Nuova ricerca

ELISABETTA PETRELLA

Docente a contratto
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

Home | Curriculum(pdf) | Didattica |


Pubblicazioni

2023 - The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study [Articolo su rivista]
Ambrosetti, Fedora; Grandi, Giovanni; Petrella, Elisabetta; Sampogna, Veronica; Donno, Lara; Rinaldi, Laura; Ghirardini, Anna Maria; Facchinetti, Fabio
abstract

Background: The use of epidural analgesia represents the gold standard for pain management during labor, but the influence of the use of epidural analgesia on delivery mode is not fully understood. Objective: This study aimed to analyze the impact of epidural analgesia on the delivery mode, namely, cesarean delivery, vaginal delivery, and operative vaginal delivery rates, in Robson class 1 women. Study design: A retrospective cohort study was conducted on all Robson class 1 women who delivered from January 1, 2019, to December 31, 2019, in the University Hospital of Modena. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were maternal, anesthesiologic, and neonatal effects of epidural analgesia (duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission). Results: A total of 744 women were included in the final analysis, of which 198 (26.6%) underwent epidural analgesia on request and 546 (73.4%) did not. In women with and without epidural analgesia, the cesarean delivery rate was 8.1% vs 7%, the vaginal delivery rate was 79.3% vs 81.1%, and the operative vaginal delivery rate was 12.6% vs 11.9%, respectively. A significant increase in both the first stage of labor (66.3±38.5 vs 43.8±38.8 minutes; P<.0001) and total duration of labor (328.0±206.7 vs 201.7±168.3 minutes; P<.0001) was found in women receiving epidural analgesia. No change was recorded in the second stage of labor. A shorter duration of labor was observed (P<.0001) when epidural analgesia was started earlier (dilation: 2-4 cm vs >4 cm). No significant difference in Apgar score and neonatal intensive care unit admission was found. Conclusion: The use of epidural analgesia was not associated with an increased risk of cesarean delivery or operative vaginal delivery in Robson class 1 women. Further investigations are needed to evaluate its impact on the duration of labor, namely the duration of the first stage of labor, and on the possible advantages of starting epidural analgesia at an early stage.

2022 - First trimester metabolomics 1H-NMR study of the urinary profile predicts gestational diabetes mellitus development in obese women [Articolo su rivista]
Piras, C.; Neri, I.; Pintus, R.; Noto, A.; Petrella, E.; Monari, F.; Dessi, A.; Fanos, V.; Atzori, L.; Facchinetti, F.
abstract

Objective: Obesity is one of the main risk factors for the development gestational diabetes mellitus (GDM). Thus, we aim to identify changes in the urinary metabolomics profile of obese women at first trimester of pregnancy in order to predict later GDM diagnosis. Research design and methods: In this nested case-control study, urine samples collected in the first trimester of pregnancy obtained from obese women who developed GDM (n = 29) and obese women who did not develop diabetes (n = 25 NO GDM) were analyzed with Nuclear Magnetic Resonance spectroscopy combined with Multivariate Statistical Analysis. GDM diagnosis was obtained with one-step oral glucose load. Results: OPLS-DA significantly separated the GDM women from NO GDM women. Specifically, GDM women were characterized by a higher level of tryptophan, trigonelline, hippurate, and threonine, and lower levels of 1-methylnicotinamide, 3-hydroxykynurenine, glycocholate, isoleucine, kynurenine, and valine compared to NO GDM women. Conclusion: In a prevalently Caucasian population, the changes of some metabolites such as tryptophan, trigonelline, and branch-chained amino acids in the urinary profile of obese women in the first trimester are able to make unequivocal prediction of those which later test positive for GDM. This approach could be useful to diagnose much earlier obese women with GDM allowing lifestyle counselling and other interventions.

2022 - First-trimester prediction of gestational hypertension through the bioelectrical impedance analysis of the body composition [Articolo su rivista]
Menichini, D.; Spelta, E.; Rossi, E.; Monari, F.; DI VINCI, P. L.; Petrella, E.; Facchinetti, F.; Neri, I.
abstract

OBJECTIVE: Obesity is a risk factor for the development of gestational hypertension, with important consequences for both the mother and fetus. This prospective observational study aims to propose an early prediction model of hypertensive disorders in pregnancy among obese women, through the bioelectrical impedance analysis (BIA) at the first trimester, thus allowing early recognition of obese women that are at risk to develop gestational hypertension, in order to target preventive interventions. PATIENTS AND METHODS: Singleton obese women (BMI ≥ 30 kg/m2) between the 9th and 12th week of pregnancy were included in the study. The exclusion criteria were chronic diseases, like type 2 diabetes mellitus, hypertension, and other medical pre-existing conditions. Eligible women were followed up at 20, 28, and 36 weeks of gestation by measuring blood pressure, weight, and body composition with the use of the BIA. The diagnosis of gestational hypertension was made after the 20th week of gestation. Pregnancy and perinatal outcomes were then recorded. RESULTS: Of the 479 women included in the study, 85 (17.7%) developed gestational hypertension; the remaining 394 (82.3%) resulted to be normotensive. A higher rate of nulliparous women was found in the hypertensive group (50.6% vs. 37.6%, p = 0.02), together with a higher rate of induction of labor (55.3% vs. 40.9%, p = 0.02) and of small for gestational age (SGA) newborns (12.9% vs. 6.9%, p = 0.03). Significant differences emerged in the body composition between the two groups already from the first trimester, indeed women developing gestational hypertension showed elevated values of Total body Mass, FM, FFM, TBW (p < 0.02), and of leg's FM, FFM (p < 0.006). At the multivariate logistics regression, the risk of developing gestational hypertension resulted higher in women with elevated total body water levels in the first trimester (OR 1.10 95% CI 1.04 -1.92). CONCLUSIONS: The BIA is a rapid, easy, non-invasive, and inexpensive tool to evaluate the body composition of obese pregnant women. It represents a promising predictor of hypertensive disorders in pregnancy, which allows an early identification of the patients at risk of developing gestational hypertension, thus opening a window of opportunity for strictly monitoring and target preventive intervention.

2020 - MRI of placenta accreta: diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women [Articolo su rivista]
Fiocchi, Federica; Monelli, Filippo; Besutti, Giulia; Casari, Federico; Petrella, Elisabetta; Pecchi, Annarita; Caporali, Cristian; Bertucci, Emma; Busani, Stefano; Botticelli, Laura; Facchinetti, Fabio; Torricelli, Pietro
abstract

To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI.

2020 - The impact of an early lifestyle intervention on pregnancy outcomes in a cohort of insulin-resistant overweight and obese women [Articolo su rivista]
Menichini, D.; Petrella, E.; Dipace, V.; Di Monte, A.; Neri, I.; Facchinetti, F.
abstract

Obese women are more likely to have decreased insulin sensitivity and are at increased risk for many adverse pregnancy outcomes. An early lifestyle intervention (LI) may have the potential to reduce the impact of insulin resistance (IR) on perinatal outcomes. We report post hoc analysis of an open-label randomized control trial that includes IR women with body-mass index ≥25 randomly assigned to a LI with a customized low glycemic index diet or to standard care (SC) involving generic counseling about healthy diet and physical activity. Women were evaluated at 16, 20, 28, and 36 weeks of gestation, at which times perinatal outcomes were collected and analyzed. An oral-glucose-tolerance test (OGTT) showed that women in the LI group had lower plasma glucose levels at 120 min at 16–18 weeks of gestation, and at 60 and 120 min at 24–28 weeks. More importantly, these women had a lower rate of large-for-gestational-age (LGA) infants (p = 0.04). Interestingly, the caloric restriction and low-glycemic index diet did not increase the rate of small-for-gestational-age (SGA) babies in the LI group. A lifestyle intervention started early in pregnancy on overweight and obese women had the potential to restore adequate glucose tolerance and mitigate the detrimental role of IR on neonatal outcomes, especially on fetal growth.

2019 - Food glycemic index changes in overweight/obese pregnant women enrolled in a lifestyle program: a randomized controlled trial [Articolo su rivista]
Facchinetti, F.; Vijai, V.; Petrella, E.; Gambigliani Zoccoli, S.; Pignatti, L.; Di Cerbo, L.; Neri, I.
abstract

BACKGROUND: The calculation of the glycemic index of food mirrors a rise in blood sugar levels. A low-glycemic index carbohydrate diet in pregnancy has been associated with normal infant birthweight. Thus, strategies to lower the food glycemic index could be successful in improving pregnancy outcomes. OBJECTIVE: The purpose of this study was to compare different prescribed diets on food glycemic index intake and its relationship with rate of large-for-gestational-age infants. STUDY DESIGN: At the 9th-12th week of gestation (with a gynecologist and a dietitian both present), 273 Italian women with a body mass index of ≥25 kg/m2 were assigned randomly either to a customized low-glycemic index diet that was detailed by a dietitian (customized intervention; n=139 women; 1800 kcal/d+30 minutes walking 4 times/wk) or to generic lifestyle advice (standard care; n=134 women) with counseling about a prudent diet and physical activity, according to Italian guidelines. At enrollment and at the 36th week of gestation, the food frequency questionnaire was completed. In 73 Italian foods, the glycemic index was assessed with the use of a classic formula (available carbohydrate×glycemic index prescribed/total carb content of the meal) then was subdivided according to meal pattern. The main outcome was the change in food- glycemic index. RESULTS: Sociodemographic features were similar between the groups. One hundred fifty-six women completed the study (customized intervention=81; standard care=75). The mean daily glycemic index decreased from 58.4±19 to 52.5±11.2 (P=.008) in the customized intervention group although it remained unchanged in the standard care group. After the intervention, women in the customized intervention group reported a significant decrease in the diet glycemic index at dinner compared with both lunch and breakfast values (P<.02). Lower birthweight and fewer large-for-gestational-age infants were observed in the customized intervention group. CONCLUSION: A customized low-glycemic index, calorie-restricted diet that was associated with constant physical activity effectively reduced the food glycemic index. This reduced food glycemic index is associated with lower rate of large-for-gestational-age newborn infants.

2019 - Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: Analysis using individual participant data from randomised trials [Articolo su rivista]
Rogozinska, E.; Zamora, J.; Marlin, N.; Betran, A. P.; Astrup, A.; Bogaerts, A.; Cecatti, J. G.; Dodd, J. M.; Facchinetti, F.; Geiker, N. R. W.; Haakstad, L. A. H.; Hauner, H.; Jensen, D. M.; Kinnunen, T. I.; Mol, B. W. J.; Owens, J.; Phelan, S.; Renault, K. M.; Salvesen, K. A.; Shub, A.; Surita, F. G.; Stafne, S. N.; Teede, H.; Van Poppel, M. N. M.; Vinter, C. A.; Khan, K. S.; Thangaratinam, S.; Coomarasamy, A.; Devlieger, R.; El Beltagy, N.; Guelfi, K.; Harrison, C.; Khoury, J.; Luoto, R.; Morkved, S.; Motahari, N.; Mcauliffe, F.; Perales, M.; Petrella, E.; Poston, L.; Rauh, K.; Sagedal, L. R.; Scudeller, T. T.; Shen, G. X.; Tonstad, S.; Vistad, I.; Vitolo, M.; Yeo, S.
abstract

Background: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging. Methods: We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m2 or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics. Results: Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased. Conclusions: Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.

2019 - Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: Individual participant data meta-Analysis [Articolo su rivista]
O'Brien, E. C.; Segurado, R.; Geraghty, A. A.; Alberdi, G.; Rogozinska, E.; Astrup, A.; Barakat Carballo, R.; Bogaerts, A.; Cecatti, J. G.; Coomarasamy, A.; De Groot, C. J. M.; Devlieger, R.; Dodd, J. M.; El Beltagy, N.; Facchinetti, F.; Geiker, N.; Guelfi, K.; Haakstad, L.; Harrison, C.; Hauner, H.; Jensen, D. M.; Khan, K.; Kinnunen, T. I.; Luoto, R.; Willem Mol, B.; Morkved, S.; Motahari-Tabari, N.; Owens, J. A.; Perales, M.; Petrella, E.; Phelan, S.; Poston, L.; Rauh, K.; Rayanagoudar, G.; Renault, K. M.; Ruifrok, A. E.; Sagedal, L.; Salvesen, K. A.; Scudeller, T. T.; Shen, G.; Shub, A.; Stafne, S. N.; Surita, F. G.; Thangaratinam, S.; Tonstad, S.; Van Poppel, M. N. M.; Vinter, C.; Vistad, I.; Yeo, S.; Mcauliffe, F. M.
abstract

Objectives To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design Individual participant data meta-Analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources Major electronic databases, from inception to February 2017. Eligibility criteria Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). Risk of bias Cochrane risk of bias tool was used. Data synthesis Principle measures of effect were OR and regression coefficient. Results Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B-0.055; 95% CI-0.098 to-0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B-0.053; 95% CI-0.069 to-0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

2018 - An early-customized low glycaemic-index diet prevents adverse pregnancy outcomes in overweight/obese women [Articolo su rivista]
Petrella, Elisabetta; Tamborrino, Valeria; Di Cerbo, Lidia; Neri, Isabella; Facchinetti, Fabio
abstract

To determine whether the prescription and follow-up of a behavioral program (customized nutritional advices and a constant physical activity) influences the occurrence of unfavorable maternal/neonatal outcomes among overweight/obese women.

2017 - Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: a randomized controlled trial [Articolo su rivista]
Bruno, Raffaele; Petrella, Elisabetta; Bertarini, Valentina; Pedrielli, Giulia; Neri, Isabella; Facchinetti, Fabio
abstract

This study aims to determine whether the prescription of a detailed lifestyle programme in overweight/obese pregnant women influences the occurrence of gestational diabetes (GDM), and if this kind of prescription increases the adherence to a healthier lifestyle in comparison to standard care. The study was designed as a randomized controlled trial, with open allocation, enrolling women at 9-12 weeks of pregnancy with a BMI ≥ 25 kg/m(2) . The women assigned to the Intervention group (I = 96) received a hypocaloric, low-glycaemic, low-saturated fat diet and physical activity recommendations. Those assigned to the Standard Care group (SC = 95) received lifestyle advices regarding healthy nutrition and exercise. Follow-up was planned at the 16(th) , 20(th) , 28(th) and 36(th) weeks. A total of 131 women completed the study (I = 69, SC = 62). The diet adherence was higher in the I (57.9%) than in the SC (38.7%) group. GDM occurred less frequently in the I (18.8%) than in the SC (37.1%, P = 0.019) group. The adherent women from either groups showed a lower GDM rate (12.5% vs. 41.8%, P < 0.001). After correcting for confounders, the GDM rate was explained by allocation into the I group (P = 0.034) and a lower BMI category (P = 0.039). The rates of hypertension, preterm birth, induction of labour, large for gestational age babies and birthweight > 4000 g were significantly lower in I group. The incidence of small for gestational age babies was not different. These findings demonstrate that the adherence to a personalized, hypocaloric, low-glycaemic, low-saturated fat diet started early in pregnancy prevents GDM occurrence, in women with BMI ≥ 25 kg/m(2) .

2017 - Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials [Articolo su rivista]
Rogozińska, Ewelina; Marlin, Nadine; Pilar Betrán, Ana; Astrup, Arne; Barakat, Ruben; Bogaerts, Annick; G Cecatti, Jose; Devlieger, Roland; M Dodd, Jodie; El Beltagy, Nermeen; Facchinetti, Fabio; RW Geiker, Nina; J Guelfi, Kym; AH Haakstad, Lene; L Harrison, Cheryce; Hauner, Hans; M Jensen, Dorte; I Kinnunen, Tarja; Khoury, Janette; Luoto, Riitta; Mcauliffe, Fionnuala; Motahari, Narges; Mørkved, Siv; Owens, Julie; Perales, María; Petrella, Elisabetta; Phelan, Suzanne; Poston, Lucilla; Rauh, Kathrin; M Renault, Kristina; R Sagedal, Linda; Å Salvesen, Kjell; X Shen, Garry; Shub, Alexis; Scudeller, Tânia; G Surita, Fernanda; N Stafne, Signe; Teede, Helena; Tonstad, Serena; NM van Poppel, Mireille; A Vinter, Christina; Vistad, Ingvild; Yeo, Seonae; Dodds, Julie; Kerry, Sally; Jackson, Louise; Barton, Pelham; Molyneaux, Emma; A Martin, Alba; Rayanagoudar, Girish; E Ruifrok, Anneloes; Roberts, Tracy; JM de Groot, Christianne; Coomarasamy, Arri; WJ Mol, Ben; Zamora, Javier; S Khan, Khalid; D Riley, Richard; Thangaratinam, Shakila
abstract

Objective To synthesise the evidence on the overall and differential effects of interventions based on diet and physical activity during pregnancy, primarily on gestational weight gain and maternal and offspring composite outcomes, according to women’s body mass index, age, parity, ethnicity, and pre-existing medical condition; and secondarily on individual complications. Design Systematic review and meta-analysis of individual participant data (IPD). Data sources Major electronic databases from inception to February 2017 without language restrictions. Eligibility criteria for selecting studies Randomised trials on diet and physical activity based interventions in pregnancy. Data synthesis Statistical models accounted for clustering of participants within trials and heterogeneity across trials leading to summary mean differences or odds ratios with 95% confidence intervals for the effects overall, and in subgroups (interactions). Results IPD were obtained from 36 randomised trials (12 526 women). Less weight gain occurred in the intervention group than control group (mean difference −0.70 kg, 95% confidence interval −0.92 to −0.48 kg, I2=14.1%; 33 studies, 9320 women). Although summary effect estimates favoured the intervention, the reductions in maternal (odds ratio 0.90, 95% confidence interval 0.79 to 1.03, I2=26.7%; 24 studies, 8852 women) and offspring (0.94, 0.83 to 1.08, I2=0%; 18 studies, 7981 women) composite outcomes were not statistically significant. No evidence was found of differential intervention effects across subgroups, for either gestational weight gain or composite outcomes. There was strong evidence that interventions reduced the odds of caesarean section (0.91, 0.83 to 0.99, I2=0%; 32 studies, 11 410 women), but not for other individual complications in IPD meta-analysis. When IPD were supplemented with study level data from studies that did not provide IPD, the overall effect was similar, with stronger evidence of benefit for gestational diabetes (0.76, 0.65 to 0.89, I2=36.8%; 59 studies, 16 885 women). Conclusion Diet and physical activity based interventions during pregnancy reduce gestational weight gain and lower the odds of caesarean section. There is no evidence that effects differ across subgroups of women.

2017 - Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation [Capitolo/Saggio]
Rogozińska, Ewelina; Marlin, Nadine; Jackson, Louise; Rayanagoudar, Girish; Ruifrok, Anneloes E; Dodds, Julie; Molyneaux, Emma; van Poppel, Mireille Nm; Poston, Lucilla; Vinter, Christina A; McAuliffe, Fionnuala; Dodd, Jodie M; Owens, Julie; Barakat, Ruben; Perales, Maria; Cecatti, Jose G; Surita, Fernanda; Yeo, SeonAe; Bogaerts, Annick; Devlieger, Roland; Teede, Helena; Harrison, Cheryce; Haakstad, Lene; Shen, Garry X; Shub, Alexis; Beltagy, Nermeen El; Motahari, Narges; Khoury, Janette; Tonstad, Serena; Luoto, Riitta; Kinnunen, Tarja I; Guelfi, Kym; Facchinetti, Fabio; Petrella, Elisabetta; Phelan, Suzanne; Scudeller, Tânia T; Rauh, Kathrin; Hauner, Hans; Renault, Kristina; de Groot, Christianne Jm; Sagedal, Linda R; Vistad, Ingvild; Stafne, Signe Nilssen; Mørkved, Siv; Salvesen, Kjell Å; Jensen, Dorte M; Vitolo, Márcia; Astrup, Arne; Geiker, Nina Rw; Kerry, Sally; Barton, Pelham; Roberts, Tracy; Riley, Richard D; Coomarasamy, Arri; Mol, Ben Willem; Khan, Khalid S; Thangaratinam, Shakila
abstract

Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.

2016 - Myo-inositol may prevent gestational diabetes onset in overweight women: a randomized, controlled trial [Articolo su rivista]
Santamaria, Angelo; Di Benedetto, Antonino; Petrella, Elisabetta; Pintaudi, Basilio; Corrado, Francesco; D’Anna, Rosario; Neri, Isabella; Facchinetti, Fabio
abstract

Objective: To evaluate whether myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) rate in overweight women. Methods: In an open-label, randomized trial, myo-inositol (2 g plus 200 μg folic acid twice a day) or placebo (200 μg folic acid twice a day) was administered from the first trimester to delivery in pregnant overweight non-obese women (pre-pregnancy body mass index ≥ 25 and < 30 kg/m2). The primary outcome was the incidence of GDM. Results: From January 2012 to December 2014, 220 pregnant women were randomized at two Italian University hospitals, 110 to myo-inositol and 110 to placebo. The incidence of GDM was significantly lower in the myo-inositol group compared to the placebo group (11.6% versus 27.4%, respectively, p = 0.004). Myo-inositol treatment was associated with a 67% risk reduction of developing GDM (OR 0.33; 95% CI 0.15–0.70). Conclusions: Myo-inositol supplementation, administered since early pregnancy, reduces GDM incidence in overweight non-obese women.

2015 - A challenging case of pregnancy with placenta accreta and very rare irregular antibodies versus Cromer blood group system: a case report [Articolo su rivista]
Busani, Stefano; VOLPI GHIRARDINI, Annamaria; Petrella, Elisabetta; Neri, Isabella; Casari, Federico; Venturelli, Donatella; De Santis, Mario; Montagnani, Giuliano; Facchinetti, Fabio; Girardis, Massimo
abstract

ntroduction: This report describes the challenges of treating a pregnant woman who had a rare case of critical placenta accreta with concurrent Cromer system anti-Tc(a) and anti-Kidd A alloantibodies. No previous case of such alloimmunization in a patient with placenta accreta has been reported. Case presentation: A 28-year-old African woman with anti-Cromer Tc(a) antibodies, anti-Kidd A antibodies and placenta accreta was admitted to the obstetric emergency department at our university hospital with persistent vaginal bleeding. Her rare Cromer blood group system antibodies had been diagnosed 1 month earlier; no compatible blood had been found despite a worldwide search. We performed a cesarean section after placement of Fogarty balloons in her uterine arteries with preoperative endovascular interventional radiology. Other therapeutic interventions included preoperative iron administration to raise hemoglobin and the scheduled predeposit of autologous blood. Intraoperative therapeutic management was aimed at preventing coagulopathy and massive bleeding. With the use of alternative medical techniques determined during perioperative planning, her intraoperative blood loss was only 1000mL, despite the placenta accreta. She was discharged from the hospital 4 days after cesarean section. Conclusions: To the best of our knowledge, this is the first report of an alloimmunized patient with two different alloantibodies and concurrent high risk of bleeding because of placenta accreta. The close collaboration among obstetricians, anesthesiologists, interventional radiologists, blood bank pathologists and intensive care doctors prevented serious consequences in this patient. The exceptional feature of this case is the patient's double risk: the placenta accreta and the inability to transfuse compatible blood. These two extreme situations challenged the multidisciplinary medical team.

2015 - Erratum to: Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes: individual patient data (IPD) meta-analysis and health economic evaluation [Articolo su rivista]
Ruifrok, Anneloes E; Rogozinska, Ewelina; van Poppel, Mireille N. M; Rayanagoudar, Girish; Kerry, Sally; de Groot, Christianne J. M; Yeo, Seonae; Molyneaux, Emma; Barakat Carballo, Ruben; Perales, Maria; Bogaerts, Annick; Cecatti, Jose G; Surita, Fernanda; Dodd, Jodie; Owens, Julie; El Beltagy, Nermeen; Devlieger, Roland; Teede, Helena; Harrison, Cheryce; Haakstad, Lene; Shen, Garry X; Shub, Alexis; Motahari, Narges; Khoury, Janette; Tonstad, Serena; Luoto, Riitta; Kinnunen, Tarja I; Guelfi, Kym; Facchinetti, Fabio; Petrella, Elisabetta; Phelan, Suzanne; Scudeller, Tânia T; Rauh, Kathrin; Hauner, Hans; Renault, Kristina; Sagedal, Linda Reme; Vistad, Ingvild; Stafne, Signe Nilssen; Mørkved, Siv; Salvesen, Kjell Åsmund; Vinter, Christina; Vitolo, Marcia; Astrup, Arne; Geiker, Nina Rica Wium; Mcauliffe, Fionnuala; Poston, Lucilla; Roberts, Tracy; Riley, Richard D; Coomarasamy, Arri; Khan, Khalid S; Mol, Ben Willem; Thangaratinam, Shakila
abstract

After publication of this work [1], we noted that we inadvertently failed to include the complete list of all coauthors and that sample sizes of some of the trials listed in Table two were incorrect. The full list of authors has now been added and includes the names of all authors within the i-WIP Collaborative Network. The Authors’ contributions and competing interests section modified accordingly. We are publishing this erratum to update the author list, which is as follows: Anneloes E Ruifrok, Ewelina Rogozinska, Mireille NM van Poppel, Girish Rayanagoudar, Sally Kerry, Christianne JM de Groot, SeonAe Yeo, Emma Molyneaux, Fionnuala McAuliffe, Lucilla Poston, Tracy Roberts, Richard D Riley, Arri Coomarasamy, Khalid Khan, Ben Willem Mol, Ruben Barakat Carballo, Maria Perales, Annick Bogaerts, Jose G Cecatti, Fernanda Surita, Jodie Dodd, Julie Owens, Nermeen El Beltagy, Roland Devlieger, Helena Teede, Cheryce Harrison, Lene Haakstad, Garry X Shen, Alexis Shub, Narges Motahari, Janette Khoury, Serena Tonstad, Riitta Luoto, Tarja I Kinnunen, Kym Guelfi, Fabio Facchinetti, Elisabetta Petrella, Suzanne Phelan, Tânia T Scudeller, Kathrin Rauh, Hans Hauner, Kristina Renault, Linda Reme Sagedal, Ingvild Vistad, Signe Nilssen Stafne, Siv Mørkved, Kjell Åsmund Salvesen, Christina Vinter, Marcia Vitolo, Arne Astrup, Nina Rica Wium Geiker and Shakila Thangaratinam. The sample sizes of trials included in Table two have been corrected (Table 1). We are publishing this erratum to update these trial sample sizes, which include Dodd 2014 (n = 2212), Prevedel 2003 (n = 41), Renault 2013 (n = 425), Stafne 2012 (n = 855), Vinter 2011 (n = 360), Walsh 2012 (n = 800) and Wolff 2008 (n = 66).

2015 - Induction of labor in women that had a previous cesarean delivery [Articolo su rivista]
Facchinetti, Fabio; DEL GIOVANE, Cinzia; Petrella, Elisabetta; Annessi, Eleonora
abstract

This study aims to evaluate factors that predict the likelihood of the success of induction of labor (IOL) in women that had a previous cesarean section (pCS).

2015 - Myo-inositol Supplementation for Prevention of Gestational Diabetes in Obese Pregnant Women: A Randomized Controlled Trial [Articolo su rivista]
Dʼanna, Rosario; Di Benedetto, Antonino; Scilipoti, Angela; Santamaria, Angelo; Interdonato, Maria Lieta; Petrella, Elisabetta; Neri, Isabella; Pintaudi, Basilio; Corrado, Francesco; Facchinetti, Fabio
abstract

OBJECTIVE: To evaluate whether myo-inositol supplementation, an insulin sensitizer, reduces the rate of gestational diabetes mellitus (GDM) and lowers insulin resistance in obese pregnant women. METHODS: In an open-label, randomized trial, myo-inositol (2 g plus 200 micrograms folic acid twice a day) or placebo (200 micrograms folic acid twice a day) was administered from the first trimester to delivery in pregnant obese women (prepregnancy body mass index 30 or greater. We calculated that 101 women in each arm would be required to demonstrate a 65% GDM reduction in the myo-inositol group with a statistical power of 80% (0.05). The primary outcomes were the incidence of GDM and the change in insulin resistance from enrollment until the diagnostic oral glucose tolerance test. RESULTS: From January 2011 to April 2014, 220 pregnant women at 12-13 weeks of gestation were randomized at two Italian university hospitals, 110 to myo-inositol and 110 to placebo. Most characteristics were similar between groups. The GDM rate was significantly reduced in the myo-inositol group compared with the control group, 14.0% compared with 33.6%, respectively (P.001; odds ratio 0.34, 95% confidence interval 0.17-0.68). Furthermore, women treated with myo-inositol showed a significantly greater reduction in the homeostasis model assessment of insulin resistance compared with the control group, -1.0±3.1 compared with 0.1±1.8 (P.048). CONCLUSION: Myo-inositol supplementation, started in the first trimester, in obese pregnant women seems to reduce the incidence in GDM through a reduction of insulin resistance.

2015 - Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging [Articolo su rivista]
Fiocchi, Federica; Petrella, Elisabetta; Nocetti, Luca; Currà, Serena; Ligabue, Guido; Costi, Tiziana; Torricelli, Pietro; Facchinetti, Fabio
abstract

This study aimed to evaluate 3-T magnetic resonance imaging in the analysis of caesarean scars in women with prior caesarean section (pCS) and investigate the potential added value of diffusion tensor imaging (3T-MR-DTI) with fibre tracking reconstruction, compared with transvaginal ultrasound (TVUS). Thirty women who had previously undergone elective CS in a singleton pregnancy at term were examined (19 women with one pCS formed group 1 and 11 women with two pCS formed group 2). Patients underwent TVUS and 3T-MR-DTI within 2 days. Twelve women with prior vaginal delivery served as controls and underwent only 3T-MR. Uterine fibre architecture was depicted by MR-DTI with 3D tractography reconstruction providing quali-quantitative analysis of fibre, described as the reduction of number of longitudinal fibres that run through the uterine scar. Six subjects were excluded. According to 3T-MR morphology, scars were described as linear (n = 12) and retracting (n = 12); disagreement with TVUS was 54 %. The thickness of myometrium at the scar level was found to be significantly greater with 3T-MR compared to TVUS in linear scars (p = 0.01). No difference was found among retracting scars. In controls, according to 3T-MR-DTI, longitudinal myometrial fibres running in the anterior wall were similar to those in the posterior wall at same level -2 %; -27 % + 22 %). In groups 1 and 2 there was significant reduction in anterior fibres compared to posterior ones (-53 %; -77 % - 34 %; p = 0.0001). Among retracting scars, fibre reduction was significantly higher compared to linear scars, p &lt; 0.016. The added value of 3T-MR with DTI lies in the prompt evaluation of muscle fibre remaining at scar level.

2015 - [11-OR]: Myo-inositol in the prevention of gestational diabetes and its complications [Abstract in Rivista]
D'Anna, Rosario; Santamaria, Angelo; Corrado, Francesco; Benedetto, Antonino Di; Petrella, Elisabetta; Facchinetti, Fabio
abstract

To check the hypothesis that myo-inositol supplementation, an insulin sensitizing substance, may reduce gestational diabetes mellitus (GDM) onset and insulin resistance in obese pregnant women.

2014 - Dietary interventions, lifestyle changes, and dietary supplements in preventing gestational diabetes mellitus: a literature review [Articolo su rivista]
Facchinetti, Fabio; Dante, Giulia; Petrella, Elisabetta; Neri, Isabella
abstract

Gestational diabetes mellitus (GDM) is associated with increased rates of fetal morbidity and mortality, both during the pregnancy and in the postnatal life. Current treatment of GDM includes diet with or without medications, but this management is expensive and poorly cost-effective for the health care systems. Strategies to prevent such condition would be preferable with respect to its treatment. The aim of this literature review was to evaluate studies reporting the efficacy of the most used approaches to prevent GDM as well as evidences of efficacy and safety of dietary supplementations. Systematic literature searches were performed in electronic databases, covering the period January 1983 to April 2014. Randomized controlled clinical trials were included. Quality of the articles was evaluated with the Jadad scale. We did not evaluate those articles that were already entered in the most recent systematic reviews, and we completed the research with the trials published thereafter. Of 55 articles identified, 15 randomized controlled trials were eligible. Quality and heterogeneity of the studies cannot allow firm conclusions. Anyway, trials in which only intake or expenditure has been targeted mostly reported negative results. On the contrary, combined lifestyle programs including diet control (orienting food intake, restricting energy intake) associated with moderate but continuous physical activity exhibit better efficacy in reducing GDM prevalence. The results from dietary supplements with myoinositol or probiotics are promising. The actual evidences provide enough arguments for implementing large-scale, high-quality randomized controlled trials looking at the possible benefits of these new approaches for preventing GDM.

2014 - The l-arginine/nitric oxide pathway is impaired in overweight/obese pregnant women [Articolo su rivista]
Petrella, Elisabetta; Pignatti, Lucrezia; Neri, Isabella; Facchinetti, Fabio
abstract

To evaluate the l-arginine/NO system and its role in insulin signaling and endothelial function during the pregnancy of women of different BMI categories.

2008 - Folates and Osteoporosis [Relazione in Atti di Convegno]
Cagnacci, Angelo; Petrella, Elisabetta; Xholli, Anjeza; Cannoletta, Marianna
abstract

I livelli di follati più che quelli di omocisteina sonno correlati in maniera diretta alla densità minerale ossea delle vertebre lombari di donne in postmenopausa

2008 - Postmenopausal osteoporosis: relation with folates, vitamin B12 and Homocysteine [Abstract in Rivista]
Cagnacci, Angelo; Bagni, B; Petrella, Elisabetta; Xholly, A; Generali, Matteo; Zanin, Renata; Cannoletta, Marianna; Volpe, Annibale
abstract

-

2008 - Supplementazione di folati e protezione cardiovascolare nella donna in postmenopausa [Abstract in Rivista]
Cagnacci, Angelo; Cannoletta, Marianna; Arangino, S; Ferrari, Serena; Caretto, S; Petrella, Elisabetta; Zanin, Renata; Volpe, Annibale
abstract

-

2007 - Drospirenone: dati di sicurezza a lungo termine [Altro]
Cagnacci, Angelo; Ferrari, Serena; Cannoletta, Marianna; Generali, Matteo; Tirelli, A; Alessandrini, Chiara; Petrella, Elisabetta; Xholli, Anjeza; Volpe, Annibale
abstract

-

2007 - Modificazioni della secrezione surrenalica in menopausa ed implicazioni cliniche. [Altro]
Cagnacci, Angelo; Caretto, S; Petrella, Elisabetta; Xholli, Anjeza; Cannoletta, Marianna; Zanin, Renata; Volpe, Annibale
abstract

-

2007 - Ritmicità circannuale in Ostetricia: Impatto sugli esiti riproduttivi [Abstract in Atti di Convegno]
Cagnacci, Angelo; Cannoletta, Marianna; Zanin, Renata; Petrella, Elisabetta; Caretto, S; Xholli, Anjeza; Generali, Matteo; Volpe, Annibale
abstract

-

2007 - Ruolo per i folati in Menopausa [Altro]
Cagnacci, Angelo; Xholli, Anjeza; Petrella, Elisabetta; Cannoletta, Marianna; Caretto, S; Generali, Matteo; Zanin, Renata; Ferrari, Serena; Volpe, Annibale
abstract

-