MECHANISMS BEHIND SEVERE INSULIN RESISTANCE DURING PREGNANCY IN
Vitamin D deficiency in pregnancy – is increased supplementation needed?
Anna Louise Vestergaard, Department of Clinical Medicine, Department of Gynecology and Obstetrics, Randers Regional Hospital
M. Christensen, Randers Regional Hospital,
M.F. Andreasen, Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University
A. Larsen, Department of Biomedicine, Aarhus University
P. Bor, Department of Obstetrics and Gynecology, Randers Regional Hospital
Background
Vitamin D deficiency is widespread among Danish pregnant women despite high
adherence (90 %) to the official recommendations on supplementation in pregnancy (10 µg Vitamin D). This puts the women at risk as vitamin D deficiency is associated with increased risk of pregnancy complications related to placental function like intrauterine growth restriction, pre-eclampsia and gestational diabetes, although the underlying mechanisms are far from elucidated.
The aim of our study is to investigate if a higher dose of vitamin D in pregnancy can reduce the above mentioned complications and to explore the placental effects of a high dose of vitamin D to improve our understanding of underlying risks and disease pathology.
Methods
A double blinded randomized trial investigating two doses of vitamin D: 10 µg vs. 90 µg, combined with molecular analysis of placental tissue from selected groups (healthy and complicated pregnancies, obese, medicine users). A total of 2000 pregnant women seeking prenatal care at Randers Regional Hospital will be included in the study. Maternal blood samples, questionnaires describing life-style habits, placental tissue, umbilical cord blood and information on maternal and fetal outcomes from medical records will be collected.
Results
The study is ongoing. Since June 2020, we have included 980 women and collected 330 placentas.
Conclusion
We expect to provide new knowledge about disease mechanisms and vitamin D's effect on pregnancy- and perinatal health and provide the scientific evidence for determining if
a higher dose of vitamin D supplementation constitutes a feasible, economically sustainable way of improving public health for future generations.
Keywords: Gynecology and obstetrics, Gynecology and obstetrics, Other
Risk factors for kidney scarring and vesicoureteral reflux in 421 children after their first acute pyelonephritis, and appraisal of international guidelines
Anders Breinbjerg, Department of Clinical Medicine, Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
C. Siggaard Jørgensen, Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; J. Frøkiær, Department of Clinical Medicine, Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus University, Aarhus, Denmark; K. Tullus, Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; S. Rittig, Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; K. Kamperis, Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
Background: Acute pyelonephritis (AP) is a common bacterial infection in childhood.
Follow-up guidelines on these children are controversial. This study aimed to identify risk factors for kidney scarring and vesicoureteral reflux (VUR). Furthermore, three international follow-up guidelines were evaluated in our cohort.
Methods: Urinary culture-confirmed first-time AP patients (aged 0-14 years) were enrolled (n = 421) from review of patient charts. All underwent kidney ultrasound (US) and kidney scintigraphy (DMSA or MAG3) at 4-6 months of follow-up. The international guidelines used for simulation were from the National Institute of Health UK (NICE), the American
Association of Paediatrics (AAP) and the Swedish Paediatric Society (SPS).
Results: 17.8% presented with an abnormal DMSA/MAG3 at follow-up, 7.1% were
diagnosed with VUR grades III-V and 4.7% were admitted for surgery. Non-Escherichia coli infections, abnormal kidney US, elevated creatinine and delayed response to treatment (>48 h) were risk factors for abnormal DMSA findings and VUR grades III-V. NICE and SPS guidelines showed best sensitivity in diagnosing VUR grades III-V (75%) compared with AAP (56%).
Conclusions: Risk factors are helpful in identifying children in need of further investigations and minimizing invasive work-up for the rest. International guidelines on follow-up detect a varying number of children with kidney damage and/or significant VUR. Future work must focus on identifying more specific risk factors, better imaging, or specific biomarkers, to enhance sensitivity and specificity in detecting the children at high risk for developing recurrent infections and/or nephropathy.
Keywords: Paediatrics, Nephrology, Urology
Paying extra attention: A qualitative study of parents’ everyday practice in families with a child with Down syndrome
Ellen Steffensen, Department of Clinical Medicine
L. H. Rosvig, Dept. of Obstetrics and Gynecology, Horsens Regional Hospital; S. Santoro, Division of Medical Genetics and Metabolism, Massachusetts General Hospital & Dept. of Pediatrics, Harvard Medical School; L. H. Pedersen, Dept. of Clinical Medicine & Dept. of Biomedicine, Aarhus University & Dept. of Obstetrics and Gynecology, Aarhus University Hospital; I. Vogel, Center for Fetal Diagnostics & Dept. of Clinical Medicine, Aarhus University & Dept. of Clinical Genetics, Aarhus University Hospital, S. Lou, Center for Fetal Diagnostics, Aarhus University & Defactum - Public Health & Health Services Research
Background: Prior studies investigating parents of children with Down syndrome have described the parenting experience as both rewarding and challenging. However, there is insufficient knowledge on how parents respond to this experience through their everyday practices – the daily actions by which they manage parenthood and everyday life.
Objective: We aimed to address this gap by exploring the experienced everyday practices of parents of children with Down syndrome.
Methods: Taking a qualitative approach, we conducted semi-structured interviews with 25 parents of children with Down syndrome aged 4-12 years. Using reflexive thematic
analysis, we identified themes concerned with the parents’ practice.
Results: The first theme, ‘Supporting our child’, describes how parents perceived their child as a valuable human being and how this perception founded parents’ support of the child’s development and social interactions. The second, ‘Managing our family life’, demonstrates how the parents acted to manage a family life that had become the ‘new normal’ including being alert towards the child, shaping the practical and logistical framework of daily life, and balancing between being at home and away from home.
Overall, the analysis presents an everyday practice characterized by the parents paying particular attention to the various aspects of family life.
Conclusion: This study provides specific knowledge on parents’ everyday practice in families where a child has Down syndrome. Our findings may inform genetic counseling about Down syndrome and are of value to service providers.
Keywords: Paediatrics, Qualitative research, Gynecology and obstetrics
Pharmacokinetics and Immunogenicity of the First Doses of PEG- Asparaginase - An ALLTogether Pilot Study
Merete Dam, Department of Clinical Medicine
M. Dam, Department of Paediatrics and Adolescent Medicine, AUH; LS.. Lynggaard, Department of Paediatrics and Adolescent Medicine, AUH; IM. Johannsdottir, Oslo University Hospital; HS. Wik, Oslo University Hospital; J. Malmros, Karolinska University Hospital; H. Hallböök, Uppsala University Hospital; GE. Vaitkeviciene, Vilnius University Hospital; L. Griskevicius, Vilnius University Hospital; ÓG. Jónsson, National University Hospital of Iceland; K. Schmiegelow, Rigshospitalet; BK Albertsen, Department of Paediatrics and Adolescent Medicine, AUH.
Introduction
Acute lymphoblastic leukemia (ALL) is the most common malignant disease in childhood.
Survival rates exceed 90% in children and 75% in adults (aged 18-45 years). Asparaginase is an indispensable part of the multiagent treatment, but is often associated with
hypersensitivity, either with clinical allergy or silent inactivation. In both cases,
asparaginase is inactivated. It is well known that truncation of asparaginase treatment reduces survival. To approach an understanding of asparaginase dynamics and hypersensitivity in ALL patients it is important to examine the pharmacokinetics.
The aim of this study is to identify serological parameters for prediction of hypersensitivity reaction after the first doses of PEG-asparaginase given intravenously on the ALLTogether protocol.
Methods:
The ALLTogether Pilot Protocol was conducted in Denmark, Norway, Sweden, Lithuania and Iceland from November 2018 – August 2021. PEG-asparaginase doses of 1500 IU/m2
<16 years, 1000 IU/m2 ≥16 years were initiated at treatment day 4 and were in most patients administered intravenously (222/252).
Therapeutic drug monitoring of asparaginase enzyme activity was used to identify patients with inactivation.
Results:
In total 252 patients (209 children/42 adults) were treated according to the ALLTogether Pilot Protocol. Inactivation of asparaginase was identified in 40/252 patient (15.9%); 5 (12.5%) with silent inactivation, 12 (30%) with mild allergy and 22 (55%) with severe allergy.
Hypersensitivity mainly occurred after 4th or 5th dose (22/6).
The ability to predict patients prone to inactivate asparaginase will have great consequences for the patients and their survival.
Keywords: Paediatrics, Oncology, Pharmacology
What can we learn during a pandemic and nationwide school lockdown about childhood incontinence?
Britt Borg, Department of Clinical Medicine
Konstantinos Kamperis, Department of pediatrics, Aarhus University Hospital; Søren Rittig, Department of pediatrics, Aarhus University Hospital and Department of Clinical Medicine, Rene F. Andersen, Department of pediatrics, Aarhus University Hospital
Background: Previous questionnaire studies have reported a strong correlation between toilet avoidance behavior and symptoms of bladder and bowel dysfunction (BBD), but the knowledge is from cross-sectional studies and studies with follow up and interventions are needed. Thus we seized the opportunity to examine the effect of school lockdown during Covid-19 on BBD
Method: We examined the effect of school lockdown on BBD by sending questionnaires regarding patient reported outcomes (PRO) to a cohort from the outpatient clinic at Centre for Childhood Incontinence at Aarhus University Hospital. One parent for each child from the outpatient clinic within the six months before onset of the investigation were asked to participate.
Results: 106 parents completed the first questionnaire. 83 % of the children received remote learning via computer at home during the lockdown of January 2021, 17 % of the children were still at school. For children with daytime urinary incontinence(DUI) receiving remote learning 64,3 % reported improvement of symptoms during lockdown compared to 33,3 % of the children who were at school. The CBBD questionnaire evaluating the
frequency of symptoms over time of concomitant childhood bladder and bowel
dysfunctions was also significantly lower in children with DUI receiving remote learning compared to children with DUI at school, 30,9 point (29.0 ; 32.9) vs 36,1 point (30.6 ; 41.5), p<0.05 .
Conclusion: More children with DUI receiving remote learning at home during lockdown had parent reported improvement than children still at school. They also had a lower frequency of symptoms reported on the CBBD questionnaire.
Keywords: Paediatrics, Nephrology, Psychiatry, psychology and mental health