Maternal vitamin D and E intakes during early pregnancy are associated with airway epithelial cell responses in neonates.

BACKGROUND: Antenatal factors including maternal diet may predispose to airway disease, possibly by impacting on fetal airway development. OBJECTIVE: This cohort study tested the hypothesis that maternal vitamin D and E status in early pregnancy is associated with airway epithelial cell (AEC) responses in new born infants and examined constitutive and TNFα/IL-1ß, house dust mite (HDM) extract or lipopolysaccharide (LPS)-stimulated neonatal AEC responses in vitro. METHODS: Maternal dietary vitamin D and E intakes (plasma 25[OH]D3 or α-tocopherol) were characterized at 10-12 weeks gestation. Neonatal nasal AECs were collected soon after birth and cultured to tertiary passage. Constitutive and stimulated - TNFα/IL-1ß, HDM extract or LPS - secretory responses (VEGF, RANTES, MCP-1, IL-17A, IFN-γ, GM-CSF, eotaxin, MIP1-α, MIP1-ß, ICAM, IL-6, IL-8, IL-10, TNF) in 139 AEC cultures were quantified. RESULTS: AEC mediator release was greater following TNF-α/IL-1ß, HDM or LPS stimulation compared to constitutive release. Increased maternal dietary vitamin D was associated with significant increases in IL-10 release by AEC after stimulation with TNF-α/IL-1ß (P = 0.024) or HDM (P = 0.049). Maternal plasma α-tocopherol at 10-12 weeks gestation was positively associated with MIP1α (Spearman's rho 0.242, P = 0.009) and IL-3 (ρ 0.189, P = 0.043) responses after TNF-α/IL-1ß stimulation and negatively associated with TNF (ρ -0.404, P = 0.011) and MIP1ß (ρ -0.322, P = 0.046) responses after LPS stimulation. DISCUSSION: Neonatal AECs respond to pro-inflammatory and allergenic stimuli in vitro demonstrating their potential to function as components of the innate immune response. Our findings suggest that associations exist between maternal micronutrient intake during early pregnancy and aspects of stimulated neonatal airway epithelial cell secretory function that may in turn impact on the development of asthma and/or allergic rhinitis in later life.

Outcomes of pregnancy following postpartum haemorrhage.

OBJECTIVE: To assess the outcomes of pregnancy following postpartum haemorrhage (PPH) in the first pregnancy. DESIGN: Cohort study. SETTING: Aberdeen Maternity Hospital, Scotland, UK. POPULATION: All women with first deliveries recorded in the Aberdeen Maternity and Neonatal Databank (AMND) between 1986 and 2005. METHODS: All women identified from the AMND were classified into exposed and unexposed cohorts, according to whether or not they had PPH in their first delivery. They were then linked to any records of a second pregnancy. MAIN OUTCOME MEASURES: Any second pregnancy, time to second pregnancy, early or late pregnancy loss, and prevalence of PPH in the second pregnancy. RESULTS: Out of 34 334 women, 10% had a PPH in their first pregnancy. There was no statistically significant difference in the time to a second pregnancy, nor in the outcome of that second pregnancy, between women who had experienced a PPH in their first pregnancy and women who had not. For women with a caesarean delivery, there was a significant reduction in the proportion conceiving again, comparing the exposed and unexposed cohorts. CONCLUSIONS: From this cohort study we can conclude that if a PPH occurs in a first pregnancy, there is no delay in achieving a second pregnancy, and no detrimental effect on the outcome of that pregnancy. Significantly fewer women conceive a second pregnancy if they have a caesarean section in their first pregnancy that is complicated by PPH.

Severe alpha1-antitrypsin deficiency and pregnancy.

This case study describes a successful pregnancy in a 27-yr-old patient with severe emphysema, secondary to alpha1-antitrypsin deficiency, genotype PiZZ. Despite significant respiratory compromise, more severe than previously reported, no complications ensued. Maternal pulmonary function did not deteriorate significantly until the 32nd week of pregnancy, with an elective Caesarean section being performed during the 37th week. This experience suggests that even severe maternal airflow obstruction is, in itself, not an absolute contra-indication to pregnancy. Pre-pregnancy multidisciplinary counselling is likely to be helpful in these patients, including frank discussion on the risks of pregnancy, the prospects of successful completion and the mother's future prognosis in relation to caring for the child.

Dietary intake and tissue concentration of fatty acids in omnivore, vegetarian and diabetic pregnancy.

The aim of this study was to determine the effect of fatty acid intake and insulin dependent diabetes on the fatty acid composition of maternal erythrocytes, the placenta and cord. Fatty acid intake (from food frequency questionnaire) and the fatty acid composition of maternal erythrocytes, the placenta and cord from pregnant vegetarians (n = 4) and insulin dependent diabetics (n = 5) was compared with pregnant omnivores (n = 10). There was a significantly lower intake of n-6 long chain polyunsaturated fatty acid (LCPUFA) (-75% P < 0.01) and n-3 LCPUFA (-92% P < 0.01) and increased ratio of n-6/n-3 LCPUFA in the vegetarians (103%; P < 0.001). The concentrations of 22:4 n-6 (+28%; P < 0.05) and 22:5 n-3 (+40%; P < 0.05) were higher in vegetarian erythrocytes. Placental 18:2 n-6 (+26.9%; P < 0.05) 18:3 n-3 (+139%; P < 0.05) and 22:5 n-3 (+24%; P < 0.05) were increased while 20:5 n-3 (-36%; P < 0.05), 22:6 n-3 (-16%; P = 0.059), and the ratios of 20:4 n-6/18:2 n-6 (P < 0.01) and 22:6 n-3/18:3 n-3 were reduced. 22:6 n-6 (-49%; P < 0.05) and total n-3 LCPUFA (-11%; P < 0.01) were reduced in vegetarian cord. For the diabetic mothers, all of the n-6 LCPUFA and n-3 LCPUFA were reduced in the maternal erythrocytes; 22:4 n-6 (-42%; P < 0.05), 22:5 n-6 (-46%; P < 0.05) and 22:6 n-3 (-41%; P < 0.05). For the diabetic placenta and cord the general pattern of n-3 LCPUFA was the same as that in the vegetarians. In the vegetarian mothers, the PUFA profiles in the maternal erythrocytes, placenta and cord are consistent with an elevation in the rate of LCPUFA synthesis in order to make up the relative deficit in LCPUFA intake. However, it may be that the higher level of desaturase activity is not able to overcome the dietary deficit of 22-6 n-3 and 22:6 n-6. Despite the fact that the dietary LCPUFA intake in the pregnant diabetic was comparable with that in the pregnant 'normal' omnivore mothers, the pattern of PUFA in the tissues resembled that of the vegetarian mothers.

Long-term outcome by method of delivery of fetuses in breech presentation at term: population based follow up.

OBJECTIVE: To compare the long-term outcome of infants delivered in breech presentation at term by intended mode of delivery. DESIGN: A population based comparison of outcomes up to school age. Data obtained from maternity, health visitor, and school medical records and handicap register. SETTING: Grampian region 1981-90. SUBJECTS: 1645 infants delivered alive at term after breech presentation. MAIN OUTCOME MEASURES: Handicap, developmental delay, neurological deficit, psychiatric referral. RESULTS: Elective caesarean section was performed in 590 (35.9%) cases. The remainder (1055; 64.1%) were intended vaginal deliveries. Handicap or other health problem was recorded in 269 (19.4%) of 1387 infants for whom records were available. Proportions of elective caesarean sections and intended vaginal deliveries in this group were 37.2% (100 cases) and 62.8% (169) respectively, almost the same as in the total cohort. There were no significant differences between elective caesarean section and planned vaginal delivery in terms of severe handicap or any other outcome measure. Case records were obtained for 23 of 27 infants with severe handicap. 11 (47.8%) were delivered by elective caesarean section. Of these, three had undiagnosed congenital abnormalities and seven were unexplained. Of the 12 (52.2%) planned vaginal deliveries, in only one was handicap possibly attributable to delivery and four cases were unavoidable even if elective caesarean section had been planned. CONCLUSION: In selected cases of breech presentation at term planned vaginal delivery with caesarean section if necessary remains as safe as elective caesarean section in terms of long term handicap. It was not possible to determine whether particular babies would have fared better had they been delivered by elective caesarean section.

A Microsoft Windows based application for acquisition and replay of cardiotocograph data.

The electronic fetal monitor or cardiotocograph is an integral part of all modern labour wards. It records fetal heart and uterine contractions and charts this data as a cardiotocogram (CTG). The CTG is used to assess fetal well-being by the labour attendants and in some circumstances for research. A means to acquire and display the CTG by microcomputer as an aid to archiving and to obstetric research is presented. A Microsoft Windows-based application was written using Microsoft C version 7.0 to acquire and replay the CTG data. The application acquires the CTG data by using the RS232 serial link fitted on most modern fetal monitors. Additionally, comments and events can be entered by the user throughout recording. The data are saved to disk files which can be replayed on screen in the manner of a CTG. The data replay functions of the application calculates the uterine activity integral and active pressure for each contraction and for 15 min intervals. This calculated data is not available from many fetal monitors but is widely used for research into the mechanics of labour. This application provides an easy, reliable and accurate means of acquiring the CTG data, for archiving and research. It also provides a framework for further CTG analysis.

Sacrococcygeal teratoma: a case of mistaken identity.

We report a case in which prenatal diagnosis of fetal myelomeningocele led to termination of the pregnancy at 17 weeks. The diagnosis was made on the basis of prenatal ultrasound scan and raised maternal alpha-fetoprotein. Although the large cystic lesion arising in the sacral region appeared to confirm the diagnosis, autopsy examination revealed that this was a cystic sacrococcygeal teratoma. This case illustrates the importance of submitting all fetuses for full autopsy.

Continuous meconium monitoring during labour using an intrauterine probe.

The fetus discharges meconium (its bowel contents) into the amniotic fluid during labour in approximately 10% of pregnancies. In about 10% of cases where meconium is passed, the fetus gasps, inhaling the sticky meconium into the upper respiratory tract. After birth, the meconium blocks the air passages in the lungs, impairing gas exchange (meconium aspiration syndrome, MAS). Up to 20% of infants suffering from MAS die and recently published studies have shown a long-term effect of MAS in causing cough and wheeze. At present, meconium is only noticed at birth or occasionally when amniotic fluid leaks past the presenting part of the fetus. We have developed a system to monitor meconium continuously during labour, using a flexible intrauterine probe. The system provides a measurement of the meconium concentration of amniotic fluid during labour every 2 min, with a 60% prediction interval of +/- 10 g l-1, and a 99% prediction interval of +/- 30 g l-1 (clinically 'thick meconium' contains around 100 g l-1). The noise of the measurement is of the order of +/- 10 g l-1, and the response to changes in the meconium concentration is from 40 to 120 s, depending on its configuration. The system also provides other obstetric variables such as fetal heart rate and uterine activity measurement, obtained from a fetal monitor. Preliminary clinical results indicate that this system can measure meconium not apparent to the attending staff; the system can detect changes in the meconium concentration of amniotic fluid; the measurements are confirmed by visual observation at delivery; and changes of meconium concentration seem to correlate with known stressful stimuli. The system therefore provides a new tool from which new variables are obtained, which can greatly enhance clinical research into the pathophysiology of meconium passage and aspiration.

A method for continuous monitoring of meconium in the amniotic fluid during labour.

In about 10% of pregnancies overall, the fetus discharges meconium (its bowel contents) into the amniotic fluid during labour. In about 10% of cases where meconium is passed, the fetus gasps, inhaling the sticky meconium into the upper respiratory tract. After birth, the meconium blocks the air passages in the lungs, impairing gas exchange--meconium aspiration syndrome (MAS). Up to 20% of infants suffering from MAS die and recently published studies have shown a long-term effect of MAS in causing cough and wheeze. The risk of meconium aspiration is thought to be increased by intrauterine hypoxia. At present, meconium is only noticed at birth or occasionally when amniotic fluid leaks past the presenting part of the fetus. A method has been developed which measures absolute meconium concentration with a 99% prediction interval of +/- 30 g l-1; allows monitoring of the rate of appearance of meconium linearly with a nonlinearity of 5%, and differentiates between meconium and blood. The method uses the ratio of the intensity of back-scattered light from the amniotic fluid at 700 and 415 nm, the latter being near the peak of light absorption by meconium and the former a reference value. The ratio is also affected by the presence of blood. However, blood has specific absorption peaks at 540 and 575 nm from which it can be detected (the presence of blood is also a significant abnormality, and is relatively uncommon). The measurement method could easily be integrated into an optical sensor mounted onto an intrauterine probe.(ABSTRACT TRUNCATED AT 250 WORDS)

Is obstetric and neonatal outcome worse in fetuses who fail to reach their own growth potential?

OBJECTIVES: To determine the perinatal outcome of fetuses who had birthweights less than that expected from early third trimester ultrasound scanning. DESIGN: Retrospective estimation of centile fetal weight at early third trimester ultrasound scanning compared with actual centile birthweight corrected for gestational age, parity and sex. SETTING: Teaching Hospital Obstetric Unit, London. SUBJECTS: 197 unselected women with singleton cephalic pregnancies who were delivered at term in our unit between October 1989 and May 1990. MAIN OUTCOME MEASURES: CTG abnormality, need for fetal blood sampling in labour, meconium-staining of the amniotic fluid, mode of delivery, Apgar scores at 1 and 5 min, need for transfer of baby to neonatal unit, and need for neonatal intubation of the neonate at delivery. RESULTS: An actual birthweight greater than 5% less than the birthweight estimated from ultrasound scanning identified 44 babies (22%) with an increased risk of CTG abnormalities (chi 2 = 8.38, P less than 0.0025; Odds ratio (OR) = 2.54; 95% CI 1.36 to 4.78) and need for operative delivery (chi 2 = 5.81, P less than 0.0125; OR = 1.94; 95% CI 1.15 to 3.27), when compared with the remainder of the sample. Overall 14 (32%) of this group had birthweights above the 50th centile. A group of 44 babies selected as being the smallest for gestational age, without reference to growth pattern, had a similar excess morbidity. (All this group had birthweights below the 39th centile). CONCLUSIONS: This study supports the hypothesis that in-utero fetal growth pattern is as important for perinatal outcome as being small for gestational age per se.

Ovarian metastatic carcinoma presenting as a primary cervical carcinoma.

A case of an ovarian carcinoma presenting as a primary cervical carcinoma is described. Although a rare event, this must be considered whenever the clinical or histological findings are unusual. The importance of careful histological review of all specimens in cases such as this is emphasized.