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1.
BMJ Case Rep ; 16(12)2023 Dec 01.
Article in English | MEDLINE | ID: mdl-38050392

ABSTRACT

Postpartum pyometra is rare; however, it may lead to sepsis. The main initial symptoms are fever, lower abdominal pain and foul-smelling lochia. The treatment includes antibiotic administration and surgical drainage. This is a report of postpartum pyometra following a caesarean section that was successfully treated with manual vacuum aspiration, a simple and minimally invasive option. Other treatment options include pyometra reduction using placenta forceps and the placement of an intrauterine drainage catheter.


Subject(s)
Pyometra , Humans , Pregnancy , Female , Pyometra/surgery , Pyometra/diagnosis , Vacuum Curettage , Cesarean Section , Anti-Bacterial Agents/therapeutic use , Postpartum Period
2.
Endocr J ; 54(6): 945-51, 2007 Dec.
Article in English | MEDLINE | ID: mdl-18000344

ABSTRACT

Leptin is a satiety hormone secreted from the adipose tissue and human placenta. We previously demonstrated that severe preeclampsia up-regulated leptin mRNA expression in the placenta and elevated maternal plasma leptin concentrations. Preeclampsia is frequently related to generation of small for gestational age (SGA) infant especially in cases with severe preeclampsia. However, it is still controversial whether the increase in maternal plasma leptin levels is associated with fetal growth restriction without complication of preeclampsia. Therefore, the aim of the present study was to explore the relationship between maternal plasma leptin levels and fetal growth in non-preeclamptic (n = 98) and preeclamptic (n = 40) women. In non-preeclamptic pregnant women, plasma leptin levels in SGA group (n = 11) were significantly higher than those in appropriate for gestational age (AGA) group (n = 87, P<0.05). In pregnant women with preeclampsia, likewise, plasma leptin levels in SGA group (n = 15) were significantly higher than those in AGA group (n = 25, P<0.05). In multiple linear regression analysis, maternal BMI, mean arterial blood pressure and Delta SD of neonatal body weight were significant factors for determining maternal plasma leptin levels in all population studied. Maternal BMI and Delta SD of neonatal body weight showed positive correlation with maternal plasma leptin levels when analysis was performed in non-preeclamptic subjects alone. In conclusion, maternal plasma leptin levels reflect, at least partly, deterioration in fetal growth.


Subject(s)
Fetal Growth Retardation/blood , Infant, Small for Gestational Age , Leptin/blood , Pre-Eclampsia/blood , Adult , Blood Pressure/physiology , Body Mass Index , Female , Humans , Infant, Newborn , Linear Models , Pregnancy
3.
Mol Hum Reprod ; 11(9): 659-65, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16199413

ABSTRACT

Hyaluronan (HA) a glycosaminoglycan with high affinity for water molecules stimulates local inflammatory reactions. Parturition causes a dramatic increase in the amount of HA fragments in the uterine cervix, thereby contributing to a rapid softening as well as opening of the cervical canal, i.e. cervical ripening. The aim of this study was to investigate the possible involvement of cyclic distension caused by labour in the augmentation of HA production during cervical ripening. Immunohistochemistry and/or RT-PCR detected hyaluronan synthase (HAS)1, 2 and 3 in samples of human cervical tissue obtained from pregnant women. Labour-like cyclic mechanical stretch for 24, 36 and 48 h significantly enhanced the secretion of HA, from cultured human uterine cervical fibroblast (CxF) cells, 128.7, 151.4 and 173.2%, respectively, concomitant with a significant augmentation of HAS1 (36, 48 h), HAS2 (24, 36 and 48 h) and HAS3 (48 h) mRNA expression. Cyclic mechanical stretch for 12, 36 and 48 h increased molecular size of the HA secreted from CxF cells. In conclusion, cyclic mechanical stretch of the uterine cervix caused by the presenting part of the fetus in labour may contribute to the increase in the secretion of HA during the process of cervical ripening.


Subject(s)
Cervix Uteri/metabolism , Glucuronosyltransferase/metabolism , Hyaluronic Acid/metabolism , Cells, Cultured , Cervical Ripening/metabolism , Female , Fibroblasts/metabolism , Glucuronosyltransferase/genetics , Humans , Hyaluronan Synthases , Hyaluronic Acid/biosynthesis , Pregnancy , RNA, Messenger/metabolism , Reflex, Stretch , Stress, Mechanical , Time Factors
4.
Cell Metab ; 1(6): 371-8, 2005 Jun.
Article in English | MEDLINE | ID: mdl-16054086

ABSTRACT

Intrauterine undernutrition is closely associated with obesity related to detrimental metabolic sequelae in adulthood. We report a mouse model in which offspring with fetal undernutrition (UN offspring), when fed a high-fat diet (HFD), develop pronounced weight gain and adiposity. In the neonatal period, UN offspring exhibited a premature onset of neonatal leptin surge compared to offspring with intrauterine normal nutrition (NN offspring). Unexpectedly, premature leptin surge generated in NN offspring by exogenous leptin administration led to accelerated weight gain with an HFD. Both UN offspring and neonatally leptin-treated NN offspring exhibited an impaired response to acute peripheral leptin administration on a regular chow diet (RCD) with impaired leptin transport to the brain as well as an increased density of hypothalamic nerve terminals. The present study suggests that the premature leptin surge alters energy regulation by the hypothalamus and contributes to "developmental origins of health and disease."


Subject(s)
Animals, Newborn/metabolism , Leptin/metabolism , Leptin/physiology , Malnutrition/etiology , Malnutrition/metabolism , Obesity/etiology , Obesity/metabolism , Pregnancy Proteins/physiology , Uterus/metabolism , Animals , Energy Metabolism/physiology , Female , Malnutrition/physiopathology , Mice , Obesity/physiopathology , Pregnancy , Pregnancy Proteins/metabolism
5.
J Soc Gynecol Investig ; 11(7): 457-64, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15458742

ABSTRACT

OBJECTIVE: To investigate whether 17beta-estradiol elevates prostacyclin (PGI(2)) production in human myometrial cells in the middle of gestation. METHODS: The concentration of 6-keto-PGF(1alpha), a stable metabolite of PGI(2), in the culture medium was assessed using enzyme-linked immunosorbent assay (ELISA). Western blot analysis and quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) using TaqMan (Applied Biosystems, Foster City, CA) technology were performed to evaluate the expression of cytosolic phopholipase A(2) (cPLA(2)), cyclooxygenase-1 (COX-1), COX-2, and prostacyclin synthase (PGIS) in cultured human myometrial cells prepared from second trimester pregnant women (n = 3) after stimulation with 17beta-estradiol. RESULTS: Treatment with 17beta-estradiol (4-400 nM) dose-dependently elevated PGI(2) secretion from cultured human myometrial cells. Western blot analysis detected cPLA(2) and COX-1 and PGIS protein expression in the cultured human myometrial cells; however, COX-2 protein expression was below the detection sensitivity. Stimulation with 40-nM 17beta-estradiol significantly up-regulated protein and mRNA expression of both COX-1 and PGIS. CONCLUSION: 17beta-Estradiol from placenta may contribute to the augmentation of PGI(2) production in the human myometrium in the middle of gestation via up-regulation of both COX-1 and PGIS expression.


Subject(s)
Cytochrome P-450 Enzyme System/genetics , Epoprostenol/biosynthesis , Estradiol/pharmacology , Gene Expression/drug effects , Intramolecular Oxidoreductases/genetics , Myometrium/drug effects , Prostaglandin-Endoperoxide Synthases/genetics , 6-Ketoprostaglandin F1 alpha/metabolism , Blotting, Western , Cells, Cultured , Cyclooxygenase 1 , Cyclooxygenase 2 , Cytochrome P-450 Enzyme System/analysis , Female , Gestational Age , Humans , Intramolecular Oxidoreductases/analysis , Membrane Proteins , Myometrium/enzymology , Myometrium/metabolism , Phospholipases A/genetics , Pregnancy , Prostaglandin-Endoperoxide Synthases/analysis , RNA, Messenger/analysis , Reverse Transcriptase Polymerase Chain Reaction
6.
Mol Hum Reprod ; 10(8): 573-80, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15194816

ABSTRACT

Intensive local leukocyte infiltration in the uterine cervix is a characteristic feature in the process of cervical ripening. The infiltrated leukocytes include neutrophils, macrophages and monocytes, which are believed to play important roles in cervical ripening by secreting elastase, matrix metalloproteinase and interleukin-1 (IL-1). Interleukin-8 (IL-8) and monocyte chemotactic protein-3 (MCP-3) belong to the CXC and CC chemokine families, and mediate the chemotaxis of neutrophils and monocytes/macrophages respectively. The aim of the present study was to investigate the possible involvement of IL-8 and MCP-3 in leukocyte chemotaxis in cervical ripening. Immunohistochemistry and RT-PCR detected both IL-8 and MCP-3 expression in human pregnant uterine cervices. Labour-like cyclic mechanical stretch for 48 h significantly elevated both IL-8 (555%) and MCP-3 (360%) secretion from cultured human uterine cervical fibroblast (CxF) cells (P<0.05 for both). Cyclic mechanical stretch for 24, 36 and 48 h significantly increased both IL-8 and MCP-3 mRNA expression in CxF cells (P<0.05 for all). The stretch-induced augmentation of both IL-8 and MCP-3 expression was significantly suppressed by an activator protein-1 (AP-1) inhibitor, curcumin. These data suggest that cyclic mechanical stretch of the uterine cervix by the presenting part of the fetus during labour may augment both IL-8 and MCP-3 production in the uterine cervix via AP-1 activation.


Subject(s)
Cervix Uteri/cytology , Cervix Uteri/metabolism , Cytokines/metabolism , Fibroblasts/physiology , Interleukin-8/metabolism , Monocyte Chemoattractant Proteins/metabolism , Stress, Mechanical , Anti-Inflammatory Agents, Non-Steroidal/metabolism , Cells, Cultured , Cervix Mucus/chemistry , Chemokine CCL7 , Curcumin/metabolism , Cytokines/genetics , Female , Fibroblasts/cytology , Humans , Interleukin-8/genetics , Monocyte Chemoattractant Proteins/genetics , Pregnancy , Pregnancy Trimesters
7.
Endocr J ; 51(2): 177-87, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15118268

ABSTRACT

Maternal plasma leptin concentration is significantly increased during pregnancy. However, its roles in pregnancy, especially in labor, have not been fully clarified. We measured plasma leptin concentrations in pregnant women during the course of induced labor, just after spontaneous vaginal delivery and Cesarean section at term. We also studied the regulation of leptin secretion from term placental tissue and BeWo cells, a trophoblastic cell-line. Plasma leptin concentrations increased significantly during labor (58.9 +/- 9.2 ng/ml) compared to those before labor induction (37.5 +/- 5.8 ng/ml, P<0.05), then decreased 3-6 days postpartum (14 +/- 3 ng/ml, n = 6, P<0.0001) to the levels of normal nonpregnant women. Leptin concentrations within an hour and 24 hours after spontaneous vaginal delivery were significantly higher than those after Cesarean section (P<0.05 for both comparisons). Similarly, leptin mRNA expression in placental tissues obtained after spontaneous vaginal delivery was significantly greater than that in those obtained after Cesarean section without labor (P<0.05). IL-1alpha and TNF-alpha treatment significantly stimulated leptin secretion and leptin mRNA expression in explant culture of human term placental tissue and in BeWo cells as compared with those in vehicle controls (P<0.05, for all comparisons). By contrast, oxytocin and prostaglandin F(2alpha) treatment had no effects on leptin secretion from explant culture of human term placental tissue or from BeWo cells. These data indicate that pro-inflammatory cytokines might stimulate placental leptin secretion, thus finally contributing to the increase in plasma leptin concentration during labor.


Subject(s)
Interleukin-1/pharmacology , Labor, Induced , Leptin/blood , Pregnancy/blood , Tumor Necrosis Factor-alpha/pharmacology , Adult , Cell Line , Cesarean Section , Female , Humans , Leptin/genetics , Leptin/metabolism , Osmolar Concentration , Placenta/metabolism , RNA, Messenger/metabolism , Tissue Culture Techniques , Trophoblasts/metabolism
8.
Mol Hum Reprod ; 10(2): 115-22, 2004 Feb.
Article in English | MEDLINE | ID: mdl-14742696

ABSTRACT

The aim of the present study was to investigate the possible contribution of estrogen to pregnancy-associated modulation of nitric oxide production in the human myometrium during pregnancy. Both endothelial nitric oxide synthase (eNOS) and inducible NOS (iNOS) proteins were clearly expressed in the non-pregnant myometrium and were elevated in the first trimester of pregnancy. Oral contraceptive pills augmented eNOS, but not iNOS, protein expression in the non-pregnant human myometrium. In cultured human myometrial cells, estrogen receptor (ER)alpha and ERbeta expression was extremely low. Therefore, we used either ERalpha or ERbeta expression vector to investigate the effect of 17beta-estradiol treatment on eNOS promoter activity using eNOS promoter/luciferase vector in cultured human myometrial cells. 17beta-estradiol treatment significantly augmented eNOS promoter activity in cells co-transfected with either ERalpha or ERbeta, and this augmentation was dose-dependently suppressed by ICI 182780, an estrogen antagonist. These data suggest the possibility that both ERalpha and ERbeta are involved in the estrogen-associated regulation of eNOS gene expression in the human myometrium.


Subject(s)
Estradiol/analogs & derivatives , Myometrium/metabolism , Nitric Oxide Synthase/genetics , Pregnancy/metabolism , Promoter Regions, Genetic , Receptors, Estrogen/physiology , Transcriptional Activation , Adult , Blotting, Western , Cells, Cultured , Endometrium/drug effects , Estradiol/pharmacology , Estrogen Receptor alpha , Estrogen Receptor beta , Ethinyl Estradiol/pharmacology , Female , Fulvestrant , Genes, Reporter/genetics , Humans , Immunochemistry , Myocytes, Smooth Muscle/drug effects , Myocytes, Smooth Muscle/enzymology , Myocytes, Smooth Muscle/metabolism , Myometrium/cytology , Myometrium/drug effects , Nitric Oxide Synthase/biosynthesis , Nitric Oxide Synthase Type II , Nitric Oxide Synthase Type III , Norgestrel/pharmacology , RNA, Messenger/biosynthesis , Reverse Transcriptase Polymerase Chain Reaction , Transfection
9.
Endocr J ; 50(5): 535-44, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14614209

ABSTRACT

Nitric oxide has various biological activities including smooth muscle relaxation, anti-inflammatory activity, anti-coagulatory activity. As the human placenta is known to express nitric oxide synthases, this study investigated the possible effect of labor on the expression of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in human placental tissues at term. Both eNOS and iNOS mRNA expression in placental tissues in labor were significantly higher than those in the amnion, chorion laeve, decidua vera and myometrium. The eNOS mRNA and protein expressions in placental tissues in labor (n = 12) were 1.6023 +/- 0.1652 (eNOS/GAPDH, mean +/- SEM) and 12.8 +/- 1.3 arbitrary units (AU), respectively, which were similar to those not in labor (n = 10), 1.5806 +/- 0.2042 (eNOS/GAPDH) and 11.4 +/- 1.8 AU. The iNOS mRNA and protein expressions in the placental tissues in labor were 1.2831 +/- 0.2436 (iNOS/GAPDH) and 10.7 +/- 2.1 AU respectively, similar to those not in labor, 1.9254 +/- 0.8004 (iNOS/GAPDH) and 13.3 +/- 1.8 AU. The guanosine 3',5'-cyclic monophosphate (cGMP) concentration in the placental tissues in labor was 23.6 +/- 1.4 fmol/g wet tissue, similar to that not in labor, 26.1 +/- 2.0 fmol/g wet tissue. These findings suggest that nitric oxide production in the human placenta is maintained during labor.


Subject(s)
Labor, Obstetric/metabolism , Nitric Oxide Synthase/metabolism , Placenta/enzymology , Cyclic GMP/metabolism , Female , Humans , Nitric Oxide Synthase/genetics , Nitric Oxide Synthase Type II , Nitric Oxide Synthase Type III , Osmolar Concentration , Pregnancy , RNA, Messenger/metabolism , Uterus/enzymology
10.
J Clin Endocrinol Metab ; 88(3): 1394-7, 2003 Mar.
Article in English | MEDLINE | ID: mdl-12629135

ABSTRACT

The mechanism for decreased insulin sensitivity in pregnant women is not fully clarified. Resistin, a novel peptide hormone, is specifically expressed in the adipose tissue and decreases insulin sensitivity in rodents. In the present study, we demonstrate resistin gene expression in the human placental tissue, mainly in trophoblastic cells. The resistin gene expression in term placental tissue was more prominent than was seen in the first trimester chorionic tissue. In contrast resistin gene expression in adipose tissue was rather weak and remained unchanged by pregnancy. Thus, resistin is a newly isolated placental hormone in humans which may modulate insulin sensitivity during pregnancy.


Subject(s)
Hormones, Ectopic/genetics , Intercellular Signaling Peptides and Proteins , Placenta/metabolism , Blotting, Northern , Cells, Cultured , Female , Hormones, Ectopic/analysis , Hormones, Ectopic/blood , Humans , Immunohistochemistry , Pregnancy , RNA, Messenger/analysis , Resistin
11.
J Clin Endocrinol Metab ; 87(11): 5209-19, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12414894

ABSTRACT

Prostacyclin (PGI(2)), a potent smooth muscle relaxant, is a major prostaglandin secreted from human myometrium. The concentrations of PGI(2) metabolites in the maternal plasma were reported to be elevated during pregnancy, especially in labor. To clarify the mechanism in PGI(2) secretion from the myometrium, we first investigated the protein expression of cytosolic phospholipase A(2), cyclooxygenase (COX)-1, COX-2, and prostacyclin synthase (PGIS) in the human uterine myometrium at various gestational ages before labor. To elucidate the involvement of labor in the increase in PGI(2) production during labor, we next examined the effect of labor-like cyclic mechanical stretch on PGI(2) production by cultured human myometrial cells. Pregnancy specifically increased COX-1 and PGIS protein expression in the myometrial tissues before labor (P < 0.01 for both). Cyclic mechanical stretch augmented PGIS promoter activity, via activation of activator protein-1 site, and PGIS mRNA and protein expression in cultured human myometrial cells and resulted in a 3.5-fold increase in the concentration of 6-keto-prostaglandin F(1alpha), the stable metabolite of PGI(2), in the culture medium (P < 0.05). However, stretch did not affect the levels of prostaglandin E(2), prostaglandin F(2alpha), or thromboxane A(2) secreted into the same culture media. These results suggest that cyclic mechanical stretch during labor may contribute to the increase in the PGI(2) concentration in the maternal plasma during parturition.


Subject(s)
Cytochrome P-450 Enzyme System/genetics , Epoprostenol/biosynthesis , Intramolecular Oxidoreductases/genetics , Muscle Spindles/physiology , Myometrium/physiology , Benzoquinones , Biomechanical Phenomena , Blotting, Western , Cells, Cultured , Culture Media, Conditioned , Curcumin/pharmacology , Cyclooxygenase 1 , Cyclooxygenase 2 , Dinoprost/metabolism , Dinoprostone/metabolism , Female , Gene Expression , Genistein/pharmacology , Gestational Age , Humans , Isoenzymes/genetics , Labor, Obstetric/physiology , Lactams, Macrocyclic , Membrane Proteins , Phospholipases A/genetics , Pregnancy , Promoter Regions, Genetic , Prostaglandin-Endoperoxide Synthases/genetics , Quinones/pharmacology , RNA, Messenger/analysis , Reverse Transcriptase Polymerase Chain Reaction , Rifabutin/analogs & derivatives , Thromboxane A2/metabolism
12.
Nippon Ganka Gakkai Zasshi ; 106(7): 416-9, 2002 Jul.
Article in Japanese | MEDLINE | ID: mdl-12187825

ABSTRACT

BACKGROUND: We report a case of canaliculitis caused by Actinomyces odontolyticus in a case of dry eye with punctal plugs. CASE: A 64-year-old female with Sjögren's syndrome type of dry eye developed lacrimation, congestion in the lower palpebral conjunctiva and corneal epithelial damage in her right eye 30 months after punctal plug occlusion. After removal of the plug from lower punctum in her right eye, white material exuded from the punctum. However, even after the removal of a plug, corneal epithelial keratopathy did not get worse, implying that the granulation tissue formed by the plug completely occluded the canaliculus. Actinomices odontolyticus was cultured from the white material. One week after topical antibiotic treatment, conjunctival congestion and irritation were resolved. CONCLUSION: This report indicates the possibility of canaliculitis as a complication of punctal plug occlusion. Careful observation is necessary after punctal occlusion with punctal plugs.


Subject(s)
Actinomycosis , Dacryocystitis/microbiology , Dry Eye Syndromes/complications , Lacrimal Apparatus/surgery , Prosthesis Implantation , Dacryocystitis/etiology , Female , Humans , Middle Aged , Prostheses and Implants
13.
Mol Hum Reprod ; 8(7): 681-7, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12087084

ABSTRACT

Human uterine cervical tissue is composed mainly of fibroblast cells and the extracellular matrix in which collagen types I and III predominate. It is hypothesized that these collagens are degraded by matrix metalloproteinases (MMPs) in the initial step of uterine cervical ripening during parturition. Among the MMPs, MMP-1, -8 and -13 have substrate selectivity for collagen types I and III. In the present study, we examined the regulation of MMP-1 secretion from the human uterine cervix. Immunohistochemistry detected strong staining of MMP-1, but not of MMP-8 or -13, in stromal cells of the pregnant uterine cervix. The MMP-1 expression in the pregnant uterine cervix was further confirmed by Western blot analysis and RT-PCR. To clarify the regulation of MMP-1 production, we subsequently investigated the effects of prostaglandins, inflammatory cytokines and cyclic mechanical stretch on the secretion of MMP-1 from cultured human uterine cervical fibroblast cells. Treatment with prostaglandin (PG)F(2alpha) (10(-7) to 10(-5) mol/l) or interleukin (IL)-1alpha (0.01-1.0 ng/ml) or stimulation with cyclic mechanical stretch increased MMP-1 secretion from cultured human uterine cervical fibroblast cells, with maximal increases of 3.4-, 4.5- and 1.9-fold respectively (24 h of treatment, P < 0.05 for all comparisons). These data suggest that MMP-1 may play a significant role in the degradation of extracellular collagen types I and III in the pregnant uterine cervix during the process of cervical ripening, in response to various stimulations such as PGF(2alpha), IL-1alpha and mechanical stretch.


Subject(s)
Cervix Uteri/metabolism , Dinoprost/metabolism , Interleukin-1/metabolism , Matrix Metalloproteinase 1/metabolism , Cells, Cultured , Curcumin/metabolism , Dinoprostone/metabolism , Female , Fibroblasts , Humans , Matrix Metalloproteinase 8/metabolism , Pregnancy , Stress, Mechanical
14.
Endocrine ; 19(1): 65-71, 2002 Oct.
Article in English | MEDLINE | ID: mdl-12583603

ABSTRACT

Leptin was initially identified as an adipocyte-derived hormone that decreases food intake and body weight via its receptor in the hypothalamus. Subsequent animal studies revealed various physiologic functions of leptin. Leptin plays an essential role in reproduction by regulating gonadotropin-releasing hormone secretion from the hypothalamus. It also modulates glucose metabolism by increasing insulin sensitivity and activates the sympathetic nervous system. In humans, leptin is also produced by placental trophoblasts and is secreted into both the maternal and fetal circulation. Leptin production in the placenta is increased in pregnancies complicated with several pathologic conditions. Leptin gene expression in the placenta is augmented in severe preeclampsia, and maternal plasma leptin levels in severe preeclampsia are significantly higher than those in normotensive pregnant women. Leptin production in the placenta is also increased in diabetic pregnancy with insulin treatment. Furthermore, leptin is proposed to play a functional role in implantation by virtue of its stimulatory effect on matrix metalloproteinase expression in cytotrophoblast. Dysregulation of leptin metabolism and/or function in the placenta may be implicated in the pathogenesis of various disorders during pregnancy, such as recurrent miscarriage, gestational diabetes, intrauterine growth retardation, and preeclampsia. In this review, possible roles of placental leptin are discussed.


Subject(s)
Leptin/physiology , Placenta/metabolism , Pregnancy/physiology , Adipocytes/metabolism , Energy Metabolism/physiology , Female , Fetus/physiology , Humans , Leptin/blood , Leptin/metabolism
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