ABSTRACT
α-Lipoic acid (ALA) is a natural molecule that is inconsistently synthesized by the human body and must be provided from exogenous sources, such as food and dietary supplements. Once absorbed, the oxidized form of ALA is transformed into its reduced form, dihydrolipoic acid (DHLA). ALA/DHLA exert direct and indirect antioxidant, anti-inflammatory and fine immunomodulatory effects. ALA/DHLA reduce the levels of pro-inflammatory cytokines (IL-1ß, IL-6, IL-8 and IL-17), while increasing the secretion of anti-inflammatory cytokines (IL-10). They also inhibit cyclooxygenase 2, thereby decreasing the secretion of prostaglandin E2 and nitrogen oxide, and reducing the risk of miscarriage in the first trimester of pregnancy. In patients at risk of abortion, administration of ALA from the first trimester has shown efficacy by accelerating subchorionic hematoma resorption, with a significant decrease in the accompanying abdominal pain. ALA has been proven to be efficient in maintaining the length of the cervix and keeping it closed following one episode of premature labor. Preeclampsia is a dysfunction caused by abnormal placentation and an excessive maternal inflammatory response, leading to extreme hypoxia in the placental bed and exaggerated oxidative stress, with release of oxygen free radicals. Oxidative stress plays a key role in the development of preeclampsia and intrauterine growth restriction. The hypothesis of antioxidant supplementation may play an essential part in disease prevention and fetal neuroprotection.
ABSTRACT
The twin pregnancy is a risk pregnancy, being associated with a series of fetal and neonatal complications when compared to singleton pregnancies. Ultrasound assessment of the fetal brain is mandatory in the prenatal screening for fetal, congenital and acquired anomalies. Fetal neurosonography is useful in the prenatal diagnosis of cerebral anomalies, combining ultrasonography with fetal ultrasound. In this study, we assessed the Kanet score in two populations of pregnant women with dichorionic twin pregnancies (DC twin) (n=67) and monochorionic twin pregnancies (MC twin) (n=24). In the two groups we included pregnancies with normal fetal growth and pregnancies with discordant fetal growth (DC twin) and selective intrauterine reatriction (MC twin). For both groups, we assessed the antenatal Kanet score during three visits and compared the results with the neurodevelopment immediately after birth up to the two-year-old children. The calculation of the average values of the Kanet score for dichorionic pregnancies revealed normal, maximal average values at all three visits, for all fetuses, no matter if they had normal growth or discordant growth. At the first and third visit, we observed statistically significant differences between the average Kanet scores in DC twins with discordant growth vs. DC twins with normal growth. The analysis of average values of the Kanet score in the group of MC twin pregnancies revealed statistically significant differences between monochorionic twins with discordant growth vs. twins with normal growth at all three visits (p=0.0001), with average values between 17.30 and 19.62 being deemed normal. Amiel-Tison score was used as a standard tool for the neurological assessment both immediately after birth and for children up to two years of age.
