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    Association between fetal fraction of cell-free DNA and adverse pregnancy outcomes
    (Springer Heidelberg, 2024) Golbasi, Hakan; Bayraktar, Burak; Golbasi, Ceren; Omeroglu, Ibrahim; Adiyaman, Duygu; Alkan, Kaan Okan; Ozdemir, Taha Resid
    Purpose To determine the association between fetal fraction (FF) levels in cell-free fetal DNA (cffDNA) testing and adverse pregnancy outcomes. Methods This retrospective cohort study, conducted at a single center, involved 2063 pregnant women with normal 1st and 2nd trimester non-invasive prenatal test (NIPT) results between 2016 and 2021. Pregnancy outcomes were examined by determining the < 4% and < 5th percentile (3.6%) cut-off values for low fetal fraction (LFF). Pregnancy outcomes were also examined by dividing the FF into population-based quartiles. Adverse pregnancy outcomes were pregnancy-induced hypertensive diseases (PIHD), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), intrahepatic cholestasis of pregnancy (ICP), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, and 1st and 5th minutes low APGAR scores (< 7). Results PIHD was significantly higher in LFF (< 4% and < 5th percentile) cases (p = 0.015 and p < 0.001, respectively). However, in population-based quartiles of FF, PIHD did not differ significantly between groups. Composite adverse maternal outcomes were significantly higher in the FF < 4% group (p = 0.042). When analyzes were adjusted for maternal age, BMI, and gestational age at NIPT, significance was maintained at < 4%, < 5th percentile LFF for PIHD, and < 4% LFF for composite adverse maternal outcomes. However, there was no significant relationship between LFF with GDM, ICP and PTB. Additionally, there was no significant association between low APGAR scores, SGA, LGA, LBW, macrosomia, and LFF concerning neonatal outcomes. Conclusion Our study showed that LFF in pregnant women with normal NIPT results may be a predictor of subsequent PIHD.
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    Blood-Based Clinical Biomarkers of Inflammation and Nutrition in Hyperemesis Gravidarum
    (MDPI, 2024) Cendek, Busra Demir; Bayraktar, Burak; Seyhanli, Zeynep; Kocyildiz, Ezgi; Golbasi, Hakan; Ibanoglu, Mujde Can; Ustun, Yaprak Engin
    Background: In this study, the aim was to investigate blood-based clinical biomarkers of inflammation and nutrition indices in hyperemesis gravidarum (HG). Methods: This retrospective case-control study was conducted at a tertiary hospital between 2018 and 2022. A total of 820 pregnant women were enrolled in this study; 410 pregnant women were diagnosed with HG (HG group) at 6-14 weeks of gestation, and 410 pregnant women were healthy controls (control group) in the same gestational weeks. Patients' demographic and clinical characteristics and laboratory parameters were recorded. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, the modified-HALP (m-HALP) score, and the prognostic nutritional index (PNI) were calculated. Results: The HALP score (32.6 (IQR: 24.9-41.5) vs. 39.2 (IQR: 30.8-49.2), p < 0.001) and the PNI score (50 (IQR: 46.3-53.6) vs. 51.3 (IQR: 48.6-53.8), p < 0.001) were significantly lower in the HG group, whereas the m-HALP score was similar between the groups. The HALP score had an AUC of 0.625 (95% CI: 0.586-0.664), with the optimal cut-off value set at 35.8, resulting in a sensitivity of 59.7% and a specificity of 59.5% (p < 0.001). Similarly, the PNI score showed an AUC of 0.580 (95% CI: 0.541-0.619), and the optimal cut-off value was set at 50.6, resulting in a sensitivity of 54.9% and a specificity of 54.9% (p < 0.001). In regression analysis, lower HALP scores (OR: 0.906, 95% CI: 0.833-0.984, p = 0.019) and lower PNI scores (OR: 0.941, 95% CI: 0.891-0.995, p = 0.033) were significantly associated with HG, highlighting their potential as diagnostic markers. Additionally, a negative statistically significant correlation was observed between PNI scores and ketonuria (r = -0.073, p = 0.036). Conclusions: This study demonstrated a decrease in the HALP score and PNI score in cases of HG. However, the m-HALP score was similar in the HG and control groups.
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    Could magnetic resonance imaging contribute to detecting isolated fetal ventriculomegaly other than additional abnormalities?
    (Soc Peruana Obstetricia & Ginecologia, 2023) Omeroglu, Ibrahim; Golbasi, Hakan; Sever, Baris; Golbasi, Ceren; Oztekin, Deniz; Oztekin, Ozgur; Ekin, Atalay
    Objective: To assess the role of brain magnetic resonance imaging (MRI) in fetuses presenting with isolated ventriculomegaly (IVM) in the ultrasound (US) evaluation of the fetal brain. Methods: US and MRI findings of 197 fetuses diagnosed with IVM between November 2018 and November 2020 were retrospectively evaluated. Fetuses with abnormal karyotypes, additional anomalies, or known etiologies for ventriculomegaly were excluded. US and MRI findings were compared both in terms of mean ventricular measurements and IVM grade. Results: MRI measurements were significantly higher in mild IMV (10.33 +/- 0.38 mm vs. 11.11 +/- 0.51 mm, p< 0.001) compared to US. In mild IVM, MRI measured ventricles larger than US with a mean difference of 0.78 mm. There was no significant difference in US and MRI measurements in terms of mean values in moderate and severe IVM. There was good agreement between US and MRI in detecting right, left and mean IVM severity (Kappa=0.265, Kappa=0.324, and Kappa=0.261, respectively). Linear regression analyses revealed a statistically significant relationship between US and MRI measurements of the right, left, and mean IVM (p<0.001, p<0.001, and p<0.001, respectively). MRI showed perfect agreement with US in detecting IVM laterality (Kappa=1.0, p<0.001). Conclusions: In fetuses with mild IVM detected by US, fetal brain MRI evaluation should be considered for accurate diagnosis. This approach may provide effective strategies in the antenatal management and counseling of these pregnancies.
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    The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study
    (Elsevier Masson, Corp Off, 2023) Ileri, Alper; Karaca, Suna Yildirim; Ileri, Hande; Karaca, Ibrahim; Golbasi, Hakan; Ozer, Mehmet; Budak, Adnan
    Aim: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage.Methods: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) >= 25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records.Results: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351).Conclusions: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.
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    Evaluation of placenta and fetal lung using shear wave elastography in gestational diabetes mellitus: An innovative approach
    (Georg Thieme Verlag Kg, 2024) Bayraktar, Burak; Golbasi, Hakan; Omeroglu, Ibrahim; Golbasi, Ceren; Can, Sevim Tuncer; Ince, Onur; Bayraktar, Miyase Gizem
    Purpose This study aims to investigate placental and fetal lung stiffness in pregnant women with and without gestational diabetes, considering the well-established delay in fetal lung maturation associated with gestational diabetes. Materials and Methods This prospective cohort study was conducted at a tertiary center and included pregnant women who underwent a 75-gram oral glucose tolerance test between 24-28 weeks of gestation. Elastography measurements were performed using point shear wave elastography (pSWE). Results The study included 60 pregnant women diagnosed with gestational diabetes and 60 pregnant women in the control group. The SWE velocity of the peripheral placenta, central placenta, and lung was higher in the gestational diabetes group compared to the control group. Furthermore, the SWE velocity of the peripheral placenta, central placenta, and lung was higher in newborns with neonatal respiratory morbidity. Based on the ROC analysis of patients with gestational diabetes, the AUC for lung SWE velocity was 0.88 (cut-off 12.4 kPa, 95% CI: 0.77-0.99, p<0.001) with a sensitivity of 71.4% and specificity of 95.6% for predicting neonatal respiratory morbidity. Conclusion Fetal placental and lung stiffness increase in fetuses of pregnant women with diabetes. Moreover, higher fetal lung stiffness during the fetal period is associated with increased neonatal respiratory morbidity.
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    Prediction of gestational diabetes mellitus and perinatal outcomes by plasma zonulin levels
    (Springer Heidelberg, 2022) Oral, Serkan; Celik, Sebahattin; Akpak, Yasam Kemal; Golbasi, Hakan; Bayraktar, Burak; Unver, Gokhan; Sahin, Sami
    Purpose Zonulin has been shown to be associated with many metabolic disorders, including type 2 diabetes mellitus, metabolic syndrome, and obesity. In this study, we aimed to evaluate the association between maternal plasma zonulin levels and gestational diabetes mellitus (GDM) and its perinatal outcomes. Materials A total of 100 pregnant women, 56 with GDM and 44 controls, were included in this prospective case-control study. Maternal plasma zonulin levels were evaluated in each trimester. The association between zonulin levels and GDM, body mass index (BMI) and adverse perinatal outcomes was evaluated. The GDM predictability of zonulin levels for each trimester was analyzed with the receiver operator curve (ROC). Results Plasma zonulin levels were significantly higher in pregnant with GDM in all trimesters (p < 0.001; for all). Optimum cut-off values of plasma zonulin levels in predicting GDM: first trimester: 6.27 ng/mL, second trimester: 12.71 ng/mL, and third trimester: 18.38 ng/mL. BMI was significantly higher in pregnant women with GDM (30.5 vs 26.1; p < 0.001). Zonulin levels were significantly higher in pregnant women with GDM with overweight BMI [>= 25-30 (kg/m(2))] in all trimesters (p < 0.05; for all). Zonulin levels were significantly higher in pregnant women with composite adverse outcomes that included at least one of neonatal intensive care unit (NICU) admission, meconium-stained amniotic fluid, and 1st minute APGAR score < 7. Conclusion Increased maternal plasma zonulin levels were associated with increased risk of GDM and adverse perinatal outcomes. Zonulin may be a potential marker to predict GDM risk and perinatal outcomes.
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    Splenic Artery Doppler Waveforms in Gestational Diabetes and Association with Fetal Pancreas: A Prospective Case-Control Study
    (Karger, 2024) Golbasi, Hakan; Bayraktar, Burak; Golbasi, Ceren; Omeroglu, Ibrahim; Cakir, Zubeyde Emiralioglu; Can, Sevim Tuncer; Pehlivanoglu, Osman Caglar
    Introduction: This study evaluated fetal pancreas size and echogenicity, and splenic artery (SA) waveforms in pregnant women with gestational diabetes mellitus (GDM). Methods: This prospective case-control study was performed from October 2022 to November 2023 and included 124 pregnant women (62 with GDM and 62 controls). Pancreatic circumference, pancreatic echogenicity, umbilical artery Doppler measurements (systolic/diastolic ratio [S/D] and pulsatility index [PI]), SA Doppler measurements (S/D, PI, peak systolic velocity [PSV], time-averaged maximum velocity, and pressure gradient [PG] mean and maximum) values were compared between the GDM and control groups. Results: The mean pancreatic circumference was higher and grade 2/3 echogenicity was more common in the GDM group, while grade 1 echogenicity was more common in the control group (p < 0.001 and p < 0.001, respectively). SA S/D and PI measurements were significantly higher in the GDM group than in the control group (p < 0.001 and p = 0.001, respectively). Moreover, PG(max) was significantly higher in the GDM group than in the control group (p = 0.038). Pancreatic circumference was positively correlated with SA PSV (p = 0.004). Additionally, pancreatic circumference was positively correlated with PG(mean) and PG(max) (p = 0.010 and p = 0.016, respectively). The increase in pancreas echogenicity was positively correlated with SA S/D and PI measurements (p = 0.007 and p = 0.002, respectively). PG(max) was also positively correlated with increased pancreas echogenicity (p = 0.023). Conclusion: This study showed that fetal pancreas size and echogenicity were significantly higher in pregnant women with GDM than in controls. SA Doppler waveforms were consistent with an increase in vascular resistance associated with elevations of both S/D and PI in the GDM group.
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    Third-trimester fetal pancreas imaging in uncomplicated pregnancies and association with pregnancy outcomes
    (Wiley, 2024) Golbasi, Hakan; Bayraktar, Burak; Golbasi, Ceren; Omeroglu, Ibrahim; Atakul, Bahar Konuralp; Cakir, Zubeyde Emiralioglu; Toka, Ilknur Gumus
    Objective: To examine third-trimester sonographic imaging of the fetal pancreas in uncomplicated pregnancies and its association with pregnancy outcomes. Methods: This was a prospective cohort study including 274 pregnant women. Uncomplicated pregnancies in the third trimester (28-40 weeks) were included in the study. Maternal chronic disease, pregnancy-related disorders such as hypertension, diabetes, cholestasis, smoking, and fetal abnormalities were determined as exclusion criteria. Sonographic fetal pancreatic measurement and echogenicity were evaluated in all participants. For intra-observer reliability, each participant's fetal pancreatic circumference was measured two times. The echogenicity of the pancreas was compared with the liver and ribs and classified as grade 1, 2, and 3. The pregnancy outcomes of all participants were obtained from the hospital digital registration system. Results: The average fetal pancreatic circumference in the third trimester was 70.7 +/- 0.6 mm (median, 70 [44-100.7]), with high intra-observer agreement (ICC 0.996 [0.995; 0.997]). A significant positive correlation was found between pancreatic circumference, body mass index (BMI), gestational age, and birth weight. Pancreatic measurements were significantly higher in composite adverse outcomes cases that included at least one of respiratory distress syndrome, hyperbilirubinemia, neonatal pneumonia, infection, and sepsis (p < 0.001). No relationship was found between pancreatic echogenicity and perinatal outcomes. Conclusion: Fetal pancreas size was positively correlated with gestational age, BMI, and birth weight, and increased fetal pancreas size was associated with composite adverse neonatal outcomes.