INTRODUCTION:Gestational diabetes mellitus (GDM) is associated with increased neonatal morbidity in singleton pregnancies, but evidence in multifetal pregnancies is limited. Current diagnostic thresholds are largely extrapolated from singleton data; It remains unclear whether plurality modifies GDM-associated neonatal and long-term offspring outcomes. We wanted to evaluate neonatal complications and long-term offspring healthcare utilization associated with GDM in multifetal versus singleton pregnancies, and to assess effect modification by plurality and the impact of gestational age at delivery. MATERIAL AND METHODS:This multicenter retrospective cohort study utilized electronic medical records across six university-affiliated medical centers in Israel (1/1/2010-6/30/2024). All live births at 22 weeks' gestation or later or with birthweight of >500 g were included. Four exposure groups were defined by plurality and GDM status (ICD-9 code 648.8x): singleton without GDM, singleton with GDM, multifetal without GDM, and multifetal with GDM. Short-term neonatal complications (neonatal hypoglycemia, neonatal ICU admission, respiratory distress, intraventricular hemorrhage, and growth abnormalities) and long-term offspring outcomes were assessed by hospital-based health-care utilization (e.g., neurology, ophthalmology, cardiology). Multivariable Firth logistic and ordinary least squares regression models were adjusted for maternal age, body mass index, parity, and fertility treatment. Additional models adjusted for gestational age were performed. False discovery rate correction and GDM-by-plurality interaction terms were applied. RESULTS:Of 134 517 pregnancies (136 579 live-born offspring) to 104 023 mothers, 10 605 singleton (7.9%) and 256 multifetal (0.2%) pregnancies were complicated by GDM. In multifetal pregnancies, GDM was not associated with increased short-term neonatal complications nor with lower adjusted odds of neonatal hypoglycemia (adjusted odds ratio [aOR], 0.30; 95% CI: 0.18-0.49), neurologic (aOR, 0.37; 95% CI: 0.24-0.59), or ophthalmologic (aOR, 0.49; 95% CI: 0.31-0.77) health-care utilization. Adjustment for gestational age attenuated associations for neonatal intensive care unit admission but did not fully explain interactions for hypoglycemia or selected long-term outcomes. Conversely, GDM in singleton pregnancies was associated with increased neonatal morbidity. CONCLUSIONS:Associations between GDM and neonatal and offspring outcomes differ by plurality. Risk stratification strategies derived from singleton pregnancies may not fully capture risk profiles in multifetal pregnancies.

Background:Preeclampsia (PE), a multisystem and complex disorder diagnosed when maternal hypertension manifests after 20 weeks of gestation with proteinuria, is one of the direct causes of maternal morbidity and mortality, in addition to bleeding and infection. Despite its critical impact, effective preventive dietary interventions are scarce. Oxidative stress and microvascular damage are central to PE pathophysiology. Extra virgin olive oil (EVOO), particularly early harvested EVOO (EVOOEH), is rich in antioxidant compounds and may mitigate these issues. Methods:This randomized, single-masked (investigator and data analysis) interventional pilot study protocol will enroll 156 high-risk pregnant women (8 to 16 weeks of gestation) at Barzilai University Medical Center. Participants will be allocated to two parallel arms: the EVOOEH arm (n=78), receiving 42 mL/day (three tablespoons) of EVOOEH in addition to general Ministry of Health (MOH) dietary recommendations for 4 weeks; and the Control arm (n=78), receiving MOH dietary recommendations only. Low-dose aspirin prophylaxis will be co-administered, if indicated. Adherence will be monitored via phone calls and assessment of maternal whole blood and plasma hydroxytyrosol (HT) at recruitment and approximately four weeks post-intervention initiation. Primary outcomes are incidence of gestational diabetes mellitus (GDM), PE, Cesarean section, preterm birth, and small for gestational age (SGA) newborns. Secondary outcomes include post-intervention maternal 1-hour glucose challenge test (GCT) and serum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF), as well as maternal blood pressure, gestational age at delivery, and newborn percentile. Blood samples will be analyzed for serum 25-hydroxyvitamin D [25(OH)D], sFlt-1/PlGF ratio and HT. Statistical analysis will include use of JMP Pro software, with compared by chi-squared or Fisher's exact tests for categorical variables and Student's t-tests or Wilcoxon rank-sum tests for continuous variables when appropriate. Multivariate analyses will be performed for significant variables. Discussion:This pilot study will provide crucial insights into the potential of EVOOEH as a dietary intervention for reducing PE risk in high-risk pregnancies, addressing a significant gap in current preventive strategies. This protocol study findings can inform larger-scale trials and contribute to evidence-based nutritional recommendations for PE prevention. Trial Registration:This study was registered on ClinicalTrials.gov (NCT06759545).

AIMS:To evaluate the independent and combined associations of gestational diabetes mellitus (GDM) and multifetal gestation with maternal morbidity, particularly hypertensive disorders of pregnancy (HDP). METHODS:We conducted a national multicenter retrospective cohort study from six university-affiliated medical centers (2010-2024) mapped to the OMOP Common Data Model. Pregnancies were categorized as singleton without GDM, singleton with GDM, multifetal without GDM, and multifetal with GDM. Outcomes included HDP, ICP, cesarean delivery, and placental abruption. Multivariable Firth logistic regression adjusted for maternal age, body mass index, parity, and fertility treatment. RESULTS:Among 134,517 pregnancies, HDP rates increased from 4.5% in singleton pregnancies without GDM to 10.2% in singleton pregnancies with GDM, 11.0% in multifetal pregnancies without GDM, and 16.4% in multifetal pregnancies with GDM. GDM was independently associated with HDP (aOR 1.7, 95% CI 1.6-1.8). Multifetal gestation showed stronger associations with HDP (aOR 2.2-2.5) and severe preeclampsia (aOR 3.6). ICP was most frequent in multifetal pregnancies with GDM (aOR 6.5,95% CI 3.5-10.9). No statistically significant interaction between GDM and multifetal gestation was detected for HDP(q = 0.088). CONCLUSION:Both GDM and multifetal gestation were independently associated with maternal morbidity. Multifetal gestation showed stronger associations with hypertensive outcomes, without evidence of interaction between the two exposures.

Background/Objectives: Preterm birth remains a major cause of neonatal morbidity and mortality, and risk stratification in pregnancies with uterine fibroids is limited. This study evaluated whether detailed phenotyping of huge uterine fibroids provides predictive information. Methods: This retrospective single-center study included 192 singleton pregnancies: 64 with a huge uterine fibroid (maximum diameter ≥ 10 cm) and 128 fibroid-free controls. We analyzed the full and fibroid-only cohorts. Machine learning (ML) models were compared across full fibroid-feature, alternative fibroid-feature, non-fibroid, and clinical benchmark configurations. Results: In validation analyses, the alternative fibroid-feature configuration was selected as the best-performing configuration in both cohorts. The best validation models were Random Forest for the full cohort and Logistic Regression for the fibroid-only cohort, achieving F1-scores of 0.67 and 0.80 and areas under the receiver operating characteristic curve (AUCs) of 0.94 and 0.90, respectively. On the held-out test set, models achieved F1-scores of 0.50 and 0.57, with AUCs of 0.82 and 1.00, respectively; uncertainty and calibration remained limited by the very small number of positive events. SHapley Additive exPlanations analysis showed that fibroid-related variables contributed to model output. Conclusions: Detailed fibroid phenotyping may add predictive information beyond clinical variables, but these exploratory findings require further validation in larger cohorts.

Huge uterine fibroids represent a rare but clinically significant complication of pregnancy. This study aimed to evaluate their impact on major obstetric outcomes and to determine whether fibroid type and anatomical location modify these risks. This retrospective observational study (2010-2023) compared 64 singleton pregnancies complicated by a single huge uterine fibroid (maximal diameter ≥ 10 cm) with 128 matched fibroid-free controls. Fibroids were classified sonographically by type and location. Outcomes included mode of delivery, gestational age (GA) at birth, preterm birth (PTB), neonatal birthweight, 5 min Apgar and maternal hemoglobin decline. Multivariable logistic regression was used to identify independent predictors of cesarean delivery (CS). Among 57,200 pregnancies, huge uterine fibroid was identified in approximately 1 in 670 pregnancies (0.15%). These pregnancies were associated with higher rates of CS compared with controls (39.1% vs. 8.6%, P < 0.01), earlier GA (median 38.0 vs. 39.6 weeks, P < 0.01), a markedly increased rate of PTB (29.7% vs. 4.7%, P < 0.01), and greater maternal hemoglobin decline. Within the fibroid cohort, fibroid size relative to the median diameter was not associated with adverse outcomes. In contrast, intramural fibroids were strongly associated with both earlier GA and an increased risk of CS compared with subserosal lesions (adjusted OR 23.79, 95% CI 3.67-534.32, P < 0.01). Fibroids located in the lower uterine segment or cervix were also associated with elevated CS rates. Obstetric risk of pregnancies complicated by a huge solitary fibroid is driven primarily by fibroid type and anatomical location rather than size alone, supporting individualized counseling and delivery planning.

Background/Objectives: Iodine deficiency disorders remain a global public health concern, as acknowledged by the World Health Organization (WHO). Adequate maternal iodine intake during pregnancy is essential for normal fetal development, yet the relationship between maternal iodine status and fetal growth remains controversial. Urinary Iodine Concentration (UIC) is a commonly used marker for assessing iodine status. This study evaluates the association between maternal UIC and neonatal anthropometric parameters. Methods: This prospective single-center cohort study included 202 pregnant women without known or reported thyroid disease, recruited between 2018 and 2021. Maternal iodine status was assessed by UIC from spot urine samples collected at the time of recruitment. Correlations were analyzed between maternal UIC and neonatal anthropometric measures, including birth weight (g), length (cm), and head circumference (cm). Analyses stratified by fetal sex were also performed. Results: No statistically significant association was found between UIC and neonatal anthropometric measures. Analysis of these correlations, stratified by fetal sex, did not reveal any statistically significant associations either. Conclusions: Maternal UIC showed no association with neonatal anthropometric outcomes in this study, regardless of fetal sex. Further research is needed to investigate the additional effects of maternal iodine status in healthy, euthyroid pregnant women on neonatal outcomes.

Childhood obesity and iodine deficiency are prevalent in developed countries and are linked to adverse health outcomes in adulthood. Mild-to-moderate iodine deficiency and insufficient maternal iodine intake during pregnancy may increase the risk of large-for-gestational-age newborns, which are associated with childhood obesity. Despite this, predicting childhood obesity during pregnancy remains a challenge. We assessed and evaluated machine learning algorithms predicting childhood obesity risk using maternal anthropometrics, thyroid function and iodine intake; and identified key prenatal factors contributing to childhood obesity. A diagnostic accuracy study was conducted based on 87 parameters collected from a mother-newborn-offspring prospective cohort (N = 191) in a mild-to-moderate iodine deficiency region. Maternal iodine status and thyroid function, including serum free tri-iodo-thyronine (FT3) concentrations, were assessed during the second half of pregnancy. Iodine intake was evaluated using a semi-quantitative food frequency questionnaire. Anthropometric measurements were obtained from mothers during pregnancy, from newborns at birth, and from children at 2 years of age. An outcome of overweight at 2 years was defined as a gender-adjusted weight percentile >85

Purpose Preeclampsia (PE) is a common complication of pregnancy that carries significant risks for both the mother and the fetus, and is frequently accompanied by hyperuricemia, yet the exact source of elevated uric acid (UA) levels remains partially elucidated. Several potential origins for increased UA levels include abnormal renal function, increased tissue breakdown, and increased activity of the enzyme Xanthine Oxidase (XO). The aim of the study was to determine serum levels of UA and XO not only in maternal serum, but also in umbilical vein (UV) and umbilical artery (UA) and explore their possible role in PE development. Methods A prospective case-control pilot study was conducted in women who were found positive for PE with severe features, and had elevated UA levels above 6 mg/dL, with normotensive pregnant women serving as controls. Renal function, UA and XO levels were measured in maternal, UV and UA serums immediately after delivery. They were then compared between PE (n = 21) and control (n = 18) groups, as well as across all mediums (maternal, UV and UA) among the total study sample (N = 39). Diastolic blood pressure (DBP) was also measured immediately following delivery. Results The mean serum maternal creatinine levels did not differ significantly between groups (0.65 +/- 0.03 vs 0.6 +/- 0.07, p = 0.13). Both mean maternal serum UA and XO concentrations were higher in PE group than in control (7.3 +/- 1.2 vs 4.2 +/- 0.9, p < 0.01 and 3.6 +/- 3.5 Vs 1.7 +/- 0.8, p < 0.01, respectively). The mean UV and UA serum XO concentrations were significantly higher in PE group compared to control (4.2 +/- 3.6 vs 2.2 +/- 1.4, p < 0.01 and 4.2 +/- 3.6 vs 2.1 +/- 1.5, p < 0.01, respectively). Polynomial fit correlation test demonstrated a significant association between maternal DBP and UV XO concentration for all the total study participants (p = 0.03). Conclusion Despite preserved renal functions, UA and XO levels were elevated in women with PE. Importantly, this pattern was found to be applied to the feto-placental unit as well, which may indicate an active involvement of the fetus in the hypoxic process. Further study is needed to clarify the possible role of the feto-placental unit in pregnancies complicated by PE.

Background Diagnosis of umbilical cord entanglement (UCE) by ultrasound (US) in monochorionic monoamniotic (MCMA) twins in the second and third trimesters is common. However, only a few cases have been reported on the diagnosis of UCE as early as the first trimester. Herein, we report a case of the earliest-ever sonographic diagnosis of UCE and demonstrate the feasibility of its diagnosis by US. Case presentation: A 32 y.o. gravida 2 para 1 woman conceived after assisted reproductive technology (ART) treatment. In transvaginal US examination at 8.5 gestational weeks, two embryos with regular heartbeats, in the same amniotic sac and with only one yolk sac, were demonstrated. The fetal crown-rump lengths were 20 and 21 mm, appropriate for 8.4 and 8.5 gestational weeks, respectively. HD-flow power Doppler 2D and 3D US demonstrated two tightly entangled umbilical cords of the two fetuses. Spectral Doppler US showed two different heart rates (162 and 167 beats per minute) and blood flow in opposite directions from the point of entanglement of the two umbilical cords. This was consistent with a diagnosis of a first-trimester MCMA pregnancy with UCE. Missed abortion of the two embryos was diagnosed by US examination at 10.5 weeks, and the pregnancy was terminated by dilatation and curettage without further complications. Conclusions UCE in the first trimester may occur as early as eight gestational weeks, and its diagnosis by ultrasound is feasible. UCE diagnosed in the first trimester may be a poor prognostic factor.

Congenital inguinal hernia (CIH) is a relatively prevalent pathology with a 3-5% incidence in term infants. However, fetal inguinal hernia (FIH) is a rare event, and only a few cases of prenatal diagnosis of the anomaly have been reported. We aim to characterise the sonographic features, clinical presentation, management, and outcome of FIH. We reviewed all cases of FIH published in the medical literature, including one new case evaluated by our group. All 17 cases (100%) were males in which the FIH presented as a scrotal mass of varying size, mean 38 ± 9.8MM. Most cases were diagnosed in the third trimester (88%) at mean gestational age of 33.1 ± 5.3W. The right side was dominant over the left and bilateral FIH (61.5%, 23%, and 15.5% - respectively). Peristalsis was reported in 80% of cases, and the presence of blood flow in two thirds. The ipsilateral testicle was observed in 30% of the cases and the contralateral in 100%. Sixty percent of the cases had isolated FIH, and two had minor malformations. In 3 / 17 cases (18%), the fetuses were syndromic, with multiple malformations: Trisomy 18, skeletal anomalies due to Jarcho-Levin syndrome, and undefined multiple joint contractures. Two cases (12%) had co-pathologies in the gastrointestinal tract; One had an echogenic bowel due to homozygosity to cystic fibrosis, and the other had low anorectal malformation. In both of these and in another isolated case (18%), bowel loop dilatation was observed prenatally. GA at delivery was 37.9 ± 1.8W, and the median time between diagnosis and delivery was 3W. All three cases of neonatal death occurred in syndromic fetuses. All the cases with non-syndromic CIH underwent definitive surgical repair at a median 14 days postpartum. No signs of strangulation and only one case with edematous bowel without necrosis were reported. FIH should be suspected when an intrascrotal mass with peristalsis is diagnosed during the third trimester. Close follow-up until term in the absence of signs of bowel obstruction is reasonable, and in isolated FIH, the prognosis is favourable.

It is unclear how maternal glycemic status and maternal iodine status influence birth weight in mild-to-moderate iodine deficiency (ID). We studied the association between birth weight and both maternal glucose levels and iodine intake in pregnant women with mild-to-moderate ID. Glucose values were assessed using a glucose challenge test (GCT), non-fasting glucose before delivery; iodine status was assessed using an iodine food frequency questionnaire, serum thyroglobulin (Tg) and urinary iodine concentrations (UIC). Thyroid antibodies and free thyroxine (FT4) were measured. Obstetric and an-thropometric data were also collected. Large for gestational age (LGA) was predicted using a Cox proportional hazards model with multiple confounders. Tg>13g/L was in-dependently associated with LGA (adjusted hazard ratio = 3.4, 95% CI: 1.4–10.2, p=0.001). Estimated iodine intake correlated with FT4 among participants reporting io-dine-containing supplements (ICS) after adjusting for confounders (β = 0.4 95 %CI: 0.0002-0.0008, p=0.001). Newborn weight percentiles were inversely correlated with maternal FT4 values (β=-0.2 95 %CI:-0.08 - -56.49, p=0.049). We conclude that in mild-to-moderate ID regions, maternal insufficient iodine status may increase LGA risk. Iodine status and ICS intake may modify the effect maternal dysglycemia has on offspring weight.

It is unclear how maternal glycemic status and maternal iodine status influence birth weight among individuals with mild-to-moderate iodine deficiency (ID). We studied the association between birth weight and both maternal glucose levels and iodine intake among pregnant women with mild-to-moderate ID. Glucose values were assessed using a glucose challenge test (GCT) and non-fasting glucose levels that were determined before delivery; individuals’ iodine statuses were assessed using an iodine food frequency questionnaire; and serum thyroglobulin (Tg) and urinary iodine concentrations (UIC) were used to assess each group’s iodine status. Thyroid antibodies and free thyroxine (FT4) levels were measured. Obstetric and anthropometric data were also collected. Large-for-gestational age (LGA) status was predicted using a Cox proportional hazards model with multiple confounders. Tg > 13 g/L was independently associated with LGA (adjusted hazard ratio = 3.4, 95% CI: 1.4–10.2, p = 0.001). Estimated iodine intake correlated with FT4 among participants who reported consuming iodine-containing supplements (ICS) after adjusting for confounders (β = 0.4, 95% CI: 0.0002–0.0008, p = 0.001). Newborn weight percentiles were inversely correlated with maternal FT4 values (β = −0.2 95% CI:−0.08–−56.49, p = 0.049). We conclude that in mild-to-moderate ID regions, insufficient maternal iodine status may increase LGA risk. Iodine status and ICS intake may modify the effect that maternal dysglycemia has on offspring weight.

Severe iodine deficiency during pregnancy has substantial hormonal consequences, such as fetal brain damage. Data on the potential effects of mild-to-moderate iodine deficiency on the thyroid function of pregnant women and their newborns are scarce and divergent. We investigated the association between iodine intake in pregnancy and maternal and neonatal thyroid function in a region with mild-to-moderate iodine deficiency. Pregnant women’s iodine status was evaluated using an iodine food frequency questionnaire, serum thyroglobulin (Tg), and urinary iodine concentration (UIC). Neonatal thyrotropin (nTSH) values were measured after birth. Obstetrics and anthropometric data were also collected. Among the 178 women (median age 31 years) included in the study, median (interquartile range) estimated dietary iodine intake, Tg and UIC were 179 (94–268) μg/day, 18 (11–33) μg/L, and 60 (41–95) μg/L, respectively. There was a significant inverse association of iodine intake with Tg values among the study population (β = −0.2, F = 7.5, p < 0.01). Women with high free triiodothyronine (FT3) values were more likely to exhibit an estimated iodine intake below the estimated average requirement (160 μg/day, odds ratio [OR] = 2.6; 95% confidence interval [CI], 1.1–6.4; p = 0.04) and less likely to consume iodine-containing supplements (OR = 0.3, 95% CI, 0.1–0.8; p = 0.01). It is possible that thyroid function may be affected by iodine insufficiency during pregnancy in regions with mild-to-moderate iodine deficiency. The relatively small sample size of the studied population warrants further investigation.

Childhood obesity and iodine deficiency are global public health concerns. Whether maternal iodine status mediates overweight in infancy has yet to be explored. We aimed to assess the relationship between maternal iodine status and infant birth weight, including small and large for gestational age (SGA and LGA, respectively). A prospective study was carried out among 134 mother–infant pairs from Israel. Maternal iodine intake and status were estimated via questionnaire and serum thyroglobulin (Tg), respectively. Estimated iodine intake below the Recommended Daily Allowance for iodine sufficiency in pregnancy (220 μg/d) considered Inadequate. Maternal and neonatal thyroid function and anthropometric measurements, as well as maternal thyroid antibodies were also tested. After screening, 118 participants met the inclusion criteria (distributed trimesters I, II and III: n = 3, n = 21, and n = 94, respectively). There was a negative association of iodine intake with Tg values among the study population. Maternal median Tg value was higher than the sufficiency cutoff (16.5 vs 13 µg/L), indicating insufficient iodine status. No SGA cases were found. Inadequate iodine intake was associated with maternal isolated hypothyroxinemia (OR = 3.4; 95% CI 1.2, 9.9) and higher birthweight (including macrosomia and LGA) rates. A suggestive association of elevated Tg with a greater risk of LGA was observed. Offsprings' birth weight percentiles were associated with Tg values in pregnant women with suggestive sufficient iodine status (n = 62, R2 = 0.11, p < 0.05). Iodine status during pregnancy can be associated with newborn anthropometric index. Maternal inadequate iodine intake may alter fetal growth and might increase the risk of LGA among newborns. These initial findings support the need to further study the impact of iodine deficiency on newborns overweight in Israel and elsewhere.

Objective: To evaluate the predictive value of local versus external cerebroplacental ratio (CPR) reference ranges for delivery outcomes in low-risk pregnancies. Methods: A retrospective analysis of all feto-maternal demographic and biometric data in fetuses with normal estimated fetal weight (EFW) and a CPR examination between the years 2014-2019, in a university medical center. The study group included healthy singleton pregnancies from 32-week gestation, with an examination-to-delivery interval of <31 days. The three models compared two thresholds: <5th percentile (CPR 1, CPR 3) and <10th percentile (CPR2). The CPR1 and CPR2 models both use local CPR reference ranges, while the CPR3 model uses an external CPR reference range. The main outcome was predictive accuracy for urgent cesarean delivery (CD), operative delivery (OD), and composite outcome (CO), defined as an Apgar score of <7, fetal blood pH < 7.1 or admission to the neonatal intensive care unit (NICU). Results: Overall, 410 low-risk pregnancies with normal weight fetuses were enrolled in the study. All three CPR models turned out to be significant predictors of CD, with an odds ratio (OR) of 9, 95% CI (2.7-27), p < .001 for CPR1, and an OR of 2.9, 95% CI (1.1-7.4), p < .04 for CPR2, and an OR of 3.4, 95% CI (1.7-6.8), p < .001 for CPR3. All the three models were also found to be predictors of OD, and an OR of 6.9, 95% CI (2.1-22) p < .04 for CPR1, and an OR of 2.8, 95% CI (1.2-6.7), p < .04 for CPR2, and an OR of 2.8, 95% CI (1.4-5.3) p < .01 for CPR3. The positive predictive values (PPV) for CD and OD were both 50% for CPR1, versus 28% and 26% in CPR2, and 24% and 25% in CPR3. The negative predictive value (NPV) was similar, around 88% in all three models. None of the models were found to be significant predictors for CO. Conclusions: A CPR model based on local reference ranges and <5th percentile cutoffs showed the highest PPV for CD and OD. The calculation of local references for CPR should be encouraged.

OBJECTIVES:To evaluate the endothelial function, through flow-mediated vasodilation parameters from brachial artery test in women receiving nifedipine for acute tocolysis with threatened preterm delivery. METHODS:In a prospective study in a university-affiliated hospital, each participant served as herself control. We evaluated various parameters of endothelial function in 22 patients between 27 and 33 weeks of gestation with a diagnosis of threatened preterm delivery (TPTD) before and after 48 h of nifedipine treatment. Each patient received 80 mg nifedipine per day. The assessment tool was Brachial artery reactivity test (BART). Primary outcome was flow mediated vasodilation (FMD). RESULTS:The average participant's age was 27 ± 4.5 years, median gestational age of 28.5 weeks, BMI, kg/m2 (mean ± SD) 28.4 ± 3.3. Systolic blood pressure (mmHg) and diastolic blood pressure (mmHg) decreased from 108 ± 6 to 104 ± 5, p < .001 and from 66 ± 4 to 63 ± 4, p < .001, respectively. FMD (%) significantly decrease from 10.8 ± 6.1 to 7.2 ± 4.7, p = .03 prior to and after nifedipine treatment. The basal brachial artery diameter (mm) at rest was (3.19 ± 0.38 versus 3.39 ± 0.49, p = .28) before versus after nifedipine. The largest brachial artery diameter (mm) was (3.54 ± 0.35 versus 3.58 ± 0.44, p = .76) before versus after nifedipine. CONCLUSIONS:Our results suggest unfavorable changes in FMD probably as a result of nifedipine used for acute tocolysis. Future prospective studies should try to evaluate the safety of acute and maintenance tocolytic therapy with nifedipine on endothelial function in pregnant women.

Background Iodine is an essential nutrient for human health throughout the life cycle, especially during early stages of intrauterine life and infancy, to ensure adequate neurocognitive development. The growing global reliance on desalinated iodine-diluted water raises the specter of increased iodine deficiency in several regions. The case of Israel may be instructive for exploring the link between iodine status and habitual iodine intake in the setting of extensive national reliance on desalinated water. The aim of this study was to explore the relationship between iodine intake, including iodized salt and iodine-containing supplements intake, and iodine status among pregnant women residing in a sub-district of Israel that is highly reliant on desalinated iodine-diluted water. Methods A total of 134 consecutive pregnant women were recruited on a voluntary basis from the obstetrics department of the Barzilai University Medical Center during 2018. Blood was drawn from participants to determine levels of serum thyrotropin (TSH), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and thyroglobulin (Tg). An iodine food frequency questionnaire (sIFFQ) was used to assess iodine intake from food, IS and ICS. A questionnaire was used to collect data on demographic and health characteristics. Results A total of 105 pregnant women without known or reported thyroid disease were included in the study. Elevated Tg values (≥ 13 μg/L), were found among 67% of participants, indicating insufficient iodine status. The estimated iodine intake (median, mean ± SD 189, 187 ± 106 μg/d by sIFFQ) was lower than the levels recommended by the World Health Organization and the Institute of Medicine (250 vs. 220 μg/day respectively). The prevalence of iodized salt intake and iodine containing supplement intake were 4 and 52% (respectively). Values of Tg > 13 μg/L were inversely associated with compliance with World Health Organization and Institute of Medicine recommendations. Conclusions While the Israeli Ministry of Health has recommended the intake of iodized salt and iodine containing supplements, this is apparently insufficient for achieving optimal iodine status among Israeli pregnant women. The evidence of highly prevalent probable iodine deficiency in a sample of pregnant women suggests an urgent need for a national policy of iodized salt regulation, as well as guidelines to promote iodine containing supplements and adherence to them by caregivers. In addition, studies similar to this one should be undertaken in additional countries reliant on desalinated iodine-diluted water to further assess the impact of desalinization on maternal iodine status.

Iodine is an essential nutrient for human health throughout the life cycle. It is especially important during early stages of intrauterine life and infancy, to ensure adequate neurocognitive development. The growing global reliance on desalinated iodine-diluted water (DIDW) may increase the risk of iodine deficiency (ID) in several countries, including Israel. The aims of this study were to 1) assess iodine status among pregnant women (PW) residing in a sub-district of Israel that is highly reliant on DIDW; 2) explore the relationship between iodine status and iodine intake - including iodized salt (IS) and iodine-containing supplements (ICS) intake - among PW. Observational study. A total of 134 PW were recruited from Barzilai University Medical Center in Ashkelon during 2018. Blood was drawn from participants to determine levels of serum thyrotropin (TSH), thyroid peroxidase antibodies (TPO-ab), thyroglobulin antibodies (Tg-ab) and thyroglobulin (Tg). An iodine food frequency questionnaire (sIFFQ) was used to assess iodine intake from food, IS and ICS. A questionnaire was used to collect data on demographic and health characteristics. A total of 105 PW without thyroid disease were included in the study. Elevated Tg values (≥ 13 μg/L), were found among 67% of participants, indicating insufficient iodine status. The estimated iodine intake (median, mean± SD 189, 187±106 μg/d by sIFFQ) was lower than the levels recommended by the World Health Organization (WHO) and the Institute of Medicine (IOM) (250 vs. 220 μg/day respectively). The prevalence of IS intake and ICS intake were 4% and 52% (respectively). Values of Tg > 13 μg/L were inversely associated with compliance with WHO and IOM recommendations. The evidence of prevalent probable ID in a PW population reliant on DIDW indicates an urgent need to probe the impact of desalinated water on maternal iodine status. A monitoring program as well as appropriate ICS should be considered to ensure sufficient iodine status during maternity in regions with DIDW reliance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)