Poland.

Introduction: Observational studies confirm a higher incidence of preeclampsia in patients with low erythrocyte concentrations of omega-3 fatty acids. Observations point to an association of disorders of pregnancy, such as intrauterine growth restriction (IUGR) and preeclampsia, with excessive apoptosis. One potential mechanism of action of docosahexaenoic acid (DHA) promoting a reduction in the risk of pathological pregnancy may be by influencing these processes in the placenta.

Materials And Methods: We investigated 28 pregnant women supplemented with a fish oil product containing 300 mg DHA starting from pregnancy week 20 until delivery (DHA group). The control group consisted of 50 women who did not receive such supplementation (control group). We determined the expression of Ki-67 and p21 as markers of proliferation and caspase 3 activity as a marker of apoptosis and DHA levels in umbilical cord blood.

Results: Caspase 3 activity was significantly lower in the DHA group in comparison to the control group. Umbilical cord blood DHA concentration was higher in the DHA group. The expression of the proteins p21 and Ki-67 did not differ significantly between the groups.

Conclusions: We observed an association between DHA supplementation and inhibition of placental apoptosis. We did not find an association between DHA and proliferation process in the placenta.
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http://dx.doi.org/10.1155/2015/482875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538367PMC
May 2016