• Mass Spectrometry Letters
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• v.13 no.1
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• pp.11-19
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• 2022

Although translational research is referred to clinical chemistry measures, correct weighting factors for linear and quadratic calibration curves with least-squares regression algorithm have not been carefully considered in bioanalytical assays yet. The objective of this study was to identify steroidogenic roles in preeclampsia and verify accuracy of quantitative results by comparing two different linear regression models with weighting factor of 1 and 1/x². A liquid chromatography-mass spectrometry (LC-MS)-based adrenal steroid assay was conducted to reveal metabolic signatures of preeclampsia in both serum and placenta samples obtained 15 preeclamptic patients and 17 age-matched control pregnant women (33.9 ± 4.2 vs. 32.8 ± 5.6 yr, respectively) at 34~36 gestational weeks. Percent biases in the unweighted model (w_i = 1) were inversely proportional to concentrations (-739.4 ~ 852.9%) while those of weighted regression (w_i = 1/x²) were < 18% for all variables. The optimized LC-MS combined with the weighted linear regression resulted in significantly increased maternal serum levels of pregnenolone, 21-deoxycortisol, and tetrahydrocortisone (P < 0.05 for all) in preeclampsia. Serum metabolic ratio of (tetrahydrocortisol + allo-tetrahydrocortisol) / tetrahydrocortisone indicating 11β-hydroxysteroid dehydrogenase type 2 was decreased (P < 0.005) in patients. In placenta, local concentrations of androstenedione were changed while its metabolic ratio to 17α-hydroxyprogesterone responsible for 17,20-lyase activity was significantly decreased in patients (P = 0.002). The current bioanalytical LC-MS assay with corrected weighting factor of 1/x² may provide reliable and accurate quantitative outcomes, suggesting altered steroidogenesis in preeclampsia patients at late gestational weeks in the third trimester.

• Journal of Preventive Medicine and Public Health
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• v.56 no.2
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• pp.190-195
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• 2023

Objectives: Pregnancy complications, including pre-eclampsia, gestational diabetes (GDM), and perinatal mood and anxiety disorders (PMADs), impact long-term health. We compared the frequency of screening documentation for pregnancy complications versus a general medical history at well woman visits between providers in primary care and obstetrics and gynecology. Methods: We conducted a retrospective cohort study of subjects with at least 1 prior birth who presented for a well woman visit in 2019-2020. Charts were reviewed for documentation of a general medical history (hypertension, diabetes, and mood disorders) versus screening for comparable obstetric complications (pre-eclampsia, GDM, and PMADs). The results were compared using the McNemar and chi-square tests as appropriate. Results: In total, 472 encounters were identified, and 137 met the inclusion criteria. Across specialties, clinicians were significantly more likely to document general medical conditions than pregnancy complications, including hypertensive disorders (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.18 to 5.48), diabetes (OR, 7.67; 95% CI, 3.27 to 22.0), and mood disorders (OR, 10.5; 95% CI, 3.81 to 40.3). Obstetrics and gynecology providers were more likely to document any pregnancy history (OR, 4.50; 95% CI, 1.24 to 16.27); however, they were not significantly more likely to screen for relevant obstetric complications (OR, 2.49; 95% CI, 0.90 to 6.89). Overall, the rate of pregnancy complication documentation was low in primary care and obstetrics and gynecology clinics (8.8 and 19.0%, respectively). Conclusions: Obstetrics and gynecology providers more frequently documented a pregnancy history than those in primary care; however, the rate was low across specialties, and providers reported screening for clinically relevant complications less frequently than for general medical conditions.

• Clinical Nutrition Research
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• v.12 no.2
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• pp.116-125
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• 2023

The present study sought to examine the association between an infant's anthropometric outcomes with maternal Dietary Inflammatory Index (DII) and Alternate Healthy Eating Index for Pregnancy (AHEI-P) scores during the third trimester of pregnancy. This prospective cohort study was applying 130 pregnant women, at the pregnancy training center in west Tehran, Iran (November 2020 to July 2021). The maternal dietary intake, and body mass index (BMI), and social economic level were evaluated. The data about birth weight, birth height, head circumference, and, gestational age at birth were extracted from each child's health records. The ultimate sample included 122 (93.8%) pairs of women/newborn children. The participants, mean age was 28.13 ± 4.66 years with gestational age between 28 to 40 weeks and the mean of BMI was 24.62 ± 3.51. Our outcomes, after adjustment for confounding factors, suggested that those newborn infants in the highest quartile of maternal DII score had a significantly lower weight (p < 0.001) and height (p = 0.05), in comparison to those in the lowest quartile, but not head circumference (p = 0.18). Moreover, after adjustment for confounding factors, results suggested that those newborn infants in the First quartile of maternal AHEI-P score had a significantly lower weight (p = 0.018) and, in comparison to those in the higher quartile. It appears that newborn infants with lower maternal DII and higher AHEI-P scores may have a better anthropometric outcome. Further longitudinal and in-depth qualitative and quantitative studies, with a longer-term follow-up, is warranted to support the integrity of our outcomes.

• Women's Health Nursing
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• v.29 no.4
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• pp.274-290
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• 2023

Purpose: This study investigated the effects of prenatal education characteristics, pandemic-related pregnancy stress, and health behaviors during pregnancy on prenatal depression in pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The participants were 180 pregnant Korean women, recruited from internet communities for pregnancy preparation, childbirth, and childcare, from July 5 to 15, 2022. The collected data were analyzed using the t-test, analysis of variance, the Mann-Whitney U-test, the Kruskal-Wallis test, and multiple regression analysis. Results: The scores for pandemic-related pregnancy stress (24.50±6.37) and health behaviors during pregnancy (67.07±9.20) were high. Nearly half of the participants (n=89, 49.4%) presented with prenatal depression, with scores of 10 or greater. Prenatal depression had a positive correlation with gestational age (r=.18, p=.019) and pandemic-related pregnancy stress (r=.27, p<.001), and a negative correlation with health behaviors during pregnancy (r=-.42, p<.001). The factors associated with prenatal depression were pandemic-related pregnancy stress (t=4.70, p<.001), marital satisfaction (dissatisfied) (t=3.66, p<.001), pregnancy healthcare practice behaviors (t=-3.31, p=.001), family type (weekend couple) (t=2.84, p=.005), and gestational age (t=2.32, p=.022). The explanatory power of these variables was 38.2%. Conclusion: Since participants had a high level of prenatal depression during the pandemic, and infectious diseases such as COVID-19 may recur, strategies should be developed to improve pregnant women's mental health with consideration of the unique variables that are relevant in a pandemic. It is also necessary to develop efficient online prenatal education programs that can be implemented even in special circumstances such as social distancing, and to evaluate their effectiveness.

• Journal of Cardiovascular Imaging
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• v.30 no.2
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• pp.112-122
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• 2022

BACKGROUND: Few studies have utilized right atrial (RA) strain to evaluate right ventricular (RV) diastolic dysfunction in preterm infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the associations of RA strain with BPD severity and respiratory outcomes in preterm infants with BPD. METHODS: We retrospectively studied 153 infants with BPD born before 32 weeks of gestational age at CHA Bundang Medical Center. Peak longitudinal right atrial strain (PLRAS) was obtained using velocity vector imaging and compared among infants across BPD severity. Conventional echocardiographic parameters and clinical characteristics were also evaluated. RESULTS: In infants with severe BPD, mean gestational age (27.4 ± 2.1 weeks) and mean birth weight (971.3 ± 305.8 g) were significantly smaller than in those with mild BPD (30.0 ± 0.9 weeks, 1,237.3 ± 132.2 g) and moderate BPD (29.6 ± 1.3 weeks, 1,203.2 ± 214.4 g). PLRAS was significantly lower in infants with severe BPD (26.3 ± 10.1%) than in those in the moderate BPD group (32.4 ± 10.9%) or mild BPD group (31.9 ± 8.3%). Tricuspid E/e' and maximum RA volume index were similar across BPD severity. A decrease in PLRAS was significantly correlated with increased duration of mechanical ventilation duration; however, tricuspid E/e' and maximum RA volume index were not. CONCLUSIONS: Evaluating PLRAS with other parameters in infants with BPD might detect RV diastolic dysfunction. Longer follow-up and larger study populations may elucidate the association between PLRAS and respiratory outcomes in infants with BPD.

• Clinical and Experimental Pediatrics
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• v.52 no.11
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• pp.1228-1233
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• 2009

Purpose : This study aimed to evaluate whether a shorter time from the arrival at a hospital to delivery is related to the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age. Methods : We studied 142 newborns of less than 34 weeks of gestational age. The time from the arrival at the hospital to delivery was measured. The correlation between the time required for delivery and the occurrence of cerebral palsy was elucidated by diagnosing cerebral palsy in neonates using the Korean Infant Development Screening Test and neurological examination. Results : Preliminary result suggested that a shorter time from hospital arrival to delivery was related to a lower development score for gross motor activity and to a higher frequency of cerebral palsy occurrence. Moreover, it was responsible for a tendency of obtaining lower Apgar scores at 1 and 5 minutes. The shorter delivery time was associated with a higher probability of respiratory distress syndrome (RDS) occurrence when the length of delivery time was less than 6 hours and there was a higher probability of a shorter gestation period. However, the multifactor analysis revealed that there was little impact of delivery time on the occurrence of cerebral palsy. Conclusions : The length of hospital arrival time to delivery did not significantly influence the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.722-728
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• 2008

Purpose : This study was designed to examine the effects of adiponectin, leptin, insulin, insulin-like growth factor (IGF)-I and IGF binding protein (BP)-3 levels in cord blood on weight, length, and adiposity at birth in healthy term infants. In addition, we evaluated the mechanism to change the hormone levels in appropriate for gestational age (AGA) during the first month. Methods : We collected cord blood from 200 term neonates (109 males, 91 females) with no perinatal problems, and measured the hormone levels and anthropometric parameters including weight, length, and skin-fold thickness. Term neonates were divided into 3 groups as follows: birth weight appropriate for gestational age (AGA) (n=132), birth weight less for gestational age (SGA) (n=29), and birth weight more for gestational age (LGA) (n=39). Venous blood samples of 15 fullterm healthy neonates were obtained at 3, 7, and 30 d after birth. Results : The adiponectin, insulin, and IGF-I levels were significantly lower in the SGA group than in the AGA and LGA groups. The leptin levels were significantly higher in the LGA group than in the AGA and SGA groups. Cord blood adiponectin, leptin, insulin, IGF-I, and IGFBP-3 levels correlated significantly and positively with birth weight and the sum of the skin-fold thickness. A significant positive correlation was observed between adiponectin, leptin, and IGF-I levels and birth weight. Adiponectin level correlated significantly with that leptin level (r=0.191, P=0.038), but not with insulin, IGF-I and IGFBP-3 levels. IGF-I levels were higher in females than in males. At 7 d after birth, the leptin level decreased along with physiologic weight loss, and then increased. IGF-I, also decreased at 3 d, significantly increased 1 month later. Conclusion : We suggest that adiponectin, leptin, insulin, IGF-I, and IGFBP-3 play an important role in regulating fetal growth. Adiponectin may be involved in regulating fetal growth through mechanisms different from those mediated by insulin or IGF-I. High levels of IGF-I in female neonates indicates a gender difference which serves as evidence for in utero sexual dimorphism. It is likely that IGF-I has a more important role than that of hormones in postnatal growth.

• Clinical and Experimental Pediatrics
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• v.49 no.1
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• pp.93-98
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• 2006

Purpose : Ghrelin stimulates the secretion of growth hormone and other pituitary hormones, and has orexigenic effects. It may have a physiologic role in fetal and neonatal growth. Leptin secreted by the adipocytes reflects fat mass in infants as well as adults. The aim of this study was to evaluate the relation of cord blood ghrelin and leptin levels to body weight(BW), body mass index(BMI), insulin-like growth factor-I(IGF-I) and insulin-like growth factor binding protein-3(IGFBP-3) levels in appropriate for gestational age(AGA) newborns. Methods : Sixty healthy AGA newborns(31 males and 29 females, gestational age[GA] 34-42 weeks) were included in this study, whose BW and BMI were measured at delivery. Umbilical cord venous blood samples were withdrawn, and ghrelin and leptin were measured by radioimmunoassay. Cord blood IGF-I and IGFBP-3 were determined by immunoradiometric assay. Results : The mean levels of ghrelin were inversely correlated with BW(r=-0.29, P<0.05) and GA (r=-0.28, P<0.05), but were not affected by gender. The mean levels of leptin levels showed positive correlation with BW(r=0.44, P<0.01), GA(r=0.36, P<0.01), and BMI(r=0.28, P<0.05). The leptin levels of females were higher than those of males. There was no gender difference in leptin levels in neonates under GA 37 weeks. However, the leptin levels of females were higher than those of males (P<0.01) in newborns with GA 37 weeks or over. There was no correlation between ghrelin and leptin levels. Ghrelin and leptin levels showed no relations to cord blood IGF-I and IGFBP-3 levels. Conclusion : These data suggest that cord blood ghrelin may have an inverse correlation with BW in AGA newborns, and leptin levels are positively correlated with BW and fat mass. Further study of ghrelin concentrations in cord blood is necessary to elucidate the physiological and pathological roles of ghrelin during the fetal and neonatal periods.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.312-316
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• 2006

Purpose : Growth hormone(GH) has been recognized as an effective treatment for short children born small for their gestational ages(SGA), and nowadays it has been widely used for the treatment of short children born SGA. The aim of this study is to assess the efficacy of GH treatment for the children born SGA. Methods : The study population was made of 40 short children born SGA with GH-treated(n=26) and untreated control group(n=14). In order to evaluate the effect of GH treatment, the changes in standard deviation scores(SDS) of the GH-treated group were compared to the changes in SDS before and after treatment from the control group in the same period. Results : There were no differences between the GH-treated group and the control group in gestational age, birth weight, chronological age, target height and the period of follow-up observation; however, the GH-treated group had lower height SDS($-3.3{\pm}0.9$) than the control group($-2.4{\pm}0.4$) before treatment(P<0.05). The GH-treated group had gained $1.2{\pm}1.0$ height SDS during GH treatment while the control group had gained $0.5{\pm}0.6$ height SDS. In the GH treatment group, HDL-cholesterol increased from $48.5{\pm}9.9mg/dL$ to $56.1{\pm}8.7mg/dL$(P<0.05) and LDL-cholesterol decreased from $88.1{\pm}23.3mg/dL$ to $76.4{\pm}19.4mg/dL$(P<0.05) after treatment. There were no changes in total cholesterol, triglyceride, free fatty acid and fasting blood sugar. IGF-I increased from $224.9{\pm}191.3{\mu}g/L$ to $443.2{\pm}152.5{\mu}g/L$(P<0.05) and IGFBP-3 also increased from $3.7{\pm}1.3mg/L$ to $5.6{\pm}1.2mg/L$(P<0.05). Conclusion : We conclude that growth hormone treatment is effective in the treatment of short children born SGA.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.1
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• pp.18-23
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• 2016

Objective: Newborn screening leads to improved treatment and disease outcomes, but false-positive newborn screening results may impact include parental stress and anxiety, perception of child as unhealthy, parent-child relationship dysfunction, and increased infant hospitalizations. The purpose of this study was to investigate of the false positive rates and the causative factors of false positive results in Tandem Mass Spectrometry (TMS) in single center. Methods: Records were reviewed for all 18,872 subjects who were born in Cheill General Hospital, during January 1st, 2012 to December 31st, 2014. 17,292 neonates (91.62%) were tested for tandem mass screening almost in 2-5th day of life. Newborn babies whose first results were abnormal had been tested repeatedly by same methods in 7-14 day. If the results were abnormal again, further evaluation was performed. TMS analysis included data for the 43 disorders screened for using TMS broken down into three categories: fatty acid oxidation disorders, organic acidurias, and aminoacidopathies. The impact of several factors on increased false positive rates was analyzed using a multivariate analysis: time from birth to sample collection, birth weight, birth height, BMI, gender, gestational age, delivery type. Results: Males of the subjects were 8942 (51.7%), female 8350 (48.3%), the mean gestational age was $38.6{\pm}1.7$ weeks, the average birth weight $3,155.6{\pm}502.4g$, the average birth height $49.1{\pm}2.9cm$, and the average BMI $13.0{\pm}3.8(kg/m^2)$. Vaginal delivery cases were 9713 (56.2%), caesarean section 7,579 (43.8%). The average date of the inspection was $2.8{\pm}1.1$ days. 224 cases were identified as TMS positive. All the subjects were false positive (222/17,292, 1.30%) except 2 cases (1 male; benign phenylketonuria and 1 female; Short chain acyl-CoA dehydrogenase deficiency). The false positive rates were 0.61% in fatty acid oxidation disorders, 0.25% in organic acidurias, and 0.45% in aminoacidopathies. In our study, the date of inspection got late, the false positive rates got higher. Because almost the cases of late test date were in treatment in neonatal intensive care unit so their test date was affected by their medical conditions. False positive rate was higher in extreme immaturity${\leq}27$ weeks than newborns of gestational age >27 weeks [OR=6.957 (CI=1.273-38.008), p<0.025] and extremely low birth weight<1,000 g than newborns of birthweight ${\geq}1,000g$ [OR=5.616 (CI=1.134-27.820), p<0.035]. Conclusion: False positive rate of TMS was 1.30% in Cheil General Hospital. Lower gestational age and birth weight impacted on increased false positive rates. Better understanding of factors that influence the reporting of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting. of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting.