Browsing by Author "Eskicioglu, F"
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Item The role of angiogenic factors in first trimester pregnancy lossesEskicioglu, F; Özbilgin, K; Taskend, S; Önal, T; Gökmen, TObjective: A good blood supply towards the peri-implantation endometrium is an essential requirement for pregnancy. Intermedin (IMD), vascular endothelial growth factor (VEGF), and endothelial nitric oxide synthase (eNOS), are angiogenic and vasoactive agents that play contributory roles in endometrial vascularity. The goal of this study was to immunohistochemically investigate the roles of various vasoactive factors in first trimester pregnancy losses. Materials and Methods: This was a prospective case-controlled study carried out on decidual and placental tissue samples obtained from women with unwanted pregnancies who served as the control group (n=10), and those with missed abortions who were the missed abortion group(n = 10). Immunohistochemistry techniques were used to compare IMD, receptor activity modifying protein (RAMP)1, RAMP2, RAMP3, VEGF, and eNOS expression of decidual and placental cells. Immunostaining for these factors was evaluated semiquantitatively by H-score analysis. Results: IMD and RAMPs in decidual cells exhibited higher expression in the control group. However, IMD and RAM-22 had a stronger expression in placental cells in the missed abortion group. In the control group, VEGF and eNOS had a higher expression in decidual cells and on the placental side, especially in syncytiotrophoblasts and cytotrophoblasts. Conclusion: Expressions of vasoactive agents, such as IMD, VEGF, and eNOS, decrease in first trimester pregnancy losses. Additionally, a compensatory mechanism against decreased endometrial and subendometrial vascularity results in the death of the embryo/fetus enhances in missed abortion cases. This mechanism characterized by increased expressions of IMD and RAMP2 initially begins in the syncytiotrophoblasts and cytotrophoblasts.Item Relationship between mean platelet volume and vitamin D deficiency in gestational diabetes mellitusGur, EB; Karadeniz, M; Genc, M; Eskicioglu, F; Yalcin, M; Hepyilmaz, I; Guclu, SObjective: To investigate whether vitamin D deficiency is associated with high mean platelet volume (MPV) in pregnancies diagnosed with gestational diabetes mellitus (GDM) compared to healthy pregnancies. Subjects and methods: This study included 200 pregnant women. 25-hydroxyvitamin D-3 (25(OH)D-3) and MPV values were monitored between pregnant women with GDM and normal glucose metabolism. Correlation between 25(OH)D-3 and MPV was calculated both in GDM and healthy pregnancies. Both 25(OH)D-3 level in different MPV percentile (<= 50, 50-75, 75-90, >= 90 percentile) and MPV value in different 25(OH)D-3 level (<= 10, 10-20, >= 20 ng/mL) were calculated. Results: Low 25(OH)D-3 level and high MPV were observed both in GDM group (p = 0.007, p = 0.06, respectively) and in glucose metabolism disorders (GMD) group (p = 0.03, p = 0.04, respectively). There was no significant relationship between 25(OH)D-3 and MPV in healthy pregnancies. Whereas, it is observed that there is a negative, but statistically insignificant correlation between MPV and 25(OH)D-3 pregnant women with GMD (r = 0.1, r = -0.7, respectively). MPV values had significantly higher in vitamin D deficient group than pregnant women with normal 25(OH)D-3 level in GMD group (p = 0.04). The optimal 25(OH)D-3 cut off point for predicting future cardiovascular risk was 10.4 ng/mL (area under curve (AUC) = 0.58). Conclusions: Vitamin D deficiency may contribute to an increased risk for future cardiovascular diseases and a risk of thrombotic complications in pregnant women with GDM.Item Diagnostic Modalities in Premature Rupture of MembranesEskicioglu, F; Gur, EBObjectives: Rupture of membranes prior to the onset of labor is known as Premature Rupture of Membranes ( PROM). Early and correct diagnosis is crucial in order to prevent fetal and maternal risks that can be life threatening. We aimed to investigate the diagnostic ability of the tests in PROM. Materials and Methods: Nitrazine test, fern test, amnio-dye test, biochemical tests (insulin-like growth factor binding protein-1 and placental alpha microglobulin-1) were evaluated in terms of effectiveness in diagnosis of PROM. Results: A gold standard method has not yet been defined in PROM. Diagnostic tests (nitrazine test, fern test, Insulin-like Growth Factor Binding Protein-1 IGFBP-1 and Placental Alpha Microglobulin-1 PAMG-1) should be used when the diagnosis is not certain following history, examination with sterile speculum and ultrasonography evaluation. Conclusion: IGFBP-1 and PAMG-1 are tests based on bedside immunochromatographic method. Especially, PAMG-1 comes into prominence with its high sensitivity and specificity.Item Evaluation of the Effects of Different Anesthetic Techniques on Neonatal Bilirubin LevelsEskicioglu, F; Ozlem, S; Bilgili, G; Baytur, YObjectives: The aim of the present study was to determine whether different anesthetic techniques applied for vaginal delivery and cesarean section affect neonatal bilirubin levels in the first 24 hours of life. Materials and Methods: A total of 511 neonates delivered by vaginal route or cesarean section were included in the study. The neonates were classified according to method of delivery and anesthetic agents as group A (cesarean section / general anesthesia with sevoflurane), group B (cesarean section / spinal anesthesia with bupivacaine hydrochloride), group C (vaginal delivery with episiotomy / local anesthesia with prilocaine hydrochloride) and group D (vaginal delivery/ no anesthesia). The levels of neonatal serum bilirubin in the groups were compared. Results: There was no difference between group A and group B in terms of neonatal bilirubin levels (p = 0.98). Depending on the use of prilocaine hydrochloride as local anesthetic agent in the vaginal delivery, there was no significant difference between the groups C and D, in terms of the neonatal bilirubin levels (p = 0.99). The serum levels of bilirubin in cesarean section groups were significantly higher than those of the vaginal delivery groups (p < 0.001). Conclusion: Prilocaine hydrochloride used for episiotomy did not exert any effects on neonatal hyperbilirubinemia. However, cesarean section with sevoflurane and bupivacaine hydrochloride seemed to result in increased bilirubin levels.Item The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancyEskicioglu, F; Özdemir, AT; Turan, GA; Gür, EB; Kasap, E; Genç, MObjective: Ectopic pregnancy (EP) is the major cause of maternal morbidity and is responsible for maternal mortality in the first trimester In order to reduce undesirable results, it is necessary to find rapid and accurate, non-surgical diagnostic tests for EP The goal of the study was to investigate the differences in complete blood count parameters between tubal EPs and healthy pregnancies in be used in the diagnosis of ectopic pregnancy Study design: White blood cell (WBC), neutrophil, monocyte, lymphocyte, platelet (PLT) counts, mean PLT volume (MPV) and PLT distribution width (POW) levels in the complete blood count samples have been obtained from subjects with diagnosed tubal EP (n=78; study group) and women with healthy intrauterine gestations (n=79; control group). Statistical comparisons between groups were performed using the t test Results: POW levels were found to be significantly higher in the control group than EP (p<0.001). However no differences between the study and control groups with regard to PLT and MPV levels were observed. WBC levels were found to be significantly higher in the EP group as compared to controls (p<0.001). When leukocyte differentials were compared, monocyte counts in the EP group were significantly higher than in controls (p=0.005). No statistically significant differences in neutrophil and lymphocyte values were observed in either group. Conclusion: POW as an indicator of PLT activation is lower in tubal EP than intrauterine pregnancy so, possibly endometrial invasion in the intrauterine pregnancy needs more PLT activation. Monocyte counts are higher in tubal indicating that monocyte activation in the pathophysiology of EP could be effective in the formation of tubal motility and microenvironment regulation.Item Prophylactic vitamin D supplementation in ovarian hyperstimulation syndrome: an animal study (vol 292, pg 421, 2015)Turan, GA; Eskicioglu, F; Sivrikoz, ON; Cengiz, H; Gur, EB; Tatar, S; Sahin, N; Yilmaz, OItem Prophylactic vitamin D supplementation in ovarian hyperstimulation syndrome: an animal studyTuran, GA; Eskicioglu, F; Sivrikoz, ON; Cengiz, H; Gur, EB; Tatar, S; Sahin, N; Yilmaz, OTo investigate the effect of vitamin D in ovarian hyperstimulation syndrome (OHSS). In this animal study, 28 immature female Wistar rats were divided into four groups: group 1 (control); group 2 (ovarian stimulation); group 3 (OHSS group); group 4 (OHSS + vitamin D group). All groups were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight, ovarian diameter, vascular endothelial growth factor (VEGF) expression (immunohistochemistry) in ovarian tissue and pigment epithelium-derived factor (PEDF) level in the serum (ELISA test) with the Kruskal-Wallis and Mann-Whitney U tests. VEGF expression in the vitamin D group was similar to that in the OHSS group. However, the PEDF level was significantly higher in the vitamin D group (p = 0.013). Prophylactic vitamin D supplementation is not sufficiently effective in preventing OHSS. Vitamin D effectively increases PEDF, which has an opposing effect on VEGF, which plays a key role in OHSS. Thus, the protective effect of Vitamin D on OHSS should be investigated with a vitamin D deficient model in the study group.Item Ultrasonographic visceral fat thickness measurement may be a good scan test for prediction of gestational diabetes mellitusGur, EB; Genc, M; Eskicioglu, F; Kurtulmus, S; Guclu, SItem Myo-inositol is a promising treatment for the prevention of ovarian hyperstimulation syndrome (OHSS): an animal study (vol 292, pg 1163, 2015)Turan, GA; Eskicioglu, F; Sivrikoz, ON; Cengiz, H; Adakan, S; Gur, EB; Tatar, S; Sahin, N; Yilmaz, OItem The role of selectins in the first trimester pregnancy lossEskicioglu, F; Laçin, S; Özbilgin, K; Köse, CObjective: There are no well-defined findings about reasons for first trimester abortion in some pregnancy cases. Selectins are cell adhesion proteins which are important for blastocyst implantation in the decidua. The goal of the study was to investigate the role of selectins in first trimester pregnancy loss by immunohistochemistry Study design: Decidual and placental tissue samples have been obtained from the women with unwanted pregnancy as the control group (n=40) and missed abortion (n=40) as the study group. Immunohistochemistry technique has been used to compare P, L and E-selectin expression of the fibroblast and the decidual cells in uterine decidual stroma; and fibroblasts and mesenchymal cells in placental villous stroma. Immunostaining for P,L,E-Selectin has been evaluated semiquantitatively by HSCORE analysis. Results: Decidual cells, for E and L-selectin showed stronger staining in the study group than controls, and the difference was statistically significant (p = 0.001, p = 0.001). P-selectin showed stronger staining in the control group, but the difference was not as significant as the E and L-selectins (p=0.04). In the placenta, cytotrophoblasts and syncytiotrophoblasts showed stronger staining for P,E,L-selectins for the control group (p<0.001, p=0.001 and p<0.001, respectively). Conclusion: Strong expression of each of the three investigated selectins in healthy pregnancy villi shows their contribution to implantation and strong placentation. There is a need for better understanding of the functions of adhesive molecules in these events to reveal unknown causes for pregnancy loss.Item Myo-inositol is a promising treatment for the prevention of ovarian hyperstimulation syndrome (OHSS): an animal studyTuran, G; Eskicioglu, F; Sivrikoz, O; Cengiz, H; Adakan, S; Gur, E; Tatar, S; Sahin, N; Yilmaz, OPurpose To evaluate the efficacy of myo-inositol (MI) pretreatment in OHSS. Methods In this experimental OHSS rat model, 42 immature Wistar albino female rats were divided into 6 groups: (1) the control group, (2) the ovarian stimulation group, (3) the OHSS group, (4) the OHSS + Metformin group, (5) OHSS + MI group, (6) OHSS + Metformin + MI group. OHSS was established after treatment with metformin and myo-inositol for 14 days, in the meanwhile the treatment of metformin and myo-inositol was also continued. All animals were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight and diameter, ovarian VEGF, COX-2 and PEDF expression (immunohistochemistry), serum PEDF and estradiol (E2) levels. Results Vascular permeability, VEGF and COX-2 expressions were reduced in animals treated with MI and/or metformin. While PEDF expression was increased in the groups taking metformin, there was no difference in PEDF expression in the group taking MI and OHSS group. There was no significant difference in serum PEDF levels between groups. Blood E2 levels were decreased in groups treated with MI or metformin compared to the OHSS group. Conclusions Our data demonstrate that myo-inositol is effective in preventing OHSS, similar to metformin. Although the two drugs are thought to act through distinct mechanisms, there is no apparent benefit to co-treatment with both drugs in an animal model of OHSS. Administration of myo-inositol prior to IVF treatment may favor the control of ovulation induction. Further studies are necessary to elucidate the mechanism of action and further support our findings.Item The effect of vitamin D level in pregnancy on postpartum depressionGur, EB; Genc, M; Eskicioglu, F; Kurtulmus, S; Guclu, SItem The association of HLA-G and immune markers in recurrent miscarriagesEskicioglu, F; Özdemir, AT; Özdemir, RB; Turan, GA; Akan, Z; Hasdemir, SPObjective: To determine role of human leukocyte antigen (HLA)-G, CD8, CD16, CD56, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha for recurrent miscarriages in feto-maternal interface. Method: Chorion and decidua samples were obtained from 11 women with unwanted pregnancies (healthy pregnancy, HP) and 10 women with missed abortion diagnosis after at least two pregnancy losses (recurrent miscarriage, RM). In addition, endometrial tissues were obtained from 10 non-pregnant women (NonP). The expressions of markers were evaluated using the Western blot analysis. The values obtained between different groups were compared. Results: The highest protein expression of CD56 was found in the HP compared to NonP and RM. Meanwhile, the lowest protein expression of CD16 was observed in the NonP compared to HP and RM. The HLA-G expression exhibited the highest level in HP; however, there was no statistically significant difference between groups. CD8 and IFN gamma expressions were lowest in the NonP group; however, TNF-alpha was highest in the RM group. Conclusions: The CD56 expression of uterine NK cells may be an indicator of a HP. However, not statistically significant, the increased expression of CD16, CD8, and also significantly increased expression of TNF may be associated with the predominant cytotoxic activity in the maternal immune system in patients with RM. Although there was no change in the expression of HLA-G, this finding may mean that the maternal immune system is unresponsive to HLA-G-mediated immunosuppressive signals originating from the fetus in these cases.Item Montelukast is effective in preventing of ovarian hyperstimulation syndrome; an experimental studyEskicioglu, F; Turan, GA; Sivrikoz, ON; Cengiz, H; Akan, Z; Sahin, N; Yilmaz, O; Yesil, H; Vatansever, SObjectives: To determine the efficacy of montelukast in comparison with cabergoline in the prevention of ovarian hyperstimulation syndrome (OHSS) in rats. Material and methods: An experimental OHSS model was formed in 35 female Wistar rats. Rats (22 days old) were randomized into 5 groups, each containing 7 animals. The control group received no therapy; the mild OHSS group was administered pregnant mare serum gonadotropin (PMSG) 10 IU for 4 days, hCG 10 IU on the 5th day; the severe OHSS group received PMSG 10 IU for 4 days, hCG 30 IU on the 5th day. The montelukast group: received montelukast 10 mg/kg/day and the cabergoline group was administered cabergoline 100 mu g/kg/day via oral gavage for 6 days (days 22-27), in addition to those of severe OHSS. All groups were sacrificed on 28th day. Body weight, ovarian diameter and weight, vascular permeability, vascular endothelial growth factor (VEGF), semiquantitative VEGF receptor-1, and VEGF receptor-2 (VEGFR-2) immunohistochemistry were evaluated. Results: Ovarian diameter and VEGF expression were significantly lower in the montelukast and cabergoline groups than in the severe OHSS group. While montelukast was more effective in limiting vascular permeability in the severe OHSS, cabergoline was superior to montelukast with respect to the limiting effect on increased body weight and VEGFR-2 expression. Conclusions: The VEGF/VEGFR-2 interaction plays an important role in OHSS pathogenesis. Montelukast limits VEGF expression, and cabergoline reduces both VEGF and VEGFR-2 expressions; they are both effective therapies for the prevention of severe OHSS.Item The relationship between uterine prolapse and premalignant endometrial pathologyGenc, M; Celik, E; Eskicioglu, F; Gur, EB; Kurtulmus, S; Gulec, E; Guclu, SObjective: The aim of this study was to stress the importance of performing a thorough uterine assessment before selecting an organ sparing surgery in patients presenting with uterine prolapse and no other complaints. Materials and Methods: This study included a total of 111 participants who presented with pelvic organ prolapse and underwent hysterectomy for grades 3-4 uterine prolapse. The post-hysterectomy histopathology results were classified as benign (atrophic endometrium, proliferative or secretory endometrium) or patho-logic (endometrial hyperplasia, endometrial polyp, adenomyosis, myoma uteri, and endometrium carcinoma). Results: Of the 111 patients enrolled in this study, 23 (20.2%) had endometrial hyperplasia, eight (7.2%) had endometrial polyps, 30 (27%) had uterine fibroids, and 20 (18%) had adenomyosis. Conclusion: There may be premalignant lesions of the endometrium in both premenopausal and postmenopausal women presenting with uterine prolapse and no other symptoms. A chronic inflammatory process resulting from the extra-vaginal location of the uterus may play a role in the development of these lesions. Further studies are needed on this subject.Item Carotid intima-media thickness in postmenopausal women is associated with an endometrial thickness greater than 5 mmEskicioglu, F; Eskicioglu, MS; Özdemir, AT; Özyurt, BAim: The aim of this study was to investigate the relationship between ultrasonographic carotid intima-media thickness (C-IMT) and visceral fat thickness (VFT) and an endometrial thickness (ET) of more than 5 mm in postmenopausal women. Methods: C-IMT, VFT, and ET measurements were performed in 63 postmenopausal women using ultrasonography. The relationships between ultrasonographic data and demographic data, anthropometric measurements, such as waist circumference, metabolic syndrome parameters, and insulin resistance were examined. Moreover, the role of VFT and C-IMT in predicting an ET of more than 5mm was investigated. Results: Only the C-IMT was higher in the ultrasonographic measurements of women with an ET >5 mm (p = 0.03). Insulin resistance was also significantly higher in these women (p = 0.03). ET showed a positive correlation with VFT and body mass index (BMI) (r = 0.286, p = 0.02 and r = 0.249, p = 0.04), and C-IMT showed a positive correlation with age, pregnancy, parity, and time since menopause (p<0.05). Multivariate analysis showed that high-C-IMT levels were associated with an ET >5 mm (p = 0.04). Conclusions: There was a positive correlation between the ultrasonographic measures of VFT and ET, and high-C-IMT levels were independently associated with an ET>5 mm. Thus, C-IMT may be a predictor of pathologic ET in the postmenopausal period.Item Complete blood count parameters may have a role in diagnosis of gestational trophoblastic diseaseEskicioglu, F; Ulkumen, BA; Calik, EObjective: The goal of this study was to investigate whether gestational trophoblastic disease (GTD) and healthy pregnancy differ with respect to complete blood count parameters and these parameters can be used both to explain the pathophysiologic mechanisms and differentiate the two conditions from each other. Methods: The data obtained from 37 women with GTD and 61 healthy pregnancies (control group) regarding platelet (PLT), mean PLT volume (MPV) and PLT distribution width (PDW), and white blood cell (WBC) levels were evaluated. Patients with GTD were further subdivided into two groups composed of 20 partial mole (PM) and 17 complete mole (CM) cases. Results: PDW and WBC were lower in the GTD than the control. There were no differences for PLT and MPV. WBC was lower in PM and both WBC and PDW were lower in CM compared with control. ROC curve analysis revealed an area under curve (AUC) 75.5% for WBC and AUC 69.3% for PDW. A cut-off value was determined 8.19 for WBC with 81.0% sensitivity and 54.1% specificity. While, 15.85 were accepted for PDW, with 87.9% sensitivity and 44.4% specificity. Conclusion: Lower WBC in GTD may suggest that molar pregnancy requires a lower inflammatory reaction facilitating trophoblastic invasion. Lower PDW as an indicator of platelet activation in CM may suggest that CM requires less PLT activation than healthy pregnancy that needs stronger trophoblast invasion for normal placental development. Decreased PDW levels especially < 15.85 and WBC levels < 8.19 may alert clinicians for risk of GTD.Item Changes in distribution patterns of integrins in endometrium in copper T380 intrauterine device usersOruç, S; Vatansever, HS; Karaer, Ö; Eskicioglu, F; Narlikuyu, BIntrauterine contraception is the most cost-effective reversible method of contraception today, but its mechanism of action is not well understood. Our objective was to investigate immunohistochemical. distribution patterns of xv, x3, beta 1 integrins in women using a copper T380 intrauterine device (IUD) for different periods of time to obtain insight into the rote of integrins in intrauterine contraception. Endometrial biopsies were obtained from patients using T Cu380A IUD in follicular and luteat phases and in menopausal women grouped according to the period of time of IUD use (group 1: < 3 year, and group 2: >= 3 years). Each group consisted of 10 patients, with a total number of 60 patients. Labelling intensity of at integrins, except for beta 1 which increased in the follicular phase, were decreased in women who used IUD for >= 3 years when compared with group 1 in the follicular and luteat phases and in the menopause. We conclude that long-term use of IUD affects integrin expression in endometrium not only in follicular and luteat phases of premenopausal women but also in postmenopausal women. Copper IUD can inhibit binding of integrins to the extracellular matrix and it may cause inhibition of the implantation stage, which is crucial for pregnancy. (c) 2005 Elsevier GmbH. All rights reserved.Item Familial Tetra-Amelia SyndromeEskicioglu, F; Ülkümen, BA; Pala, HG; Koyuncu, FMTetra-amelia is known as an anomaly characterized by the absence of all four limbs. It is a rare congenital anomaly, with an incidence of 1.5-4 per 100,000 births. It occurs as a result of developmental interruption between 24th and 36th days after fertilization. Its etiology is not well known. It may be observed isolated or associated with other anomalies. In this paper, we present an interesting case of an intra-uterine diagnosed tetra-amelia male fetus with the recurrence in the previous two more male fetuses in the same family. Tetraamelia syndrome observed in all three male fetuses of a couple with blood relationship is presented. The first two male newborn died just after birth due to prematurity in 28th and 32nd weeks. The third male fetus was in 23nd weeks of the intrauterine life. There was no exposure to teratogenic agents in this pregnancy. It detected that the third male baby had subcutaneous edema, intra-abdominal ascites and lateral ventricle enlargement in cranium. Since tetra-amelia due to genetic inheritance based on X chromosome was suspected, the family was offered the options of termination of pregnancy, karyotype analysis and genetic consultation.Item Mid-pregnancy vitamin D levels and postpartum depressionGur, EB; Gokduman, A; Turan, GA; Tatar, S; Hepyilmaz, I; Zengin, EB; Eskicioglu, F; Guclu, SObjectives: Postpartum depression (PPD) is a common disorder that affects 10-15% of postpartum women, and it can have negative effects on both the mother and newborn. Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression. The aim of this prospective study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 (25 (OH)D3), a reliable measurement of vitamin D, during mid-pregnancy. Study design: The source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital, Sifa University. In order to better evaluate a possible effect between vitamin D levels and PPD, individuals with characteristics that put them at risk for developing PPD were excluded from the study. Serum 25 (OH)D3 levels were evaluated mid-pregnancy in the study group. Serum 25(OH)D3 concentrations <= 20 ng/mL (50 nmol/L) were classified as a mild deficiency and those <= 10 ng/mL (25 nmol/L) were classified as a severe deficiency. Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal PPD 1 week, 6 weeks, and 6 months after delivery. A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods. A logistic regression analysis was used to determine the independent effects of vitamin D on PPD. Results: Six hundred and eighty-seven pregnant women were included in this study. After excluding women due to PPD risk factors (in two stages), 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum. Eleven percent of our study group had severe vitamin D deficiency and 40.3% had mild vitamin D deficiency. The frequency of PPD was 21.6% at the 1st week, 23.2% at 6th week, and 23.7% at the 6th month. There was a significant relationship between low 25 (OH)D3 levels in mid-pregnancy and high EPDS scores, which is indicative of PPD for all three follow-up periods (p = 0.003, p= 0.004 and p < 0.001, respectively). In addition, there was a significant negative correlation between vitamin D levels and EDPS at all three time points (r= -0.2, -0.2, -0.3, respectively). Conclusions: Vitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD. More extensive studies are required to be carried out on this subject. (C) 2014 Elsevier Ireland Ltd. All rights reserved.