Folic acid, Vitamin B(12), and homocysteine in smoking and non-smoking pregnant women.

INTRODUCTION: Lower plasma levels of vitamins may result in hyperhomocysteinemia, a known risk factor in pregnancy. As smoking may alter nutrition, we were interested in its effect on folate and Vitamin B(12) in pregnancy. MATERIALS AND METHODS: A cross-sectional study of 62 smoking and 76 non-smoking healthy pregnant women. Serum folic acid, Vitamin B(12) and homocysteine were measured at four points in pregnancy: 0-10, 11-20, 21-30 and 31-40 weeks. RESULTS: Folate concentrations of the smoking women decreased continuously during pregnancy, and were significantly lower than those of non-smoking women during the last 30 weeks. Vitamin B(12) levels decreased significantly in both groups. The homocysteine levels were higher in the smoking group during the second-half of pregnancy. DISCUSSION: Smoking women have lower and decreasing folate levels during pregnancy, possibly as a result of lower intake of these nutrients. Lower folate levels can lead to hyperhomocysteinemia, a known risk factor for several complications in pregnancy. This is an other important reason to convince pregnant women to refrain from smoking.

Salivary oestradiol in spontaneous and stimulated menstrual cycles.

The determination of steroids in saliva provides useful information in the clinical study of various endocrine functions, and salivary progesterone concentration has been widely used for assessing corpus luteum function during the spontaneous menstrual cycle and early pregnancy. However, the determination of oestradiol in saliva (SE2) has previously been found unsatisfactory. SE2 profiles and saliva/plasma E2 ratios were established (during the different periods of the menstrual cycle) by a highly sensitive radioimmunoassay method during normal menstrual cycle. During cycles hyperstimulated for in-vitro fertilization and embryo transfer, the SE2 pattern is similar to the corresponding profile in plasma with a peri-ovulatory oestradiol peak. There is a significant difference between fertile and non-fertile cycles with a higher saliva/plasma ratio in conception cycles.

Evolution of tissue levels of steroids: oestradiol-17 beta, oestrone and progesterone in the macaque myometrium during gestation.

In 15 cynomolgus monkeys between days 30-160 of gestation, tissue levels of oestrone (E1), oestradiol 17 beta (E2) and progesterone (P4) were assayed by RIA in the myometrium and the placenta. Myometrial samples were subdivided as follows: inner and outer layers adjacent to the placental area (IMP and OMP) and inner and outer layers from antiplacental areas (IMAP and OMAP). Steroid levels (ng/g wet wt) were in the range of known plasma values (ng/ml) and there was no asymmetric distribution of steroids between the various locations. When the results obtained in all the layers were pooled the gestational profiles indicated a decrease of E1 between days 80-130, whereas at the same time E2 and P4 increased. The ratio P4/E2 was 8 on day 40, 17 on day 80 and 9 on day 160. In the placenta, levels of E2 and P4 were 4 times higher, levels of E1 10 times higher than in the myometrium. Gestational profiles of the three steroids in the placenta increased from day 30 to day 160. Myometrium steroid content therefore does not appear to be a simple reflection of steroid diffusion from the site of production.

Progesterone and estradiol in saliva after in vitro fertilization and embryo transfer.

The importance of the luteal function to ensure adequate implantation prompted us to assay salivary estradiol (SE2) and salivary progesterone (SP) concentration serially after embryo transfer by simple and rapid radioimmunoassays to allow a noninvasive easily repeatable approach. SE2, which has fallen 1 day after human chorionic gonadotropin injection, increased after reimplantation (day 3), plateaued during approximately 1 week, and returned to basal levels before menstruation in absence of conception or in chemical pregnancy, whereas it increased steadily in successful pregnancy. SP increased in all the cases, formed a plateau, and returned progressively to basal levels before menstruation, whereas in ongoing pregnancy there was a transitory decline in the midluteal phase followed by a rapid and continuous increase, with a significantly higher ratio day 13/day 10 in successful pregnancy.

Influence of the oral administration of micronized progesterone on plasma and tissue levels of steroids in human pregnancy.

A single dose of micronized progesterone, orally administered to women at different stages of pregnancy, induced an immediate increase in the plasma levels of progesterone. Progesterone was administered to another group of women just before elective cesarean section. Levels of progesterone, oestradiol-17 beta and oestrone were determined in plasma, placenta and at different sites of the myometrium obtained during the surgical procedure. Results were compared to those observed in a control group of women who did not receive progesterone. Progesterone levels demonstrated a marked increase in plasma and in the whole myometrium 150 min after administration; the levels then decreased rapidly to control values within one hour. The concentrations of progesterone in the placenta did not show any change. Evident modifications of the oestrogen levels appeared in the myometrium and in the placenta after the administration of progesterone whereas no change occurred in the plasma. No difference was observed in estradiol-17 beta in the myometrium whereas an increase was seen in the placenta. Estrone levels decreased in the myometrium and in the placenta. This study demonstrates a prompt delivery of an orally administered natural progesterone to the myometrial target tissue and subsequent modifications in the estrogen pattern. This provides a theoretical mechanism for the clinical use of progesterone in the prevention of premature labor.

Salivary progesterone as an index of the luteal function.

Salivary progesterone (SP) is proposed as a useful index for estimation of luteal function. In 32 normal luteal phases with in-phase endometrial biopsies, the luteal SP assayed three times between 11 and 4 days before menses correlated significantly with the matched plasma P (PP) values and the ratio of SP to PP X 100 = 1.02. In 19 disharmonic luteal phases, a syndrome characterized by retarded endometrial development and apparently normal corpus luteum function, SP and PP were both in the normal range. In five conception cycles, SP and PP correlated significantly and increased during the evolution of the corpus luteum of pregnancy. In four cycles of luteal insufficiency, P concentrations were lower than normal in saliva as well as in plasma.

Radioimmunoassay of plasma and salivary progesterone during the menstrual cycle.

We have developed specific and sensitive radioimmunoassays for progesterone in saliva (SP4) easily applicable in routine practice to assess ovarian function. One of them uses [3H]progesterone, the other 3-CMO-[125I]histamine as tracer. The reliability criteria of both techniques have been controlled and the results obtained with the two methods in 50 saliva samples are correlated well. Our clinical study has been chiefly done with [3H]progesterone. In the present study we reported the values obtained daily during the greatest part of the menstrual cycle in 14 normal cases and they are in agreement with previous reports. The use of [125I]tracer, by increasing the sensitivity of the RIA and shortening the duration of the assay, improves the use of SP4 as a practical non-invasive sampling alternative for many clinical situations involving evaluation of the ovarian function.

[Significance of the diamine-oxidase test in the diagnosis of spontaneous rupture of fetal membranes]. / Intérêt du test à la diamine-oxydase (DAO) dans le diagnostic de la rupture spontanée des membranes ovulaires.

The authors report on their experience collected over a year of the use of the diamine-oxydase activity test after having collected the vaginal secretions on strips of Whatman paper placed in the vagina when they were trying to recognise premature rupture of the membranes. They studied: a control series of 90 patients (30 where the rupture was certain, 60 where it was definite that there was no rupture). They point out how reliable the method is at all stages of pregnancy and how simple and easy it is to carry out; a series of 89 consecutive patients whose clinical picture suggested premature rupture of the membranes; the diagnosis was shown to be wrong 48 times and confirmed 41 times (either immediately in 38 tests using DAO, or 48 hours after carrying out the first test in 3 cases). If this test is used to confirm that the membranes have really ruptured and to say when they have ruptured diamine-oxydase can be a very valuable factor when it is associated with the clinical picture and the ultrasound picture in leading to a rational handling of the case.

Oral administration of micronized natural progesterone in late human pregnancy. Effects on progesterone and estrogen concentrations in the plasma, placenta, and myometrium.

A single dose of micronized oral progesterone was administered to 15 pregnant women immediately prior to elective cesarean section. Levels of progesterone, 17 beta-estradiol, and estrone were measured in the plasma, in the placenta, and at different sites in myometrium obtained during the surgical procedure. Results were compared to those observed in a control group of women who did not receive progesterone. Progesterone levels demonstrated a marked increase in plasma and in the whole myometrium 150 minutes after administration. The levels then decreased rapidly to control values in 1 hour. The concentrations of progesterone in the placenta did not show any changes. No difference appeared in 17 beta-estradiol levels in the plasma or the myometrium, whereas an increase was observed in the placenta. Estrone levels did not change in the plasma, but they decreased in the myometrium and in the placenta.

Steroid concentrations and delta 5, 3 beta-hydroxysteroid dehydrogenase activity in human placenta. Comparison between elective cesarean section and spontaneous vaginal delivery.

The level of delta 5, 3 beta-hydroxysteroid dehydrogenase (delta 5, 3 beta-HSDH) was measured in the mitochondrial and microsomal fractions of the human term placenta. The capability of the placenta to transform pregnenolone to progesterone was found to be significantly higher after spontaneous vaginal delivery than after elective cesarean section (p < 0.001). There was a significant rise in the placental concentration of estrone occurring at the time of parturition (p < 0.01). The placental concentration of estradiol-17 beta was also greater after than before parturition but the diffference was not statistically significant. Conversely to the estrogen concentration, no difference existed in the progesterone concentration between the two groups of placentas. The significance of these findings is discussed in relation to the parturition process.

Steroid concentrations in human myometrial and placental tissues at week 39 of pregnancy.

Endogenous levels of P, E1, and E2 were determined by radioimmunoassay in human myometrium and placenta at week 39 of pregnancy. In the myometrium, P and estrogens were higher in the inner layer near the placenta than in other zones. Higher E2/P ratios were found in placental sites. A large difference in the E2/P ratios was observed between placenta and corresponding adjacent myometrial area, indicating an easier diffusion of E2 from the site of its production.