High-Risk Pregnancy Is Associated With Increased Alpha-Fetoprotein Concentrations in the Amniotic Fluid and Foal Plasma.

This study aimed to determine alpha-fetoprotein (AFP) concentrations in amniotic fluid, plasma of mares and respective foals: carrying normal pregnancies and delivering healthy foals (n = 20; Group 1); carrying apparently normal pregnancies and delivering sick foals (n = 15; Group 2); carrying high-risk pregnancies and delivering sick foals (n = 14; Group 3). High-risk pregnancy was defined by a history of premature udder development/lactation or increased of the combined thickness of the uterus and placenta, or vulvar discharge and/or mares' systemic illness. Sick foals were affected by neonatal encephalopathy, sepsis, prematurity/dysmaturity, or hypoxic-ischemic encephalopathy. Based on histological examination of the chorioallantois, AFP trend was analyzed in pregnancies with pathologic (PFM) and normal fetal membranes (NFM). Concentrations of AFP were measured using a commercially available immunoassay previously validated for horses. Mares' plasma AFP did not change during the last 15-20 days of pregnancy in the three groups, and there was no difference among them. Amniotic fluid AFP was higher in Group 3 (P = .014). Foals' plasma AFP concentration was higher from birth to 72hours in foals of Group 2 and 3 than in healthy ones, and foals of Group 3 had the highest value. The strong association (r = 0.84; P < .0001) between AFP in amniotic fluid and foals' plasma at birth is likely due to the presence of AFP in fetal urine. AFP was higher in pregnancy with PFM than with NFM in mare's plasma at admission (P = .031), amniotic fluid (P = .004), foal's plasma at birth (P = .002), at 24 (P = .005) and at 72 hours of life (P = .004). AFP is higher in pregnancy with histopathological lesions of the chorioallantois providing the evidence of the differences between pregnancy with a normal placental barrier and the more compromised ones. The increased AFP concentration in the amniotic fluid and plasma of high-risk foals suggests upregulation.

Interferon alpha for essential thrombocythemia during 34 high-risk pregnancies: outcome and safety.

PURPOSE: Pregnancies in women with essential thrombocythemia (ET) are at a higher risk for obstetrical complications. Acetylsalicylic acid (ASA) and low-molecular weight heparin (LMWH) are common options to prevent miscarriages and maternal complications, whereas interferon alpha (IFN) seems to be the cytoreductive therapy of choice. This retrospective study analyzes the largest number of IFN pregnancies to date in terms of outcome and safety. METHODS: Data of 34 high-risk pregnancies in 23 women presenting at the University hospitals of Minden and Jena from 01-Jun-2007 to 01-Jun-2020 were collected. Reasons defining high-risk ET pregnancy in all 23 patients were: Thrombosis (n = 9) or severe hemorrhage (n = 2) in history, platelet count ≥ 1500 × 103/µl (n = 8) or severe microcirculatory disturbances not completely responding to ASA (n = 4). RESULTS: Without the use of IFN, live birth rate was 60% (6/10), however, after the use of IFN live birth rate increased to 73.5% (25/34 pregnancies). Nine pregnancies ended in miscarriages (9/34; 26.5%); all of them spontaneous abortions. Live birth rate significantly improved with ASA (90% versus 50%, p = 0.0168), however, if ASA and LMWH was added (n = 14), live birth rate was 100%. IFN compound (PEGylated versus standard IFN) and JAK2-driver mutation had no impact on pregnancy outcome. One major maternal complication occurred as a major peripartal bleeding after abortion curettage. CONCLUSION: IFN was associated with an encouraging live birth rate of 73.5% with no fatal maternal events and manageable side effects.

The 15-Epilipoxin-A4 Pathway with Prophylactic Aspirin in Preventing Preeclampsia: A Longitudinal Cohort Study.

INTRODUCTION: The benefit of aspirin in preventing preeclampsia is increasingly recognized; however, its mechanism of action remains unclear. Nonobstetric studies have described an anti-inflammatory effect of aspirin through the 15-epilipoxin-A4 pathway (aspirin-triggered lipoxin [ATL]). However, the anti-inflammatory mechanism of aspirin in the prevention of preeclampsia remains unknown. OBJECTIVE/HYPOTHESIS: To examine (1) the difference in longitudinal endogenous lipoxin-A4 (En-Lipoxin-A4) concentration in low-risk (LR) and high-risk (HR) pregnancies, and (2) the effect of aspirin on endogenous ATL concentration and the associated effect on cytokine profile of HR women. METHODS: Plasma from 220 HR women was collected at 12, 16, 20, 24, 28, 32, and 36 weeks of gestation. Adherence to aspirin was biochemically verified. Plasma En-Lipoxin-A4 and ATL concentrations were analyzed using liquid chromatography mass spectrometry, and cytokines, interleukin (IL)-10, tumor necrosis factor-α, interferon-γ, IL-8, and IL-1ß, with the high-sensitivity multibead Luminex® assay. RESULTS: HR women have up to 70% lower plasma concentration of En-Lipoxin-A4 (P < 0.001) than LR women. HR women with adequate aspirin adherence (HR-AA) (n = 82) had higher plasma concentration of ATL (P < .001), lower concentration of IL-8 from 16 to 36 weeks of gestation (P < .001), and increased IL-10 concentration from 16 to 28 weeks of gestation (P = .03) compared with high-risk women who were not on aspirin (HR-NA). HR-AA who did not develop preeclampsia had higher plasma En-lipoxin-A4 (P < .001), ATL (P = .02), and IL-10 concentrations (P < .001) with lower IL-8 concentration (P = .004) than HR women who developed preeclampsia. DISCUSSION: Plasma concentration of En-Lipoxin-A4 is lower in HR women than in LR controls. Adequate adherence with aspirin results in an increase in ATL and IL-10 with reduced IL-8 plasma concentration. This study suggests a potential anti-inflammatory role of aspirin through the ATL pathway with prophylactic aspirin in HR pregnant women.

Effectiveness of nitric oxide agents in preventing the early onset of pre-eclampsia and possible modification of metabolic factors in high-risk pregnancies: a systematic review protocol.

OBJECTIVES: To determine the effectiveness of nitric oxide agents in modifying the metabolic factors of pre-eclampsia and its effectiveness in preventing the onset of pre-eclampsia in high-risk pregnancies. INTRODUCTION: Pre-eclampsia is a major cause of maternal death during the prenatal and neonatal periods. Nitric oxide is a vasodilator and platelet aggregation inhibitor responsible for the vascular adaptation of the placenta. Although various studies have established that nitric oxide is effective in preventing complications from pre-eclampsia, there is limited evidence to show that administering nitric oxide agents to high-risk women before 20 weeks' gestation will prevent the onset of pre-eclampsia. INCLUSION CRITERIA: This review will consider randomized controlled trials that compare nitric oxide donors and precursors with a placebo or no intervention on pregnant women (18 to 44 years) with ≤ 20-week gestational age that are at high risk of pre-eclampsia. The primary outcome of interest will be the onset of pre-eclampsia. Secondary outcomes include increased systolic and diastolic blood pressure, elevated asymmetric dimethylarginine levels, decreased endothelial nitric oxide synthase activity, reduced maternal placental vasculature, and abnormal Doppler ultrasound waveforms. METHODS: Data sources will be drawn up from MEDLINE, CINAHL, ProQuest (Health and Medicine), and Web of Science from inception till current date. No language restrictions will be applied in the search strategy. Selected studies will be assessed against the JBI critical appraisal checklist, and the certainty of evidence and strength of recommendations from findings will also be ascertained. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018099298.

C-allele of rs4769613 Near FLT1 Represents a High-Confidence Placental Risk Factor for Preeclampsia.

The variant rs4769613 T/C within the enhancer element near FLT1, an acknowledged gene in preeclampsia, was previously identified as a risk factor for preeclampsia in the genome-wide association study (GWAS) targeting placental genotypes. We aimed to test the robustness of this association in 2 Estonian cohorts. Both placental sample sets HAPPY PREGNANCY (Development of novel non-invasive biomarkers for fertility and healthy pregnancy; preeclampsia, n=44 versus nonpreeclampsia, n=1724) and REPROMETA (REPROgrammed fetal and/or maternal METAbolism; 52/277) exhibited suggestive association between rs4769613[C] variant and preeclampsia (logistic regression adjusted for gestational age and fetal sex, nominal P<0.05). Meta-analysis across 2 samples (96/2001) replicated the genome-wide association study outcome (Bonferroni corrected P=4×10-3; odds ratio, 1.75 [95% CI, 1.23-2.49]). No association was detected with gestational diabetes mellitus, preterm birth, and newborn parameters. Also, neither maternal nor paternal rs4769613 genotypes predisposed to preeclampsia. The exact role of placental rs4769613 genotype in the preeclampsia pathogenesis is to be clarified as no effect was detected on maternal baseline serum sFlt-1 (soluble fms-related receptor tyrosine kinase 1) levels. However, when placental FLT1 gene expression and maternal serum sFlt-1 measurements were stratified by placental rs4769613 genotypes, significantly higher transcript and biomarker levels were detected in preeclampsia versus nonpreeclampsia cases in the CC- and CT- (Student t test, P≤0.02), but not in the TT-genotype subgroup. We suggest that rs4769613 represents a conditional expression Quantitative Trait Locus, whereby only the enhancer with the C-allele reacts to promote the FLT1 expression in unfavorable placental conditions. The study highlighted that the placental FLT1 rs4769613 C-allele is a preeclampsia-specific risk factor. It may contribute to early identification of high-risk women, for example, when genotyped in the cffDNA available in maternal blood plasma.

Neurodevelopment of high and low-risk pregnancy babies at 6 months of age.

OBJECTIVE: to compare neurodevelopment differences between babies born from low-risk pregnancies and babies born from high-risk pregnancies. STUDY DESIGN: Longitudinal design SETTING: Spain PARTICIPANTS: A total of 91 women participated in the study, divided into two groups: 49 women in the low-risk pregnancy group and 42 women in the high-risk group. MEASUREMENT AND FINDINGS: The average amount of cortisol in pregnant mothers' hair was determined in both groups. Following their birth, the babies' neurodevelopment was evaluated using the Bayley-III instrument at 6 months of age and a new sample of cortisol was obtained from both the baby and the mother. The results showed that pregnancy risk group could predict cognitive, fine motor, gross motor and general motor neurodevelopment. KEY CONCLUSIONS: These results seem to show that an appropriate treatment tailored to the needs of individualised pregnancies may favor babies' neurodevelopment, including that of babies born from high-risk pregnancies. IMPLICATIONS FOR RESEARCH: It is essential to take special care of pregnant women no matter their medical condition and offer them the best medical care available.

Relación entre niveles de vitamina D y perfil lipídico en embarazadas de alto riesgo / Relationship between level of vitamin D and lipid profile in high risk pregnant women

En la Argentina, las embarazadas presentan alta prevalencia (80%) de hipovitaminosis D y de sobrepeso u obesidad (27,4%). Ambas condiciones pueden aumentar la morbimortalidad materno-fetal. Bajos niveles de vitamina D se han relacionado con aumento del colesterol total, LDL, triglicéridos (Tg) y descenso de HDL. Objetivo: evaluar los niveles de 25-hidroxivitamina D (25OHD) y su relación con el perfil lipídico en pacientes embarazadas de alto riesgo. Materiales y métodos: estudio de corte transversal entre septiembre de 2016 y abril de 2017. Se excluyeron pacientes que recibieron suplementos de vitamina D, con disfunción tiroidea no compensada, malabsorción, insuficiencia cardíaca, renal o hepática y dislipidemia familiar. Niveles circulantes de 25OHD < 30 ng/ml se consideraron hipovitaminosis. Resultados: se evaluaron 86 embarazadas de 29,3 ± 7,1 años durante la semana 28 ± 6,5. El IMC pregestacional fue 28,3 ± 6,5 kg/m2 y la ganancia de peso 7 ± 4,3 kg. Perfil lipídico: colesterol total 240 ± 54 mg/dl; LDL 156 ± 54 mg/dl; HDL 66 ± 15 mg/dl; Tg 204 ± 80 mg/dl. La media de 25OHD fue de 23,8 ± 9 ng/ml, con una prevalencia de hipovitaminosis D de 77,9 %. Las pacientes con hipovitaminosis D presentaron mayores valores de colesterol total y LDL (p < 0,05), con tendencia no significativa a presentar mayores valores de Tg. Conclusión: en embarazadas de alto riesgo se observó una alta prevalencia de hipovitaminosis D, asociada con mayores concentraciones de colesterol total y LDL. (AU)

In Argentina, pregnant women have a high prevalence (80 %) of hypovitaminosis D and verweight/obesity (27.4%), conditions that can increase maternal-fetal morbidity and mortality. Low levels of 25-hydroxyvitamin D (25OHD) have been linked to an increase in total cholesterol, LDL cholesterol, triglycerides (TG) and a decrease in HDL cholesterol. Objective: to evaluate the levels of vitamin D and its relationship with the lipid profile in high risk pregnant patients. Materials and methods: cross-sectional study between September 2016 and April 2017. Patients who received vitamin D supplements or had non-compensated thyroid dysfunction, malabsorption, heart failure, renal or hepatic failure, or familial dyslipidemia were excluded. Hypovitaminosis D was defined as a circulating level of 25OHD < 30 ng/ml. Results: We assessed 86 women of 29.3 ± 7.1 years during pregnancy week 28 ± 6.5. Pre-gestational BMI was 28.3 ± 6.5 kg/m2. Their weight gain was 7 ± 4.3 kg. Lipid profile: total cholesterol 240 ± 54 mg/dl; LDL cholesterol 156 ± 54 mg/dl; HDL cholesterol 66 ± 15 mg/dL; TG 204 ± 80 mg/dl. The mean 25OHD level was 23.8 ± 9 ng/ml, with a 77.9 % prevalence of hypovitaminosis D. Patients with hypovitaminosis D had higher values of total cholesterol and LDL cholesterol (p<0.05), and a non-significant trend toward higher triglyceridemia. Conclusion: A high prevalence of hypovitaminosis D, associated with high total and LDL cholesterol was found in high risk pregnant women. (AU)

Calcium intake in high-risk pregnant women assisted in a high-complexity hospital.

Pregnancy is characterized by physiological changes. One of these changes involves calcium. During this period, an increased in calcium excretion occurs as well as an increased intestinal absorption and renal reabsorption, so that the adequate growth and development of the fetus can happen. Low calcium intake is associated with chronic diseases, such as diabetes and hypertension, which have negative impact on both mother and fetus. This study aimed to evaluate the average calcium intake of high-risk pregnant women, assisted in a clinic of high complexity service and correlated with chronic diseases. To perform this study, it was used a food frequency questionnaire. As a result, high-risk pregnant women showed daily calcium intake lower than the recommended by DRI during this period. Hypertensive or diabetic pregnant women showed lower average intake of calcium. Significant association between calcium intake and nutritional status was not observed. Calcium supplementation was present, however, at low percentage in the groups with hypertensive pregnant women. To analyze the relation between calcium intake and the comorbidities, as well as calcium intake and the nutritional status of the pregnant women, it was used one-way analysis of variance and Bonferroni multiple comparison. Further studies are required for evaluating other parameters that justify the low calcium intake among this population group, and the definition of pathways for the management of the nutritional deficit considering the possible damage to maternal and neonatal health in the short and long term.

Association Between Lactation and Postpartum Blood Pressure in Women with Preeclampsia.

PURPOSE: Preeclampsia affects 3% to 8% of all pregnancies. There are two distinct subtypes; early- (<34 weeks) and late-onset (≥34 weeks). Each subtype is associated with increased risk of cardiovascular disease. Lactation has been shown to improve cardiovascular outcomes. The purpose of this study was to describe lactation practices among women with each subtype of preeclampsia and determine the association between lactation and blood pressure at the initial postpartum visit. STUDY DESIGN AND METHODS: This retrospective cohort study included 246 subjects; 120 early- and 126 with late-onset preeclampsia who gave birth to live singleton newborns at a large suburban tertiary referral center in south central Pennsylvania between January 2012 and June 2016. Electronic health records were reviewed and data abstracted. Univariate and bivariate analyses were conducted. RESULTS: There was a significant difference in breastfeeding intent (p = .004) as well as rate of breastfeeding at maternal hospital discharge (p< .001) by preeclampsia subtype. However, there was no difference in rate of breastfeeding at the initial postpartum visit (p = .21) between subtypes. There was a significant difference in systolic (p = .03) and diastolic (p = .04) blood pressure between those breastfeeding and those who were not breastfeeding at the initial postpartum visit. CLINICAL IMPLICATIONS: Healthcare providers should provide women with preeclampsia clear and consistent messaging about importance of breastfeeding during pregnancy and the postpartum period on its association with improved neonatal outcomes, and specifically education on the cardioprotective benefit of sustained lactogenesis.

Factors associated with patients with gestational diabetes in Japan being at increased risk of requiring intensive care.

OBJECTIVE: To investigate factors associated with high-risk gestational diabetes (GDM) among patients with GDM. METHODS: The present retrospective study included women with singleton pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Group criteria at a single tertiary perinatal care center in Japan between July 1, 2010, and October 31, 2014. High-risk GDM was defined as patients who required at least 20 units of insulin therapy a day, delivering a large-for-gestational age neonate regardless of insulin therapy, or both. Maternal characteristics and diagnostic test results were investigated to identify associations with the high-risk criteria, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Among 217 patients, 95 (43.8%) were categorized as high risk. After adjusting for confounders, a fasting plasma glucose level at diagnosis of at least 4.66 mmol/L (adjusted OR 2.88, 95% CI 1.51-5.58) and pre-pregnancy body mass index (calculated as weight in kilograms divided by the square of height in meters) of at least 24 (adjusted OR 3.27, 95% CI 1.60-6.90) were independently associated with meeting the high-risk criteria. CONCLUSION: Among Japanese patients with GDM, pre-pregnancy body mass index and fasting plasma glucose levels could be used to identify high-risk patients requiring intensive care during pregnancy.

The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth.

OBJECTIVE: Spontaneous preterm birth is the leading cause of neonatal morbidity and mortality. Cervicovaginal fetal fibronectin (fFN) has enhanced prediction of preterm birth and, more recently, quantified results have become available so that management can planned more effectively and targeted to individual women. Manufacture guidelines stipulate that fetal fibronectin (fFN) samples should be discarded in the presence of moderate to heavy vaginal bleeding but there hasn't yet been any formal investigation into the effect of blood staining on fetal fibronectin concentration and subsequent preterm birth prediction. The objective for this study was to determine the impact of blood stained swabs on quantitative fetal fibronectin (qfFN) concentration and prediction of spontaneous preterm birth (sPTB) in asymptomatic high-risk women. STUDY DESIGN: Predefined blinded sub-analysis of a larger prospective study of qfFN in asymptomatic women at high-risk of preterm labour. Women with and without blood stained swabs were matched for gestational age at testing and delivery, risk factors and cervical length measurement. RESULTS: Median fFN concentration in blood stained swabs (n=58) was 66ng/ml vs. 7.5ng/ml in the controls (n=58) (p<0.0001). At ≥50ng/ml threshold the false positive ratio (FPR) in blood stained was 25/33 (75.8%) vs. 8/15 (53%) in controls, (risk difference 22.4; -6.8 to 51.6, p=0.18). At ≥50ng/ml threshold the false-negative ratio (FNR) in blood stained was 2/25 (8.0%) vs. 1/43 (2.3%) in controls (risk difference -5.7; -17.2 to 5.9, p=0.55). At each threshold 10, 50 and 200ng/ml blood stained swabs had higher sensitivity but lower specificity for predicting preterm birth. Receiver Operating Characteristic (ROC) curve, the strongest global measure of test performance, for prediction of delivery at <34 weeks gestation was similar in blood stained vs. control groups. (0.78 vs. 0.84) in blood stained vs. control groups respectively. CONCLUSION: Blood stained swabs have elevated qfFN concentrations but may still have predictive value, and clinical utility. Very low fFN values (<10ng/ml) are especially reassuring and indicate lower risk of delivery than non-blood stained swabs. The higher false positive rate must be noted and explained to the patient.

Placental respiratory chain complex activities in high risk pregnancies.

OBJECTIVES: Mitochondrial oxidative phosphorylation is the key energy source for placental functions and fetal growth. The purpose of this study was to investigate the function of placenta in high risk pregnancies by measuring mitochondrial respiratory chain complex (RCC) activities, and to evaluate the correlation between double test risk ratio and RCC activities. METHODS: The placenta samples were collected from 50 pregnant women. The controls consisted of 20 normal uncomplicated pregnancies and the study group (n = 30) consisted of preeclampsia (PE), intrauterin growth restriction (IUGR), advanced maternal age (AMA), twins and preterm deliveries. Complexes I, II-III, IV and citrate synthase (CS) activities were measured by spectrophotometric assays. RESULTS: Complexes I, II-III and IV activities were significantly lower in the study group than the controls (p < 0.05). Complexes I and II-III activities were significantly reduced in placenta of preterm deliveries compared with the controls (p < 0.003). Double test risk ratio was above the cut-off limit (1:300) in 43% of the study group in which decreased complexes I and II-III activities were observed. CONCLUSIONS: Impaired placental mitochondria RCC functions can lead to adverse pregnancy outcomes. Pregnant women with high risk in double test should be monitored carefully in terms of PE, IUGR and preterm delivery.

Iron Metabolism in African American Women in the Second and Third Trimesters of High-Risk Pregnancies.

OBJECTIVE: To examine iron metabolism during the second and third trimesters in African American women with high-risk pregnancies. DESIGN: Longitudinal pilot study. SETTING: Large, university-based, urban Midwestern U.S. medical center. PARTICIPANTS: Convenience sample of 32 African American women with high-risk pregnancies seeking care at an urban maternal-fetal medicine clinic. METHODS: Nonfasting venous blood was collected in the second and third trimesters to assess iron status, hepcidin, and systemic inflammation. Anthropometric and survey data were obtained via self-report. Descriptive statistics were calculated from these data, and changes in the clinical parameters between the second and third trimesters were evaluated via paired t tests. Associations among demographic, reproductive, anthropometric, inflammatory, and iron-related parameters were also assessed in each trimester. RESULTS: The mean age of participants was 28.3 (± 6.8) years, and mean prepregnancy body mass index was 31.9 (± 10.7) kg/m2. In the longitudinal analysis, significant (p < .05) declines in serum iron, ferritin, transferrin saturation, and C-reactive protein were observed between the second and third trimesters. There was no statistically significant change in hepcidin between trimesters. When using a ferritin level cut-point of less than 15 ng/ml and soluble transferrin receptor level of greater than 28.1 nmol/L, 48% of the participants (14 of 29) were classified with iron deficiency in the third trimester. CONCLUSION: In this pilot study, iron deficiency was prevalent among a small cohort of African American women with high-risk pregnancies. Hepcidin concentrations were greater than previously reported in healthy, pregnant, primarily White women, which suggests decreased iron bioavailability in this high-risk group.

Placental antioxidant enzyme status and lipid peroxidation in pregnant women with type 1 diabetes: The effect of vitamin C and E supplementation.

AIM: In view of the increased rates of pre-eclampsia observed in diabetic pregnancy and the lack of ex vivo data on placental biomarkers of oxidative stress in T1 diabetic pregnancy, the aim of the current investigation was to examine placental antioxidant enzyme status and lipid peroxidation in pregnant women with type 1 diabetes. A further objective of the study was to investigate the putative impact of vitamin C and E supplementation on antioxidant enzyme activity and lipid peroxidation in type 1 diabetic placentae. METHODS: The current study measured levels of antioxidant enzyme [glutathione peroxidase (Gpx), glutathione reductase (Gred), superoxide dismutase (SOD) and catalase] activity and degree of lipid peroxidation (aqueous phase hydroperoxides and 8-iso-prostaglandin F2α) in matched central and peripheral samples from placentae of DAPIT (n=57) participants. Levels of vitamin C and E were assessed in placentae and cord blood. RESULTS: Peripheral placentae demonstrated significant increases in Gpx and Gred activities in pre-eclamptic in comparison to non-pre-eclamptic women. Vitamin C and E supplementation had no significant effect on cord blood or placental levels of these vitamins, nor on placental antioxidant enzyme activity or degree of lipid peroxidation in comparison to placebo-supplementation. CONCLUSION: The finding that maternal supplementation with vitamin C/E does not augment cord or placental levels of these vitamins is likely to explain the lack of effect of such supplementation on placental indices including antioxidant enzymes or markers of lipid peroxidation.

Impacto da ingestão dietética e do estresse oxidativo em pacientes com doença trofoblástica gestacional / Impact of dietary intake and oxidative stress in patients with gestational trophoblastic disease

A doença trofoblástica gestacional (DTG) é um termo aplicado a um grupo de tumores relacionados à gestação, caracterizando formas benignas (mola hidatiforme - MH) e malignas (neoplasia trofoblástica gestacional - NTG). O estresse oxidativo, a ingestão dietética e o estado nutricional da gestante constituem possíveis fatores de risco para a ocorrência da MH e sua progressão para NTG. A presente revisão tem como objetivo abordar a relação entre essas entidades. Apesar de haver evidências mostrando que a ingestão dietética e o estresse oxidativo possam ter papéis relevantes na etiopatogênese da DTG, ainda são necessários muitos estudos para uma melhor investigação da atuação desses agentes na gravidez molar e suas sequelas malignas e proliferativas.(AU)

The gestational trophoblastic disease (GTD) is a term applied to a rare group of pregnancy related tumors of benign forms (hydatidiform mole - HM) as well as malignant ones (gestational trophoblastic neoplasia - GTN). Oxidative stress, dietetic intake and nutritional status of pregnant women are possible risk factors for the occurrence of HM and its progression to GTN. This review aims to address the relationship between these entities. Besides the evidences supporting that dietetic intake and oxidative stress may have important roles in the GTD etiopathogenesis, many studies are needed to better investigate the role of these agents in molar pregnancy and their proliferative and malignant sequelae.(AU)

Correlation between an absence of cervical gland area on transvaginal sonography and cervical mucus hyaluronic acid levels in women with threatened preterm delivery.

PURPOSE: Transvaginal sonographic findings of an absent cervical gland area (CGA) and a short cervical length (CL) are frequently observed in patients with threatened preterm delivery. The present study aimed to clarify whether sonographic findings are due to active production of hyaluronic acid (HA)in the cervix. METHODS: Possible relationships between sonographic findings of the presence or absence of the CGA and/or a short CL and cervical mucus HA concentration were investigated in 68 women with threatened preterm delivery at 22 ­ 31 weeks' gestation and 136 women without threatened preterm delivery as controls. RESULTS: HA levels were higher in women with threatened preterm delivery (68.0 ng/mL) than in controls (39.0 ng/mL; P = 0.001). Similarly, HA levels were higher in women with preterm labor showing an absent CGA and a short CL than in women with threatened preterm delivery without such findings (P < 0.01). Stepwise multivariate logistic regression identified an absent CGA and threatened preterm delivery as independent predictors of high HA levels (P = 0.04). HA concentration was not predictive for preterm delivery. CONCLUSION: A sonographic finding of an absent CGA reflects high HA levels in the cervix with threatened preterm delivery.

Concentraciones de neuroquinina B como marcador de riesgo en pacientes con preeclampsia / Neurokinin B concentrations as a risk marker in preeclamptic patients

Objetivo. Establecer la utilidad de las concentraciones de neuroquinina B como marcador de riesgo en pacientes con preeclampsia. Método. Se seleccionó a un total de 100 pacientes. Se incluyeron a 50 pacientes con preeclampsia como los casos (grupo A) y un grupo control seleccionado por tener una edad y un índice de masa corporal similares al grupo de estudio, que consistió en 50 gestantes normotensas sanas (grupo B). Las muestras de sangre se recolectaron en todas las pacientes antes del parto e inmediatamente después del diagnóstico en el grupo B para determinar las concentraciones de neuroquinina B. Resultados. Se encontraron diferencias estadísticamente significativas en las concentraciones de neuroquinina B entre las pacientes en el grupo de estudio (grupo A; 16,3±9,6ng/l) y las pacientes del grupo control (grupo B; 3,5±2,0ng/l; p<0,05). Se observó una correlación positiva y significativa con los valores de presión arterial sistólica y diastólica (p<0,05). Un valor de corte de 5pg/ml presentó un valor por debajo de la curva de 0,93 y tiene una sensibilidad del 75,0%, una especificidad del 87,5%, un valor predictivo positivo del 90,0% y un valor predictivo negativo del 70,0% con una exactitud diagnóstica de 81,2%. Conclusiones. Las pacientes con preeclampsia presentaron concentraciones significativamente más altas de neuroquinina B al compararlas con gestantes normotensas sanas. Este péptido es útil como marcador de riesgo en pacientes con preeclampsia (AU)

Objective. To establish the usefulness of neurokinin B concentrations as a risk marker in patients with preeclampsia. Method. A total of 100 patients were selected. Fifty patients with preeclampsia were selected as cases (group A) and 50 healthy normotensive pregnant women with a similar age and body mass index to the study group were selected as controls (group B). Blood samples were collected in all patients before labor and immediately after diagnosis in group B to determine neurokinin B concentrations. Results. Statistically significant differences in neurokinin B concentrations were found between group A (16.3±9.6ng/L) and group B (3.5±2.0ng/L; P<.05). There was a positive and significant correlation with values of systolic and diastolic blood pressure (P<.05). A cut-off value of 5pg/ml had a value under the curve of 0.93, sensitivity of 75.0%, specificity of 87.5%, a positive predictive value of 90.0%, a negative predictive value of 70.0%, and a diagnostic accuracy of 81.2%. Conclusions. Concentrations of neurokinin B were significantly higher in patients with preeclampsia than in healthy normotensive pregnant women. This peptide is useful as a risk marker in patients with preeclampsia (AU)

Effect of exercise on vascular superoxide dismutase expression in high-risk pregnancy.

Endothelial dysfunction of the maternal vasculature induced by pro-oxidants may contribute to the development of preeclampsia. Obesity results in vascular inflammation and oxidative stress and is therefore a risk factor for preeclampsia. Regular exercise is known to induce antioxidants. We recently demonstrated that stretchers (subjects who performed low-intensity exercises) had a lower incidence of preeclampsia as opposed to walkers (moderate-intensity exercise; 2.6% versus 14.6%). We now seek to determine the possible protective mechanisms. We hypothesized that stretchers will have higher vascular levels of the antioxidant superoxide dismutase (SOD) and plasma transferrin levels, an antioxidant marker. We conducted immunohistochemical analyses of blood vessels embedded in fat biopsy samples obtained during cesarean sections from women who were randomized to either stretching ( N = 6) or walking ( N = 5) exercises. In addition, levels of plasma transferrin were measured. SOD expression was increased ( P < 0.05) in stretchers [106.3 (interquartile range 84.2 to 127.8 arbitrary units (AU)] when compared with that of walkers [56.92 (interquartile range 46.35 to 82.32 AU)]. Transferrin levels continued to increase throughout gestation only among the stretchers. There appears to be a higher antioxidant protective effect in subjects who performed low-intensity exercise during pregnancy.

Rates of fetal alcohol exposure among newborns in a high-risk obstetric unit.

Meconium fatty acid ethyl esters (FAEEs) are sensitive and specific biomarkers for prenatal alcohol exposure (PAE) in pregnancy. We recently reported a 2.5% rate of FAEE positive meconium in a general population sample of infants born in the region of Grey-Bruce, Ontario. Women in this region with high-risk pregnancies are transferred to a tertiary care facility in London, Ontario. The objective of this study was to determine, in a population-based sample, whether high-risk pregnancies are associated with an increased risk of in utero alcohol exposure. Grey-Bruce residents transferred to the high-risk obstetric unit of St. Joseph's Health Care in London, Ontario were identified and consented to this anonymous prevalence study. Meconium was collected and analyzed for FAEE using gas chromatography with mass spectrometry. The prevalence of FAEE positive meconium was compared with the population-based prevalence in the Grey-Bruce. Fifty meconium specimens were collected from August 1, 2006 to July 31, 2007. Fifteen (30%) specimens tested positive for FAEE. The results indicate that infants born in the high-risk obstetric unit had a 12-fold higher risk of screening positive for second and third trimester alcohol exposure compared with infants born in the general population of Grey-Bruce (relative risk=12.04, 95% confidence interval=6.40-22.65, P<.0001). These results suggest that the high-risk pregnancies should be screened for PAE and followed-up for potential diagnosis of fetal alcohol spectrum disorder.

Estudo descritivo sobre a antibioticoprofilaxia na rupturaprematura pré-termo de membranas / Perinatal results of antibioticprophyxalis with erythromycin in preterm premature rupture of the membranes

Objetivo: avaliar os resultados perinatais do uso profilático de estearato de eritromicina nas pacientesinternadas na unidade de gestação alto risco da Maternidade Carmela Dutra (MCD), Florianópolis–SC, com diagnóstico de ruptura prematura pré-termo de membranas (RPM). Métodos: estudo descritivo com análise de todas as pacientes internadas com o diagnóstico de RPM e com idade gestacional entre 20 semanas e 33 semanas e cinco dias. Foram excluídas da pesquisa gestantes com históriade hipersensibilidade à eritromicina, com sinais clínicos e/ou laboratoriais de corioamnionite, que estavam emtrabalho de parto ou que faziam uso de antibióticos no momento da internação. A amostra obtida entre 1º de abril de 2007 e 15 de maio de 2008 foi de 22 pacientes. Resultados e conclusões: o tempo médio de latência foi de 12 dias. Não houve casos confirmados decorioamnionite. Uma (4,54%) gestante desenvolveu quadro de endometrite puerperal. Não houve óbitos maternos. Dois (9,09%) recém-nascidos desenvolveram sepse. A taxa de óbito neonatal foi de 13,63%. Apesarda nossa pequena casuística, o uso de eritromicina nas pacientes com RPM parece estar associado a umadiminuição na taxa de corioamnionite.

Objective: The purposes of this study were to evaluate perinatal results of the prophylactic use of erythromycin to patients admitted in the high-riskgestation unit at Carmela Dutra Maternity Hospital, Florianópolis – SC with preterm premature rupture ofmembranes (PROM). Methods: We performed a descriptive analysis ofall patients with PROM and gestational age between 20 weeks and 33 weeks plus 5 days. Patients with erythromycin allergy, with chorioamnionitis signs orwomen who already being prescribed antibiotics were excluded from this study. Enrolment was from April 1,2007, until May 15, 2008. Twenty-two women had been followed up in this study. Results and Conclusions: The medium latency period was 12 days. There was not confirmed chorioamnionitis case. The occurrence of endometritis was 4,54%. There was not maternal death. The occurrence of neonatal sepsis was 9,09% and theoccurrence of neonatal deaths was 13,63%. Despite our small casuistry, the prophylactic use of erythromycinseems to reduce the chorioamnionitis rate.