Factors associated with size and proportionality at birth in term Jamaican infants.

The objective of this study was to identify the factors associated with size and proportionality at birth in a cohort of term infants established to investigate their growth and development. One hundred and forty term low-birth-weight (birth-weight < 2,500 g) infants and 94 normal birth-weight infants (2,500- < 4,000 g) were recruited within 48 hours of birth at the main maternity hospital, Kingston, Jamaica. Birth anthropometry and gestational age were measured, and maternal information was obtained by interview and from hospital records. Controlling for gestational age, variables independently associated with birth-weight were rate of weight gain in the second half of pregnancy, maternal height, haemoglobin level < 9.5 microg/dL, time of first attendance in antenatal clinic, birth order, pre-eclampsia, and consumption of alcohol, with 33% of the variance in birth-weight explained. Birth length was associated only with maternal height and age, while measures of proportionality (ponderal index and head/length ratio) were associated with characteristics of the environment in late pregnancy, including rate of weight gain, weight in late pregnancy, and pre-eclampsia. The variation in maternal characteristics associated with size or proportionality at birth may reflect the times during gestation when different aspects of growth are most affected.

Preeclamptic decidual microvascular endothelial cells express lower levels of matrix metalloproteinase-1 than normals.

In preeclampsia, invasion of intrauterine decidual blood vessels by placental cytotrophoblasts is significantly reduced. This study examined the secretion of matrix metalloproteinases (MMP) by cultured human decidual endothelial cells from normal (NDEC) and preeclamptic (PEDEC) pregnancies. MMPs secreted into the culture medium were measured using zymography, Western blotting, and ELISA. Results were confirmed by Northern analysis. Phorbol myristate acetate, known to induce protease activity in other endothelial cell populations, stimulated MMP1, MMP9, and TIMP1 secretion in both NDEC and PEDEC. Neither tumor necrosis factor-alpha nor transforming growth factor-beta, both thought to have significant roles in the control of placentation, affected MMP secretion. MMP9 and TIMP1 levels were similar between the two cell types; however, MMP1 secretion was markedly different between the cell types. NDEC expressed higher levels of MMP1 under both basal (160 +/- 32 ng/10(6) cells) and stimulated (275 +/- 50) conditions compared to PEDEC (32 +/- 24 and 70 +/- 53, respectively). The lower MMP1 expression of decidual endothelial cells from preeclamptic women may inhibit endovascular invasion by cytotrophoblasts. These findings may, at least partly, explain the relative failure of trophoblasts to invade maternal decidual blood vessels in preeclamptic pregnancy.

[The pathomorphology of the kidneys in the fetuses of mothers suffering from late gestosis, type-1 diabetes mellitus and chronic glomerulonephritis]. / Patomorfologiia pochek plodov ot materei, stradaiushchikh pozdnim gestozom, sakharnym diabetom I tipa i khronicheskim glomerulonefritom.

Fetal kidneys from mothers with late gestosis, diabetes mellitus-1 and chronic glomerulonephritis were studied. There were features of the maturation slowing down and some disturbances in differentiation of rental tissue were revealed. Local degenerative, membranous, proliferative and fibroplastic changes with formation of immune complexes including IgM and C3-complement in late gestosis, IgA, G, C3-complement fractions IgG, M, C3-complement fraction and traces of membranous and proliferative alteration were observed in chronic glomerulonephritis, they were less frequent in diabetes mellitus in mothers, and not so often in late gestosis. Activation of collagen production of types I, III, IV and V was most commonly observed in diabetes mellitus, in chronic glomerulonephritis and late gestosis, it being more rare.

Changes observed in Doppler studies of the fetal circulation in pregnancies complicated by pre-eclampsia or the delivery of a small-for-gestational-age baby. I. Cross-sectional analysis.

The aim of this study was to compare changes in Doppler ultrasound studies of the fetal circulation in normal pregnancies with a group of pregnancies complicated by proteinuric pregnancy-induced hypertension (PPIH), delivery of a small-for-gestational-age (SGA) baby, or both. A total of 167 uncomplicated pregnancies with a term delivery of an appropriately grown baby (AGA) were used to define the normal range. Altogether, 123 high-risk pregnancies with a known outcome constituted the study group. A color duplex ultrasound machine was used to perform biometry and fetal Doppler studies. Measurements obtained from the fetal circulation included the umbilical artery (UA) pulsatility index (PI), the middle cerebral artery (MCA) PI and time-averaged velocity (TAV), the thoracic aorta (AO) PI and TAV. In addition, the ratio between the MCA PI and UA PI, the MCA PI and the AO PI, and the product of the MCA PI and AO TAV were used in the analysis. A total of 105 pregnancies had a complicated outcome. They were divided into three categories: PPIH only (pregnancies complicated by PPIH with the delivery of an AGA fetus, n = 17), SGA only (delivery of an SGA baby, with no evidence of PPIH, n = 55), and PPIH + SGA (pregnancies complicated by pre-eclampsia and delivery of an SGA baby, n = 37). The PPIH + SGA group represented true clinical intrauterine growth retardation. Cross-sectional reference ranges were created using the observations from the normal group. z-scores (standard deviation from the mean of the normal range) of the last observations made before delivery were calculated for each of the vessel velocimetry measurements and ratios. The statistical significance of z-score values was calculated using analysis of variance. The MCA and UA PI values showed the greatest deviation for any single-vessel parameter. The ratios of fetal Doppler indices (MCA/UA PI ratio, MCA/AO PI ratio and the MCA PI/AO TAV index) demonstrated greater deviation from normal than any individual vessel. The UA PI z-score for PPIH+SGA delivering < 34 weeks gestation (2.92) was significantly greater than the z-score for PPIH+SGA delivering > or = 34 weeks (1.20, p < 0.05). Fetal Doppler indices, in particular ratios that include measurements obtained from the cerebral circulation, help in the recognition of the small fetus that is growth-retarded. At term, evidence of fetal hemodynamic redistribution may exist in the presence of a normal umbilical artery PI. Fetal Doppler indices provide information that is not readily obtained from more conventional tests of fetal well-being.(ABSTRACT TRUNCATED AT 400 WORDS)

[The prenatal development of the normal kidney and in gestoses]. / Prenatal'noe razvitie pochki v norme i pri gestozakh.

Kidneys of the foetuses in cases of normal pregnancy (37) and in gestosis (31) were studied in following gestative terms; 24-28, 30-36 and 39-40 weeks. Dynamics of specific volume of structural elements of cortical substance (CS) and of external and internal zones of medullary substance (MS) of kidney was established in normal pregnancy and in gestosis. In normal pregnancy specific volume of the CS vessels and tubules increases in proportion with gestative term. Differences in dynamics of specific volume of vessels and tubules were found in external and internal zones of MS. Specific volume of nephrogenic blastema and tubules of cortex and medulla reduces in gestosis, placental insufficiency and hypoxia of the foetus. Specific volume of the CS stroma and vessels of both zones also increases in combined gestosis, while in the one without combination with other diseases specific volume of the cortical and medullary stroma increases. Correlative analysis revealed that the growth of these structures of cortex and medulla is dependent on the increase of the number of the connections in proportion with the gestative term. Number, direction and significance of correlative connections, reflecting adaptive possibilities of the foetal kidney structures in conditions of prolonged hypoxia were found to alter in gestosis.

[The morphogenetic patterns of the higher autonomic centers in a pathological pregnancy]. / Zakonomernosti morfogeneza vysshikh vegetativnykh tsentrov pri patologicheskoi beremennosti.

Neurosecretory, parasympathetic and sympathetic centers of 49 mature fetuses subjected to toxicity were studied using light and electron microscopy. These centers were characterized by similar regularities of neurocytes development. Higher degree of maturity was typical for neurosecretory, while minimal for sympathetic centers. A higher degree of maturity and functional performance of vegetative regulatory system predominated in large fetuses. A general rule was a relative independence of forming truncal and spinal morphosystems and their nuclei on body and brain masses. Dyschronia of vegetative centers development reduces an adaptive potential of the fetus and causes fatal outcome in intranatal period.