الفهرس 
RECURRENT MISCARRIAGEOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Recurrent pregnancy loss (RPL) is estimated to occur in 2%-4% of reproductive-age couples. Recurrent spontaneous miscarriage (RSM) remains a very disturbing event to the affected patients by this health problem; they are always anxious to find the underlying reasons for their miscarriages. This is also a major challenge to the treating physicians (Diejomaoh et al., 2007).
Intensive researches including immunological and genetic studies are still in progress to illustrate the cause of RSM. chromosomal abnormalities, uterine malformations or anomalies, hypothyroidism, cervical incompetence, antiphospholipid syndrome, bacterial infections and poly-cystic ovary syndrome (PCOS) are some of the etiological factors associated with RSM. There are some reports of high RSM rates in over weight/obese infertile women treated by ART (Maryamet al., 2012).
Other reports are the condition of PCOS which is probably linked with obesity; this may be due to the high prevalence of overweight/obesity in PCOS women. PCOS is associated with insulin resistance (IR) independent of total or fat- free body mass which can be a key factor behind the link between PCOS/obesity and the risk of spontaneous abortion (Tian et al., 2007).
IR is a condition in which the efficacy of insulin in promoting the absorption and utilization of glucose by organs, tissues, and cells is lower than normal. Individuals with IR show glucose levels that are either normal or high, and insulin levels that are more or no less than normal.
IR is often increased in 40% women with PCOS, and hyperinsulinaemia is an etiological factor in the pathogenesis of PCOS. Further studies detected a correlation between increasing insulin resistance and fasting insulin level, with PRL (Ehrmann et al., 2006).
This a case-control study which was performed during the period from (December 2013) till (June 2014). We had 80 participants presented to the outpatient clinic in Ain Shams University Maternity hospital; they were classified into two groups:
(group A) case group: 40 pregnant females at 6-13wks presenting with a history of recurrent pregnancy loss (two or more failed clinical pregnancies as documented by ultrasonography or histopathology examination according to the American Society of Reproductive Medicine) (ASRM, 2008).
(group B) control group: 40 pregnant females at 6-13wks with no history of abortion.
They were selected according to inclusion and exclusion criteria:
* Inclusion criteria:
1) Women in the child bearing period between 23-40 years.
2) All patients were pregnant.
3) The gestational age of both groups 6-13 weeks(1st trimester)
* Exclusion criteria:
1) Patients with history of gestational diabetes.
2) The patients on medication that could affect glucose metabolism at the time of the study (as metformin, Pioglitazone, rosiglitazone).
3) Patients with other causes of recurrent abortion as (thyroid dysfunction, uterine anomalies, chromosomal abnormalities, antphospholipid antibody syndrome).
4) Patients with PCOS in the control group (they have insulin resistance).
5) Obese patients (BMI >30).
For all participants consent (signed or verbal) was taken, detailed history taking, full examination including body mass index. The subjects were asked to go on a normal diet for 3 days prior to oral glucose tolerance test (OGTT). A fast for 8–10 h was required prior to sampling. A venous blood sample was drawn on the following morning from each subject to determine the concentrations of fasting glucose (FG) and fasting insulin (FI), afterwards subjects were required to drink a mixture of 75 g of pure glucose in 250 ml of water, venous blood samples were drawn again after 1, 2, and 3 h to determine the concentrations of glucose and insulin, blood samples for determination of fasting glucose and fasting insulin after 8-10hours fasting and oral glucose tolerance test (ADA , 2007). We measured also HOMA-IR, HOMA-B, AUCG and AUCI.
No statistically significant differences were found in age and BMI and gestational age the between the two groups. Also for fasting blood glucose, the difference was not statistically significant between the two groups.
The differences were statistically significant in blood glucose after 1h, 2h and 3h, between the two groups with higher values in recurrent miscarriage group than control group.
For fasting serum insulin, the difference was not statistically significant between the two groups. But for serum insulin after 1 h, 2 h and 3 h, the difference was statistically significant between the two groups with higher values in recurrent miscarriage group than control group.
For HOMA-IR and HOMA-b the difference was not statistically significant between the two groups. But for AUCG andAUCI,the difference was statistically significant between the two groups with higher values in recurrent miscarriage group than control group.
For AUCI/AUCG, the difference was not statistically significant between the two groups.