Pregnancies exposed to methadone, methadone and other illicit substances, and poly-drugs without methadone: a comparison of fetal neurobehaviors and infant outcomes.

BACKGROUND: It is suspected that there is a continuum of impairment among prenatally drug-exposed infants, such that opioid and/or poly-drug exposure confers the highest risk for adverse neonatal outcomes than other classes of substances or single substance exposures. Suitable control groups are difficult to identify. This study compared fetal neurobehavioral development and infant outcomes in offspring of three groups of pregnant women in drug treatment. Exposure groups include: Methadone+other illicit substances (MM+Poly) and two groups currently abstinent for poly drug exposures: Methadone only (MM/A) and Non-Methadone (NM/A). METHODS: Forty-nine women (19 MM+Poly, 18 MM/A, and 12 NM/A) underwent fetal monitoring at 36 weeks gestation at peak and trough levels of methadone (MM+Poly; MM/A) or at comparable morning and afternoon times (NM/A). Fetal heart rate (FHR), heart rate variability (FHRV) and motor activity (FM) data were collected. Infant measures included birth outcomes and Neonatal Abstinence Syndrome (NAS) assessment. RESULTS: As compared to the NM/A group, cardiac measures were decreased in methadone-exposed fetuses at peak levels. FHR was significantly more suppressed in the MM+Poly group. FM was significantly lower in the MM/A vs. the NM/A group at both peak and trough, indicative of more persistent exposure effects. The MM+Poly group delivered 1 week earlier and required NAS pharmacological treatment twice as often as the MM/A group. CONCLUSIONS: Results support the notion that poly-drug exposure may potentiate the effects of methadone on the fetus and infant and highlights the need for intensified treatment for methadone-maintained women who abuse other substances.

Type I insulin-like growth factor receptors in the BeWo choriocarcinoma cell (b30 clone) during cell differentiation.

The expression of insulin-like growth factor (IGF) receptors in the differentiating human trophoblast was studied using the b30 clone of the BeWo choriocarcinoma cell line (BeWob30) as a model system. This clonally derived cell line differentiates over 48-72 h, in culture, to form syncytiotrophoblasts when intracellular cAMP levels are elevated by exposure to 100 microM forskolin (FSK). IGF receptors were studied at various times during the differentiation process by measuring the specific binding of [125I]-IGF-I and [125I]-IGF-II to attached cells. First, [125I]-IGF-I bound to a single class of binding sites in the untreated cells (KD approximately 1-2 x 10-10 M) that exhibited binding specificity characteristic of the type I IGF receptor (IGF-I > or = IGF-II > > Insulin). FSK treatment resulted in a two- to threefold increase in the number of these binding sites. Increased receptor expression was observed as early as 24 h after FSK treatment and remained elevated for at least 72 h. Next, [125I]-IGF-II bound to two classes of binding sites in the untreated cells, a high-affinity (KD approximately 2.5 x 10(-10) M), low-capacity site and a low-affinity (KD approximately 6 x 10(-9) M), high-capacity site. The Bmax and KD of the high-affinity site suggested that it represented the type I IGF receptor. Competition studies revealed that 15-20 per cent of total [125I]-IGF-II binding only was sensitive to IGF-I competition in the untreated cells. After FSK treatment, however, unlabelled IGF-I inhibited 60-70 per cent of specific [125I]-IGF-II binding. Scatchard analysis revealed a two- to fourfold increase in the number of both binding sites with no change in their respective binding affinities. Cross-linking analysis demonstrated that [125I]-IGF-II bound to two structurally distinct binding sites in the untreated BeWob30 cell consistent with both the type I and II IGF receptors. After FSK treatment, however, there was an increase in the relative amount of [125I]-IGF-II associated with the higher affinity type I IGF receptor. The BeWob30 cells expressed no insulin receptors at any stage of differentiation. These data demonstrate that the BeWob30 choriocarcinoma cell line expresses both type I and II IGF receptors. Induction of cell differentiation is associated with an increase in type I IGF receptors expressed at the cell surface. These receptors bind IGF-II with high-affinity, providing additional binding capacity for locally available IGF-II. These data are consistent with specific roles for the type I IGF receptor in regulating differentiated trophoblast cell function. Furthermore, the early rise in type I IGF receptor number suggests they may play a regulatory role in the differentiation process itself.

Binding of insulin-like growth factor I to human trophoblast cells during differentiation in vitro.

The binding of insulin-like growth factor I (IGF-I) to its receptor stimulates cell proliferation and differentiation in several cell systems. In the present studies, we have characterized the expression of IGF-I receptors during trophoblast differentiation in vitro. During differentiation of cytotrophoblast cells to syncytiotrophoblasts, IGF-I binding capacity increased 40 per cent from 80 to 130 fmol/mg protein on day 1 to day 2, then decreased by 70 per cent from 130 to 40 fmol/mg protein on day 2 to day 3. IGF-I binding affinity increased non-significantly with a change in kDa from 6.5 to 3.5 nM between day 1 and day 3 in culture. In contrast, when cells were maintained in an undifferentiated state, there was no change in either binding capacity or affinity over three days in culture. Down-regulation of the IGF-I receptor by pre-incubation with IGF-I was demonstrated for syncytiotrophoblasts with a maximum decrease in IGF-I binding of 67 per cent after 72 h pre-incubation. Minimal down-regulation was seen for the cytotrophoblast cells (maximum decrease in IGF-I binding of 22 per cent after 48 h pre-incubation). In conclusion, these results demonstrated that IGF-I binding to the trophoblast cell surface changes during trophoblast differentiation in vitro and suggest involvement of IGF-I in this process.

Successful pregnancies in the presence of spinal muscular atrophy: two case reports.

We report two cases of successful pregnancy in women with chronic, infantile onset, or type II spinal muscular atrophy, both of whom delivered healthy, unaffected babies. The patients required concurrent management by a physiatrist, pulmonologist, and perinatologist throughout the pregnancy. Complications included recurrent urinary tract infections, dyspnea and worsening of pulmonary function, wheelchair seating and positioning problems, and musculoskeletal and low back pain. These problems resolved postpartum. One woman had vaginal delivery, the other had caesarean section, both of which were well-tolerated. Because of severe musculoskeletal deformity, pelvic assessment is necessary to determine the mode of delivery. The uterus has normal contractility and effective labor patterns can be established. Spinal/epidural anesthesia may be contraindicated because of spine deformity. The pregnancies had no deleterious effect on the progression of the disease in our patients, both of whom reported a positive experience with great personal fulfillment.

Myosin light chain and caldesmon phosphorylation in arterial muscle stimulated with endothelin-1.

Endothelin-1 contracts porcine carotid arterial smooth muscle with an ED50 of 10 nM. Contraction is associated with phosphorylation of the 20,000 dalton-regulatory light chain subunits of vascular myosin. Phosphopeptide mapping of light chains isolated from 32PO4-loaded muscle strips stimulated by endothelin-1 (5 x 10(-8) M) and comparison with maps generated from light chains phosphorylated in vitro or muscles stimulated with KCl (110 mM) or angiotensin-II (5 x 10(-8) M) indicates that Ca2(+)-calmodulin activation of myosin light chain kinase is a biochemical pathway stimulated by all three agonists. However, a small amount of phosphate (17%) was detected in a light chain peptide phosphorylated by protein kinase C. Endothelin-1 also stimulated phosphorylation of the thin filament protein, caldesmon, (from 0.35 mol PO4/mol caldesmon to 0.52 mol PO4/mol). Collectively, these results provide evidence that the effects of endothelin-1 on force generation and maintenance in vascular muscle may be dependent upon myosin light chain phosphorylation by Ca2+ calmodulin--requiring myosin light chain kinase and upon a thin filament mechanism that is modulated by phosphorylation of caldesmon.

Antenatal diagnosis and treatment of fetal bronchopulmonary sequestration.

Bronchopulmonary sequestration with associated nonimmune hydrops has been previously reported with generally poor prognosis for the neonate. We report a case of bronchopulmonary sequestration and associated pleural effusion successfully managed with a transthoracic catheter placement. The embryology and clinical pathophysiology of bronchopulmonary sequestration are discussed.

Hybrid antibody-induced topographical redistribution of surface immunoglobulins, alloantigens, and concanavalin A receptors on mouse lymphoid cells.

Redistribution of surface immunoglobulins, H-2(b), Thy-1.2, and TL.1,2,3 alloantigens, and concanavalin A receptors on mouse lymphoid cells induced by hybrid rabbit F(ab')(2) antibody (anti-mouse immunoglobulin/anti-visual marker or anti-concanavalin A/anti-visual marker) was studied by immunofluorescence. When used directly to label surface immunoglobulin, and indirectly to label alloantigens and concanavalin A receptors, hybrid antibodies induced similar displacement of all surface components from a uniform distribution into "patches" and "caps" at 37 degrees . One hybrid antibody preparation, antimouse immunoglobulin/anti-ferritin, contained negligible amounts of bivalent anti-mouse immunoglobulin antibody, and was therefore "monovalent" for the antimouse immunoglobulin specificity. This observation suggests that factors other than multivalent crosslinking are responsible for hybrid antibody-induced redistribution of cell-surface components. Cap formation induced by hybrid antibody was enhanced markedly by attachment of the visual marker, either ferritin or southern bean mosaic virus, at 37 degrees . At -5 degrees , hybrid antibody does not displace uniformly distributed H-2(b) alloantigen-alloantibody complexes, but patches of label develop when ferritin attaches to the hybrid antibody. These results explain the patchy distribution of cell-surface components, which is a temperature-independent characteristic of labeling with hybrid antibodies and visual markers for electron microscopy.