Immunological studies on pre-eclampsia in Nigerian women.

Circulating immune complexes, C3b inactivator, C3 activator, C3c, C4 and C-reactive protein were assayed in 49 patients with pre-eclampsia and 35 apparently healthy pregnant Nigerian women. Pre-eclamptic women had significantly higher mean levels of circulating immune complexes, C3c and C-reactive protein. C3 activator mean level was also higher in pre-eclampsia than in normal pregnancy, C3b inactivator concentrations were greatly depressed and the mean level was also significantly lower in the pre-eclamptic group (P less than 0.001). However, C4 mean levels were the same in both groups. From the results, it is postulated that in pre-eclamptic conditions the significantly depressed levels of C3b inactivator could predispose to the persistence of deposited immune complexes in the kidneys, resulting in tissue damage. The findings also generally indicate an immunologic pathogenesis for the renal lesions in pre-eclampsia in Nigerian women.

Basal metabolic rate and energy expenditure of pregnant Nigerian women.

The purpose of the present study was to compare basal metabolic rates (BMR) of pregnant Nigerian women from rural and urban areas with values from similar studies in other Third World countries. We also investigated possible changes in BMR during the course of pregnancy. An open-circuit indirect calorimeter was used to measure BMR and energy expenditure (EE) during sedentary activity in forty-one pregnant Nigerian women. The results showed marked variability in BMR among individuals. A correlation analysis between BMR and other biological and physical characteristics revealed bodyweight and gestation as the only variables related to BMR and oxygen consumption. The study revealed no significant difference between BMR and EE of sedentary activity in the subjects. The wide variability may have been due to the nutritional status of the subjects studied, who were drawn largely from the lower socioeconomic groups of Nigerian society. The present study shows that socioeconomic status and nutritional interventions should be taken into account when framing recommendations for maternal nutrition during pregnancy.

PIP: This study compared basal metabolic rates (BMR) of pregnant Nigerian women from rural and urban areas with values from similar studies in other 3rd world countries. The authors also investigated possible changes in BMR during the course of pregnancy. An open-circuit indirect calorimeter was used to measure BMR and energy expenditure (EE) during sedentary activity in 41 pregnant Nigerian women. The results showed marked variability in BMR among individuals. A correlation analysis between BMR and other biological and physical characteristics revealed body weight and gestation as the only variables related to BMR and oxygen consumption. The study revealed no significant difference between BMR and EE of sedentary activity in the subjects. The wide variability may have been due to the nutritional status of the subjects studied, who were drawn largely from the lower socioeconomic groups of Nigerian society. The present study shows that socioeconomic status and nutritional interventions should be taken into account when framing recommendations for maternal nutrition during pregnancy.

Plasma zinc and copper concentrations in pregnant Nigerian women and newborn.

Plasma zinc and copper concentrations were determined in a group of pregnant Nigerian women at various stages of gestation. The levels of these trace elements were also determined in paired maternal and cord blood at delivery. The results showed that the plasma levels rose with increase in gestation from 94.8 (+/- 20.6) micrograms/100 ml in the first trimester to 161.6 (+/- 22.4) micrograms/100 ml at term. This rise is statistically very significant (P less than 0.001). Conversely, there was a fall in the plasma zinc concentrations with increase in gestation--from 77.2 (+/- 14.8) micrograms/100 ml in the first trimester to 65.8 (+/- 15.3) micrograms/100 ml at term. However, this fall is not significant at the 5% level. The mean concentration of copper in the maternal blood at delivery was about three times the mean concentration of 54.6 (+/- 20.8) micrograms/100 ml found in the corresponding paired cord blood. There were no statistically significant differences in zinc concentrations found in maternal and paired cord blood at delivery. Statistically significant correlations were found between copper zinc concentrations and fetal birth weight.

Clinicopathologic study of breast carcinoma occurring during pregnancy and lactation.

In a 16-year study of 703 cases of female breast carcinomas seen at the University College Hospital, Ibadan, Nigeria, seven cases were found in pregnant women and another seven cases in lactating women. Thus, pregnancy and lactation complicated breast carcinoma about two times per 100 female breast carcinomas. During the same period there were 51,058 deliveries, for a rate of three breast carcinomas per 10,000 deliveries. When women in the most active reproductive age group (20-40 years) were considered, there were 309 cases of female breast carcinomas. Therefore, 5% of women with breast carcinoma in this age group had concurrent pregnancy or lactation. The patients presented late, and the prognosis was generally poor. While the clinical features of inflammatory carcinoma are similar in most countries, the characteristics of some of the histologic types of breast neoplasia encountered in pregnancy and lactation in Nigerian women appear to differ from those reported in most European and American studies.

Vitamin E levels in pregnant Nigerian women and newborn.

Vitamin E (tocopherol) concentrations were measured at various stages of gestation and at delivery in a group of Nigerian women who were not given any vitamin supplements during pregnancy. Levels in the third trimester of pregnancy were found to be significantly higher than in the first and second trimesters (P less than 0.001). There were no correlations between mean maternal vitamin E levels at delivery and the corresponding mean cord plasma levels. However, the mean maternal vitamin E level at delivery was nearly five times higher than the mean cord plasma level. The mean cord plasma vitamin E was found to increase with increase in the mean birthweight but the maternal vitamin E levels did not show any consistent pattern with infant sex or birthweight.

The immunogenicity of malarial antigen obtained from infected human placenta.

Malarial placenta antigen (MPA) was obtained from heavily parasitized human placenta. The immunogenicity of this antigen was tested by immunizing rabbits. The rabbit antiserum to malarial placenta antigen (anti-MPA) was absorbed with homogenate from nonparasitized human placenta. The anti-MPA serum was also absorbed with malarial placenta extract. Evaluation of the anti-MPA serum was done using the Ouchterlony immunodiffusion technique and by immunoelectrophoresis in agar. The results show that human malarial placenta antigen can stimulate the formation of anti-plasmodium antibodies. Although the antiserum produced also contained antibodies to some placental components, absorption studies showed that some malarial specific precipitinogens were produced. The significance of this in efforts to develop an effective malarial vaccine is discussed.

The effect of malarial chemoprophylaxis on immunoglobulin levels of pregnant Nigerian women and the newborn.

Immunoglobulins G, M and A were estimated at various stages of gestation in a group of 60 Nigerian primigravidae who were given malarial chemoprophylaxis throughout pregnancy. Immunoglobulin levels were also determined in paired maternal and cord sera of the same women at the time of delivery. Corresponding values for the malarial fluorescent antibody titres were also obtained. There was a fall in both the IgG levels and the fluorescent antibody titres with increasing gestation. The mean IgG and malarial fluorescent antibody titres were generally lower than those previously reported in Nigerian women not on malarial chemoprophylaxis. The mean cord IgG in this study was lower than the mean paired maternal IgG value. This agrees with reported studies in the African population but differs from those reported in Caucasians. The cord IgG values were correlated to the paired maternal IgG levels and those were found to be correlated with the corresponding malarial antibody titres. The factors that influence the fetomaternal IgG gradient are discussed. It is concluded that the newborn of mothers on prolonged malarial chemoprophylaxis may have a lowered acquired immunity to malaria.

Malarial immunity in pregnant Nigerian women and their newborn.

The levels of malarial fluorescent antibody titers (MFAT) were estimated throughout pregnancy and at delivery in 20 urban Nigerian primigravidas who received malarial chemoprophylaxis. There was a statistically significant (p < 0.001) fall in the MFAT levels as pregnancy progressed. The mean logarithmic MFAT levels were 2.8664 +/- 0.3326 and 2.2794 +/- 0.1656 in the first and last trimesters of pregnancy, respectively. The MFAT level in the newborn was positively correlated to the maternal MFAT level at delivery (r = 0.9468; p < 0.001). If malarial prophylactics are used for a prolonged period, the maternal MFAT level will fall, leaving newborns with lowered immunity to malaria.

Post-operative wound sepsis following obstetrical and gynaecological laparotomies in Nigeria.

The results of a prospective survey of post-operative wound sepsis following obstetrical and gynaecological laparotomies at the University College Hospital, Ibadan, Nigeria are presented. The overall wound sepsis rate was 20.2 per cent, but the corresponding rates in the gynaecological, primary obstetrical and repeat obstetrical cases were 14.9 per cent, 7.0 per cent and 29.9 per cent respectively. Statistical tests indicate that these rates differ significantly. The rate among the gynaecological cases did not differ significantly from the primary obstetrical cases, but that of the repeat obstetrical cases was significantly higher than those of the other two groups. The poorer wound healing in the repeat obstetrical laparotomies is thought to be due to poor blood supply. The variables that correlated significantly with wound sepsis rate were: pre-operative anaemia, number of medical students in theatre, antibiotic chemoprophylaxis and excision of previous scar in repeat laparotomies. The commonest organism involved in the wound sepsis was staph pyogenes. The wound sepsis rate obtained in this survey was high and various preventive measures are discussed.