COVID-19, embarazo, vacunas y lactancia materna / COVID-19, pregnancy, vaccines and breastfeeding

Las mujeres embarazadas o en período de lactancia han sido excluidas de los ensayos clínicos sobre vacunas contra SARS-CoV-2, evitando así la obtención de datos sólidos que permitan determinar la seguridad e inmunogenicidad de las vacunas en esta población, a la vez que se han asociado peores resultados maternos ­ fetales. La evidencia acerca de la seguridad e inmunogenicidad en esta población es limitada, en base a estudios observacionales, con pocos casos y en mujeres vacunadas con plataformas ARNm, en las cuales no se ha descrito por ahora una mayor asociación a eventos adversos relacionados a vacunas, como tampoco, variaciones significativas en la respuesta inmunológica en comparación a la población no embarazada. También existen datos que documentan la adquisición de anticuerpos transplacentarios, considerándose de bajo riesgo la posibilidad de transmisión vertical. Se hacen necesarios ensayos clínicos que permitan precisar recomendaciones basadas en evidencia para esta población, en un contexto de utilización de emergencia de vacunas contra SARS-CoV-2. (AU)

Pregnant or breastfeeding women have been excluded from clinical trials on vaccines against SARSCoV-2, thus avoiding obtaining solid data to determine the safety and immunogenicity of vaccines in this population, as well as being associated worse maternal-fetal outcomes. The evidence about safety and immunogenicity in this population is limited, based on observational studies, with few cases and in women vaccinated with mRNA platforms, in which a greater association to adverse events related to vaccines has not been described or significant variations in the immune response compared to the non-pregnant population. There are also data that document the acquisition of transplacental antibodies, considering the possibility of vertical transmission as low risk. Clinical trials are necessary to evidence-based recommendations for this population, in a context of emergency use of vaccines against SARSCoV-2. (AU)

El efecto de la vitamina D3 y su relación. con el nivel de glóbulos blancos en las mujeres con aborto espontáneo, inyección intracitoplasmática de espermatozoides (ICSI) técnicao / The effect of vitamin D3 and its relationship with the level of white blood cells in women spontaneous miscarriage undergoing intracytoplasmic sperm injection (ICSI) technique

Women were studied undergoing ICSI for 84 who suffer non-pregnancy at the Fertility Center, Al-Sadr Medical Hospital in Najaf Governorate, Period between January 2019 and March 2020. WBC, Vitamin D3 and ß-hCG were measured, The pregnant women was divided into (Pregnancy Group, and spontaneous miscarriage) and then demonstrate the immunological effect on pregnancy of women after ICSI technique. Current resultsstudy showed a significant increase (p<0.05) in hormone level ß-hCG is evidence of the presence of high success rates for pregnancy in women who performed operations IVF, where the success rate at the beginning of the matter reached 61.9%, after which it decreased to 33.3% after the first three months due to the occurrence of spontaneous miscarriage of pregnant women due to various immunological and physiological reasons, a positive correlation between the level of ß-hCG and other parameters in the study (Vitamin D3 -WBC).Also The current resultsshowed a significant decrease in a groups (pregnancy failure) and the group (spontaneous miscarriage) compared with the control group (continued pregnancy) in relation to the level of vitamin D3 Also, The current results showed a significant increasein (pregnancy failure) and (spontaneous miscarriage) compared with control groups (continuation of pregnancy) in relation WBC numbers, and the present study founds a negative relationship between the level of vitamin D3 and WBC.

Evaluation of immunological parameters in pregnant women: low levels of B and NK cells / Avaliação dos parâmetros imunológicos em mulheres gestantes: baixos níveis de células B e NK

Abstract Objective To describe the immunological and hematological reference intervals of low-risk pregnant women. Methods A cross-sectional retrospective database analysis of a basic and translational study analyzing the hematological evaluation blood counts and immunophenotyping of TCD3 + , TCD4 + , TCD8 + , B, and natural killer (NK) cells of the peripheral blood in 79 low-risk pregnant women and of 30 control women from the state of Pernambuco, Brazil, was performed. Results No significant differences were detected between the hematological profiles of the 2nd and 3rd trimesters. Nevertheless, the median level of B cells decreased significantly in the 2nd (174 x 103 μL; p < 0.002) and 3rd trimesters (160 x 103 μL; p < 0.001), compared with the control group (296 x 103 μL). Similarly, the median level of NK cells was lower in the 2nd (134 x 103 μL; p < 0.0004) and 3rd trimesters (100 x 103 μL, p < 0.0004), compared with the control group (183 x 103 μL). In contrast, relative TCD4+ and TCD8+ levels increased in the 2nd and 3rd trimesters compared with the controls (TCD4 + : 2nd trimester = 59%; p < 0.001; 3rd trimester = 57%; p < 0.01; control = 50%; and TCD8 + : 2nd trimester = 31%; p < 0.001; 3rd trimester = 36%; p < 0.01; control = 24%). Conclusion Low-risk pregnant women have ~ 40% less B and NK cells in the peripheral blood, compared with non-pregnant women. These parameters may improve health assistance for mothers and contribute to define reference values for normal pregnancies.

Resumo Objetivo Descrever o intervalo de referência imunológico e hematológico de gestantes de baixo risco. Métodos Realizou-se uma análise retrospectiva, de um estudo básico e translacional, analisando o perfil hematológico e a imunofenotipagem das células TCD3 + , TCD4 + , TCD8 + , B e natural killer (NK) do sangue periférico de 79 gestantes de baixo risco e de 30 mulheres (controles) do estado de Pernambuco, Brasil. Resultados Não observamos diferenças significativas entre os perfis hematológicos do 2° e 3° trimestres. No entanto, houve redução das células B no 2° (média = 174 x 103 μL; p < 0,002) e no 3° trimestres (160 x 103 μL; p < 0,001), comparado como grupo controle (296 x 103 μL). A mediana das células NK foi menor no 2° (134 x 103 μL; p < 0,0004) e no 3° trimestres (100 x 103 μL; p < 0,0004), comparado com o grupo controle (183 x 103 μL). Porém, o percentual de TCD4+ e de TCD8+ aumentou no 2° e 3° trimestres em relação aos controles (TCD4 + : 2° trimestre = 59%; p < 0,001; 3° trimestre = 57%; p < 0,01; controle = 50%; e TCD8 + : 2° trimestre = 31%; p < 0,001; 3° trimestre = 36%; p < 0,01; controle = 24%). Conclusão Mulheres grávidas de baixo risco têm ~ 40% menos células B e NK no sangue periférico em comparação com mulheres não grávidas. Estes parâmetros podem melhorar a assistência à saúde das mães e contribuir para a definição de valores de referência para gestações normais.

Inmunología perinatal / Perinatal immunology

Se ha considerado que el útero gestante es un lugar inmunológicamente privilegiado, donde el feto es protegido del rechazo por el sistema inmune materno, mediante un amplio repertorio de estrategias de evasión que contribuye a la sobrevivencia del feto. La gestación en sí misma constituye un acontecimiento de equilibrio inmunológico y la tolerancia inmunológica permite la progresión del embarazo, donde participan una secuencia sincronizada de eventos que se inicia desde la concepción y fertilización para dar lugar a la implantación y progresa hasta alcanzar un embarazo a término. El sistema inmune es la principal barrera que poseemos para protegernos de las infecciones. Durante la vida intrauterina, el feto está protegido por la madre de las agresiones externas, por lo que no necesita que su sistema inmunológico sea operativo, sin embargo, al nacer, recibe una avalancha de elementos extraños, por lo que necesitará disponer de cierta protección, así como una preparación para ejecutar las defensas necesarias para su protección inmunológica. La inmunidad sérica durante la vida fetal queda limitada a la transferencia a través de la placenta de IgG materna, a pesar de que el feto tiene la facultad de sintetizar inmunoglobulinas desde las primeras etapas de la gestación. Al nacimiento, el niño tiene su sistema inmunológico completo, aunque inmaduro, pero es capaz de responder a los estímulos antigénicos. Tiene múltiples anormalidades en el desarrollo de su sistema inmune, que involucran a los anticuerpos/inmunoglobulinas, complemento y granulocitos pudiendo contribuir a la alta incidencia de sus infecciones. El recién nacido carece de memoria inmunológica debido a que, en condiciones normales, el feto está exento de estímulos producidos por antígenos extraños. Dicha memoria se va adquiriendo a medida que entra en contacto con los diferentes antígenos. Se obtendrá cierta protección a las infecciones entéricas gracias a las IgA que aporta la lactancia materna. La exposición prenatal y postnatal a productos microbianos ambientales que pueden activar la inmunidad innata, puede acelerar el proceso de maduración del sistema inmune.(AU)

It has been considered the pregnant women`s womb as an immunological exceptional place, where fetus is protected against been rejected because of maternal immune system by means of a wide groups of evasive strategies that help in its survival. Pregnancy itself is an immunological equilibrium state and the immunological tolerance allow the progression of this event, where participate a synchronized sequence of biological events started from conception and fertilization to allow the implantation, and progress until to reach the pregnancy end. The immune system is our main barrier against infections. During intrauterine life fetus is protected by the mother against external aggressions, therefore he don`t need an operative immune system, nevertheless, at birth the new organisms receive an avalanche of strange elements needing some kind of protection as well as a preparation to carry out the necessary defense for his immunological protection. Serum immunity during fetal life is limited to the transference of maternal IgG through placenta, despite fetus capability to synthesize immunoglobulins from first stages of gestation. At birth the babe has a complete immunological system although immature but capable to respond to antigenic stimulus. He has multiples abnormalities in the immune system development that take account antibodies/immunoglobulin, complement and granulocytes contributing to his high incidence of infections. Newborn lack immunological memory because in normal conditions fetus is not stimulated by odd antigens. This memory is acquired through the contact with different antigens. It will be obtained some protection against enteric infections because IgA from maternal lactation. The prenatal and postnatal exposition to environmental microbial products that activate the innate immunity can accelerate the immune system maturing process.(AU)

HTLV em gestantes de dois municípios da região sul da Bahia e avaliação da transmissão materno-infantil / HTLV in pregnant women in two cities of southern Bahia and evaluation of maternal-infant transmission

A prevalência de HTLV- 1 no Brasil é diversa, dependendo tanto da região geográfica quanto do grupo analisado. Um estudo populacional realizado em Salvador detectou prevalência de 1,76%, além de maior prevalência em mulheres e associação com menores níveis de escolaridade e renda. Como a via mais frequente de transmissão vertical do HTLV-1 é a amamentação e considerando a maior prevalência nas mulheres, é muito importante a realização de exames de triagem para HTLV-1 como parte do prénatal. Até o momento, não existem estudos publicados sobre a soroprevalência do HTLV-1 em gestantes na região sul da Bahia. No presente estudo, as gestantes foram selecionadas em dois centros de referência regionais de saúde do sul da Bahia. Um total de 2.766 gestantes atendidas na sala de pré-parto entre novembro de 2008 e maio de 2010 foram analisados. Um questionário foi aplicado, e todas as amostras de plasma reagentes foram testadas em duplicata e confirmadas por Western blot e PCR. Além disso, mulheres positivas foram contactadas e visitadas. Os membros da família que estavam presentes durante a visita foram convidados a serem testados para o HTLV...

The prevalence of HTLV-1 in Brazil is diverse, depending on both the geographic region and the group analyzed. A study conducted on general population revealed that the prevalence in Salvador was 1.76%. Besides, it was also found that the prevalence was higher amongst women and that the virus was associated with lower education and lower income. As the most frequent pathway of vertical transmission of HTLV-1 is breast-feeding, and considering the higher prevalence in women, it is very important to perform screening examinations for anti-HTLV-1...

Feto-maternal interactions and immunological tolerance of the mother to her semiallogeneic fetus

Pregnancy is a cooperative interaction between the mother and her fetus, allowing survival and normal growth of the fetus. Successful pregnancy remains a fascinating phenomenon as it resists the immunological rules of rejection. Immunological recognition of the fetus is vital for maintenance of gestation. The maternal immune system undergoes changes that lead to tolerance of the fetus. Inadequate recognition of fetal antigens may cause abortion. In fact, fetal cells express paternal alloantigens that are not recognized as foreign by the mother. A special balance between lymphocytes is present at the feto-maternal interface to control the immune response. In addition, placenta! trophoblasts act as a physical barrier and exert an immunoregulatory function. Trophoblast cells regulate the expression of human leucocyte antigens. Dysfunction of these cells leads to morphological and functional alterations of the feto-maternal barrier as well as to recurrent spontaneous abortions. Uterine natural killer cells are appropriate residents of the materno-fetal interface to support the adaptation of the blood vessels of the pregnant uterus and regulate trophoblast invasion into the decidua and myometrium. Cytokines are involved at the feto-placental unit by adapting normal T-cell trafficking and modulating the inflammatory process. This study discusses the complex immunological aspects of immune tolerance and the balance of immunity in pregnancy in terms of the role of the human leucocyte antigen, placental trophoblasts, maternal immunosuppression, immune cells, cytokines and immunoregulatory molecules at the feto-maternal interface

Seroprevalence of tetanus antibodies among pregnant women in Duhok Governorate, Iraq

Maternal immunization with tetanus toxoid [TT] is the most effective was to prevent neonatal tetanus. In Duhok, Iraq data indicate low vaccination coverage. This study assessed TT immunization status among 600 randomly selected pregnant women attending Azadi teaching hospital, Duhok for delivery, by both tetanus antibody seroprevalence and TT history. WHO criteria for protective levels were used for seroprevalence and vaccination history. Overall, 90% of the women at delivery had protective tetanus antitoxin titres compared to only 55% considered protected according to their vaccination history. Immunity rates for women who had received no TT vaccination, 1 dose, 2 doses and >/= 3 doses were 28.0%, 92.6%, 100.0% and 99.0% respectively. Groups with lower serological immunity levels were women aged less than 25 years, those reporting no history of vaccination and those living in Akre, Bardarash or Shekhan districts of Duhok. Tetanus immunity determined by seroprevalence of tetanus antitoxin levels exceeded that estimated by vaccination history, and serological markers should be used instead of vaccination history in determining immunity status

Inmunología del embarazo / Immunology of pregnancy

Uno de los fenómenos que abre más interrogantes en la Inmunología es ¿Por qué el embrión, comportándose como un injerto semialogénico, no es rechazado por la madre? Se sabe que la madre produce una activa respuesta inmunológica frente al feto y sin embargo, en condiciones normales, el rechazo inmunológico no se produce. En el presente trabajo de revisión, se describen algunos mecanismos por medio de los cuales se genera la tolerancia inmunológica específica de la madre hacia el embrión. Todos estos mecanismos son interdependientes, y en conjunto constituyen una trama para evitar el rechazo fetal. Aquí se detalla la acción de las hormonas sexuales femeninas sobre el sistema inmunológico, el cambio del perfil de citoquinas, la generación de proteínas inmunomoduladoras y de anticuerpos bloqueantes, el efecto de la expresión de los HLA-G y el papel de algunas células inmunocompetentes como los linfocitos T reguladores, las células dendríticas y las células asesinas naturales o Natural Killer. Asimismo se detallan otras vías por las cuales el embrión se defiende del ataque inmunológico materno como la inducción de la apoptosis en el endometrio y en los leucocitos, el metabolismo de hierro y triptofano, la inhibición del sistema del complemento y la expresión de anexinas.

One of the phenomena that offers more questions in Immunology is: Why the embryo, behaving like a semialogenic graft, is not rejected by the mother? It is known that the mother produces an active immunological response against the fetus and, nevertheless, in normal conditions, the immunological rejection does not take place. In the present work of revision, some mechanisms are described by means of which the specific immunological tolerance of the mother is generated towards the embryo. All these mechanisms are interdependent and altogether they constitute a safety network to avoid the fetal rejection. Here the effects of female sex hormones on the immunological system, the change of the profile of cytokines, the generation of immunomodulating proteins and blocking antibodies, the effect of the expression of the HLA-G and the paper of some cells, like Regulatory T lymphocytes, dendritic and Natural Killer cells, are detailed. Also other routes by which the embryo defends itself of the maternal immunological attack are described, like the induction of apoptosis in the endometrium and leukocytes, the tryptophan and iron metabolisms, the inhibition of the complement system and the expression of annexins.

Anti-Toxoplasma gondii antibodies in pregnant women and their newborn infants in the region of São José do Rio Preto, São Paulo, Brazil / Anticorpos anti-Toxoplasma gondii em gestantes e seus neonatos na região de São José do Rio Preto, São Paulo, Brazil

CONTEXT AND OBJECTIVE: Toxoplasmosis transmission during pregnancy can cause severe sequelae in fetuses and newborns. Maternal antibodies may be indicators of risk or immunity. The aim here was to evaluate seropositivity for anti-Toxoplasma gondii (anti-T. gondii) immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies and IgG avidity in pregnant women and their newborn infants. DESIGN AND SETTING: Cross-sectional study in a high-risk pregnancy outpatient clinic. METHODS: Serum samples from pregnant women (n = 87) and their respective newborns (n = 87) were evaluated for anti-T. gondii antibodies using indirect immunofluorescence (IIF) (IgM and IgG), enzyme-linked immunosorbent assay (ELISA) (IgG) and an avidity test. RESULTS: Anti-T. gondii antibodies were identified in 64.4 percent of the serum samples from the mothers and their infants (56/87). Except for two maternal serum samples (2.3 percent), all others were negative for anti-T. gondii IgM antibodies, using IIF. The results showed that 92.9 percent of the pregnant women had high IgG avidity indexes (> 30 percent) and four samples had avidity indexes between 16 and 30 percent. Two women in the third trimester of pregnancy were positive for anti-T. gondii IgM antibodies; their babies had avidity indexes between 16 and 30 percent. The avidity indexes of serum from the other 83 newborns were similar to the results from their mothers. CONCLUSIONS: The results showed that 2 percent of the pregnant women were at risk of T. gondii transmission during the gestational period. These data seem to reflect the real situation of gestational toxoplasmosis in the northwestern region of the state of São Paulo.

CONTEXTO E OBJETIVOS: A toxoplasmose, quando transmitida durante a gestação, pode causar graves sequelas em fetos e neonatos. Anticorpos maternos podem ser indicadores de risco ou de imunidade. O objetivo foi avaliar a positividade dos anticorpos das classes imunoglobulina M (IgM) e imunoglobulina G (IgG) anti-Toxoplasma gondii (anti-T. gondii), bem como a avidez de IgG em gestantes e seus neonatos. TIPO DE ESTUDO E LOCAL: Estudo transversal em ambulatório de gestação de alto risco. MÉTODOS: Anticorpos anti-T. gondii foram avaliados em amostras de soro de gestantes (n = 87) e seus respectivos neonatos (n = 87) com o uso dos métodos imunofluorescência indireta (IFI) (IgM e IgG), ensaio imunoenzimático (ELISA) (IgG) e avidez. RESULTADOS: Anticorpos anti-T. gondii foram identificados em 64,4 por cento das amostras de soro das mães e seus bebês (56/87). Com exceção de duas amostras de soro materno (2,3 por cento), todas as demais foram negativas anticorpos IgM anti-T. gondii determinado pela IFI. Os resultados mostraram que 92,9 por cento das gestantes tinham índices elevados de avidez de IgG (> 30 por cento) e 4 amostras apresentaram índices de avidez entre 16-30 por cento. Duas gestantes no terceiro trimestre da gravidez eram positivas IgM anti-T. gondii; seus bebês apresentaram índices de avidez entre 16 e 30 por cento. Os índices de avidez dos soros dos outros 83 recém-nascidos foram semelhantes àqueles encontrados nas amostras maternas. CONCLUSÕES: Os resultados mostraram que 2 por cento das gestantes estavam sob risco de transmissão de T. gondii durante o período gestacional. Estes dados parecem refletir a real situação da toxoplasmose gestacional na região noroeste do Estado de São Paulo.

Avances en inmunidad gestacional / Advances in gestational immunity

El inicio y establecimiento de la gestación en los mamíferos dependen de la adaptación del sistema inmunológico de la madre para tolerar un feto semi-alogénico. La gestación en sí misma constituye un acontecimiento de equilibrio inmunológico, ya que mientras el sistema inmune mantiene la competencia para la defensa contra antígenos foráneos, mecanismos de tolerancia local y periférica previenen una respuesta inapropiada contra alo-antígenos fetales de origen paterno lo que pudiera provocar el rechazo del feto. La interacción materno-fetal es extremadamente compleja y es difícil determinar todos los componentes del sistema inmune involucrados. Hasta ahora se ha demostrado la participación activa de las células T y sus productos, las citoquinas y también se ha involucrado a las moléculas del complejo mayor de histocompatibilidad, los antígenos paternos y algunos inmunomoduladores como progesterona, indoleamina 2,3-dioxigeneasa y glicodelina, entre otros. Todos estos elementos parecen confluir para producir un gran cambio sistémico en el sistema inmune materno, promoviendo por una parte la tolerancia materno-fetal, crucial para finalmente permitir una gestación exitosa y, por otro lado, manteniendo una activa vigilancia inmune contra las infecciones que pondrían en riesgo la gestación y sobrevivencia de diversas especies. Se revisó la literatura más reciente acerca de los diferentes componentes del sistema inmune que han demostrado ser clave en el inicio y mantención de la gestación en mamíferos.

The initiation and establishment of pregnancy in mammals depends on the adaptation from maternal immune system to tolerate a semi-allogeneic fetus. Pregnancy itself constitutes an event of immune balance because, while the immune system maintains the capacity for defense against foreign antigens, mechanisms of local and peripheral tolerance may prevent an inappropriate response against fetal alloantigens of paternal origin which could lead to rejection of the fetus. The maternal-fetal immune interaction is extremely complex and it has therefore been difficult to identify all the immune components involved. So far, it is known that the active participation of T cells and their products, cytokines, and has also involved molecules from the major histocompatibility complex, other paternal antigens and some immunomodulators molecules such as progesterone, glycodelin and indoleamine 2,3-dioxigenase among others. All these elements seem to converge to produce a major systemic change in the maternal immune system, promoting on one hand the maternal-fetal tolerance, crucial to allow a successful pregnancy and on the other hand, maintaining an active immune surveillance against infections that might endanger pregnancy and survival of diverses species. A review of recent literature about the different components of the immune system that have proven key in the beginning and maintenance of pregnancy in mammals.

Gestação: um fenômeno imunológico? / Pregnancy: an immunological phenomenon?

Objetivo: A gestação apresenta relativa analogia com transplante, sendo um intrigante paradoxo do ponto de vista da Imunologia. Esta revisão procura abordar os principais aspectos imunológicos envolvidos na interação materno-fetal, destacando a participação da resposta celular. O reconhecimento destes processos fisiológicos contribui para o esclarecimento de patologias obstétricas. Um grande foco de interesse é a implicação do fator imune na etiologia do aborto espontâneo recorrente. Por sua importância prática, a identificação destas alterações e as estratégias terapêuticas propostas para estes casos têm sido objeto de investigações. Fonte de dados: Para realização desta revisão foram consultadas publicações científicas internacionais. As referências bibliográficas foram selecionadas por consulta à base de dados Pubmed. Procuramos incluir dados recentes, focalizando em especial o período de 2000 a 2007. Síntese de dados: É notável a evolução observada no conhecimento da fisiopatologia da gestação, porém ainda existem questões não esclarecidas. Um grande número de provas diagnósticas ainda não está disponível para uso clínico. Os exames disponíveis são pouco específicos e os tratamentos são discutíveis. Os avanços nas áreas da biologia molecular e da genética ampliaram as possibilidades das pesquisas, criando perspectivas de progresso na identificação de marcadores de risco e definição de protocolos terapêuticos para patologias obstétricas. Conclusão: O sucesso gestacional envolve o desencadeamento de resposta imunológica materno-fetal com a participação de diversos mecanismos e tipos celulares. Baseado neste conhecimento tem-se investido na busca por marcadores genéticos de valor preditivo, que além de identificar a susceptibilidade a patologia obstétrica, possam contribuir para a definição de abordagens terapêuticas mais efetivas.

Objective: Pregnancy is somewhat similar to a transplant and is an immunological paradoxo this review discusses the main immunological aspects involved in maternal-fetal interaction, emphasizing the role of cellular response. The knowledge of these physiological mechanisms contributes to the understanding of obstetric pathologies. Much interest has been roeused on immune factors beca use of their participation in the etiology of recurrent spontaneous abortion. Due to practical implications, investigations have mostly concentrated on the identification of these alterations and the development of possible therapeutic strategies. Data source: In order to elaborate this review, international scientific papers were consulted. The bibliographic references were achieved from Pubmed database. We searched for recent data, focusing specially the period from 2000 to 2007. Data synthesis: Although knowledge on pregnancy physiopathology has remarkably evolved in recent years, there are still many unsolved points. The available diagnostic tests are not specific, and the treatments are questionable. Recent advances in molecular biology and genetics have expanded research possibilities, created perspectives of rapid progress in the identification of risk markers and the proposal of new therapeutic protocols for obstetric pathologies. Conclusion: Gestational success includes the development of maternal immune response to the fetus, counting with several mechanisms and cellular populations. Based in this knowledge, the search for genetic markers with predictive values that, besides identifies susceptibility to obstetric pathologies may contribute for the definition of more effective therapeutic strategies.

Asma y embarazo / Asthma and pregnancy

El asma es una condición médica común potencialmente seria y que complica aproxcimadamente al 4-8% de las mujeres embarazadas. En general, la prevalencia de la morbilidad por asma se ha incrementado aunque la mortalidad ha disminuido en los últimos años.

Distinguishing between primary infection and reinfection with rubella vaccine virus by IgG avidity assay in pregnant women

During the mass measles/rubella vaccination campaign in 2003 in Iran, many pregnant women were vaccinated mistakenly or became pregnant within 1 month of vaccination. To distinguish pregnant women who were affected by rubella vaccine as primary infection from those who had rubella reinfection from the vaccine, serum samples were collected 1-3 months after the campaign from 812 pregnant women. IgG avidity assay showed that 0.3% of the women had no rubella-specific IgG response; 14.4% had low-avidity anti-rubella IgG and were therefore not immune to rubella before vaccination; 85.3% had high-avidity antirubella IgG and were regarded as cases of reinfection

Pregnancy immunology: decidual immune cells.

Human pregnancy is a complex process. Placental development depends on the function of secretory molecules produced by placental trophoblast cells as well as by maternal uterine immune cells within the decidua. These decidual immune cells are T cells, natural killer cells, macrophages and dendritic cells. The interactions between the trophoblast cells and the maternal immune cells have an impact on the outcome of the pregnancy. Knowledge about the phenotypes and functions of the maternal immune cells in normal and pathological pregnancies including recurrent spontaneous abortions, preeclampsia and hydatidiform moles may improve our understanding of the immunobiology of the normal pregnancy as a whole and may provide approaches for improving the treatment of pathological pregnancies.

Vilosidades e outras estruturas coriônicas encontradas no sangue periférico de gestantes: número, tamanho e uma técnica para sua recuperação / Villus and other chorionic structures found at the peripheral blood of pregnant women: number, size, and a technique for their recovery

Objetivos: desenvolver uma técnica para recuperar, identificar contar e medir as vilosidades e outras estruturas coriônicas presentes no sangue periférico de gestantes. Métodos: foram selecionadas para o estudo 10 gestantes normais, com idade gestacional igual ou superior a 37 semanas, internadas no Hospital São Lucas da PUCRS para o parto. Foram colhidos 3 ml de sangue de uma veia em EDTA e 5.000 UI de aprotinina (Trasylol Bayer) de uma veia cubital de cada paciente. As amostras foram imediatamente fixadas em Bouin, embebidas em parafina, cortada 3 µm, coradas por hematoxilina/eosina tricômico de Masson e por anticorpos monoclonais específicos para tecidos trofoblásticos. Cada lâmina foi escrutinada de forma linear em toda a sua superficie, a um aumento de 250 vezes, e as estruturas coriônicas reconhecidas foram medidas com uma ocular micrométrica calibrada. Os resultados foram apresentados por média erro padrão. Resultados: foram recuperadas 15,4 3,4 placas de sinciciotrofoblasto maiores de 100 e 5,8 ± 0,9 vilosidades coriônicas por ml de sangue materno. O comprimento médio das vilosidades foi 289, 3 ± 13,6 µm, a largura média foi de 116,3 ± 5,3 µm e a espessura média do sinciciotrofoblasto foi de 33,4 ± 1,7 µm. O descolamento dos cortes impediu os estudos imunológicos em 4 dos 10 casos. Em duas das seis amostras estudadas com anticorpos monoclonais específicos para trofoblasto as estruturas recuperadas foram relativas. Conclusões: a fixação imediata das amostras foi apresentada como um novo método para recuperar as estruturas coriônicas presentes no sangue periférico de gestantes. Elas foram identificadas, contadas e medidas. Sua quantidade e dimensões foram grandes . Os mecanismos que podem explicar seu surgimento e seu destino, bem como o significado de sua presença e quantidade no sangue periférico das gestantes foram discutidos.

Efeitos adversos materno-fetais associados às trombofilias e à síndrome do anticorpo antifosfolípide / Adverse maternal-fetal effects associated to thrombophilias and to the antiphospolipid syndrome

O feto representa um corpo estranho ao organismo materno, uma vez que traz antígenos paternos distintos daqueles de sua genitora, entretanto, durante a gestação, o organismo materno desenvolve uma resposta imune ao feto, levando à tolerância materno-fetal sem reações patogênicas. Quando ocorrem desequilíbrios nessa tolerância, pode haver complicações obstétricas (perdas fetais, abortamentos recorrentes, pré-eclâmpsia, descolamento prematuro de placenta e restrição no crescimento intra-uterino). A investigação dessas complicações requer análise da associação entre a presença de trombofilias e anticorpos antifosfolípides. Nas trombofilias são encontradas mutações genéticas (como a resistência à proteína C ativa - RCPA e mutação do Fator V Leiden), diminuição dos níveis séricos dos anticoagulantes naturais (proteína C, proteína S e antitrombina) e hiper-homocisteinemia, que levam a distúrbios hemostáticos, sugeridos como causa de eventos adversos na gravidez. A presença de anticorpo antifosfolípide pode inibir a secreção de gonadotrofina coriônica, afetando o desenvolvimento embrionário, inibir a proteína placentária anticoagulante, levando à trombose placentária e à perda fetal, aumentar a síntese de tromboxano, bem como reduzir a síntese de prostaciclinas nos vasos placentários. O objetivo da presente revisão é atualizar os gineco-obstetras em relação aos efeitos adversos obstétricos associados às trombofilias e à síndrome do anticorpo antifostolípide.

Emerging role of uterine natural killer cells in establishing pregnancy

Normal pregnancy has been considered as a controlled state of inflammation at an early stage of blastocyst implantation that subsequently develops systemically. Till recent past most popular hypotheses regarding status of immune system in pregnancy were dominated by the Th[1] and Th[2] hypothesis, in which the fetus avoids maternal rejection through a bias towards I-helper [Th[2]] cytokine production. Recent findings have shown that predominant immune interactions in the human deciduas are between the placental trophoblast and maternal uterine natural killer [uNK] cells rather than the I cells. Thus NK cells are emerging as important players in the uterine immune response to invasive forms of placenta, as in cases of hemochorial placenta. In humans there is a lack of evidence for I-cell responses to trophoblast cells; therefore it was thought that uterine NK cells are the key factors by which the maternal immune system recognizes trophoblast cells. In this review we are trying to summarize the role of uNK cells in the maintenance of normal pregnancy in humans

[MR vaccination in pregnancy and its subsequent complications]

MR vaccination is prohibited among pregnant women, therefore pregnancy is recommended three months after vaccination. On the other hand, pregnant women acquiring these diseases face unwanted complications. We tried to determine the frequency of congenital disorders in the newborns of the vaccinated pregnant women under 25 years in Mazandaran province. This historical cohort study was done by consent method on 1031 cases throughout Mazandaran province. 406 cases out of the population were vaccinated without prior information about their pregnancy. The data were collected by questionnaires through referring to their healthcare files and telephone contacts just to make sure about their vaccination conditions. The data obtained from these cases along with the data from 493 pregnant women who were not vaccinated during the years 2002-2003 were statistically analyzed. Pregnancy complications were observed in 58 [6.5%] subjects; 24 [41.38%] in the control group and 34 [58.62%] in the case group. The rate of complications in the subjects under the study was as follows: premature delivery in 27 [46.57%] subjects; 8 [29.62%] in the control group and 19 [70.38%] in the case group; weight under 2500 gram at birth in 19 [32.75%] subjects; 12 [63.16%] in the control group and 7 [36.84%] in the case group; still birth in 6 [10.34%] subjects 1 [16.67%] in the control group and 5 [83.33%] in the case group; abortion in 6 subjects [10.34%]; 2 [23.33%] in the control group and 4 in [66.67%] in the case group. Only one person in the control group had intra uterine growth retardation. No significant pregnancy complication difference was observed between the case and the control groups in this study [P>0.05] Results of this study and the related researches indicate that though MR vaccination during pregnancy is safe, the randomly performed vaccination of pregnant women, should be advised and the followed up for the probable unwanted complications

Causes of low tetanus toxoid vaccination coverage in pregnant women in Lahore district, Pakistan

To assess the causes of low tetanus toxoid [TT] vaccination coverage in pregnant women a mixture of quantitative and qualitative methods were adopted at the community, primary health care delivery and management levels in Lahore district, Pakistan. Out of a random sample of 362 women who had delivered during the previous 3 months, 87% recalled receiving 2 doses of TT. The main reasons for non-vaccination were poor knowledge about the importance of TT [32% of women] or the place and time to get vaccinated [18%]. According to the managers and primary health care medical officers, the main reasons for low coverage were lack of awareness about the importance of vaccination among the public and misconceptions about TT vaccination [e.g. that it was a contraceptive]