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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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    Early Initiation and Long-Term Use of Vaginal Progesterone may Cause Gestational Diabetes Mellitus
    (Georg Thieme Verlag Kg, 2022) Oztekin, Deniz; Senkaya, Ayse Rabia; Gunes, Mehmet Emin; Keskin, Omur; Dogdu, Irmak Atci
    Background Preterm birth (PTB) is an important cause of neonatal mortality and morbidity. Spontaneous PTB (sPTB) is the most common cause of PTB. In patients with a singleton pregnancy, progesterone treatment appears to reduce the rate of spontaneous preterm birth in those with a previous history of spontaneous preterm labor and/or cervical shortening in the current pregnancy. Progesterone therapies used for the prevention of sPTB may increase the risk of gestational diabetes mellitus (GDM) towards the end of pregnancy owing to their effects on carbohydrate metabolism. Aim We aimed to show the effects of vaginal progesterone use, starting time, and duration of treatment on GDM. Methods A retrospective cohort study was carried out in pregnant women 18 to 39 years old who came to our hospital between January 1, 2021, and August 31, 2021, and who had a 2- hour 75-g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation. In a total of 540 patients, 68 were diagnosed with GDM based on at least one abnormal plasma glucose value at screening. The remaining 472 patients with normal plasma glucose levels were considered as the control group. The groups were compared in terms of age, parity, pre-pregnancy body mass index (BMI), smoking, gestational age, and vaginal progesterone use. Patients using vaginal progesterone with and without GDM were then compared again in terms of indications for vaginal progesterone use, initiation time of progesterone therapy, duration of progesterone use, and cervical length. Results The incidence of GDM in our study group was 12.5 %. Despite the use of vaginal progesterone at a higher rate in the GDM group than in the control group (23.5 vs. 13.9 %; p = 0.07), it was not statistically significant. When we examined patients using progesterone as a subgroup analysis, the mean time to start vaginal progesterone treatment was 19.8 +/- 2.6 (14-24), and it was significantly earlier in the GDM group (18.1 +/- 2.0 vs. 20.2 +/- 2.6; p = 0.007). Initiation of vaginal progesterone before 20 weeks of gestation was statistically significantly more frequent in the GDM group than the control group (68.8 vs. 39.4 %; p = 0.050 OR :3.3, 95 %CI: 1.0-10.8). The mean duration of vaginal progesterone use was 50.0 +/- 15.6 days (28-90) and it was longer in the GDM group (57.8 +/- 13.4 vs. 48.1 +/- 15.6; p = 0.027). Conclusion Since the duration of vaginal progesterone use will be prolonged, there may be a risk of GDM, especially in patients who started vaginal progesterone before the 20th week of pregnancy. Even if the OGTT test performed between 24-28 weeks is normal, it should be kept in mind that these patients may have GDM in the later weeks of pregnancy, and repeating the OGTT test should be considered if necessary.
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    Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis
    (Elsevier Science Inc, 2023) Motrico, Emma; Bina, Rena; Kassianos, Angelos P.; Le, Huynh-Nhu; Mateus, Vera; Oztekin, Deniz; Rodriguez-Munoz, Maria F.
    Background: To date, dozens of systematic reviews (SRs) and meta-analyses (MAs) summarize the effectiveness of preventive interventions for perinatal depression. However, the results are inconclusive, making an urgent need to step up to higher levels of evidence synthesis.Aims: To summarize and compare the evidence from the SR&MA examining the effectiveness of all types of interventions for preventing perinatal depression.Method: PubMed, PsycINFO, Cochrane Database of Systematic Reviews and OpenGrey were searched from inception to December 2022. We selected SR&MA of randomized controlled trials (RCTs) that compared all types of preventive interventions for perinatal depression with control groups whose outcome was the reduction of depressive symptoms and/or incidence of new cases of perinatal depression (PROSPERO: CRD42020173125).Results: A total of 19 SRs and MAs evaluated 152 unique RCTs that included 83,408 women from 26 countries and five continents. The median effect size for any intervention was SMD = 0.29 (95% CI: 0.20 to 0.38). Ex-ercise/physical activity-based, psychological, and any type of intervention showed median effect sizes of 0.43, 0.28 and 0.36, respectively. The degree of overlap among RCTs was slight. According to AMSTAR-2, 79% of them were rated as low or critically low-quality. The strength of evidence, according to GRADE, was poorly reported and, in most cases, was low.Conclusions: Exercise/physical activity-based and psychological interventions have a small-to-medium effect on reducing perinatal depressive symptoms. There is insufficient evidence to conclude that dietary supplements and pharmacological interventions are effective in preventing perinatal depression. There is a need for high-quality SR&MA of RCTs, mainly focusing on universal preventive interventions.