Reduction in maternal circulating ouabain impairs offspring growth and kidney development.

Ouabain, a steroid present in the circulation and in various tissues, was shown to affect the growth and viability of various cells in culture. To test for the possible influence of this steroid on growth and viability in vivo, we investigated the involvement of maternal circulating ouabain in the regulation of fetal growth and organ development. We show that intraperitoneal administration of anti-ouabain antibodies to pregnant mice resulted in a >80% decline in the circulating ouabain level. This reduction caused a significant decrease in offspring body weight, accompanied by enlargement of the offspring heart and inhibition of kidney and liver growth. Kidney growth inhibition was manifested by a decrease in the size and number of nephrons. After the reduction in maternal circulating ouabain, kidney expression of cyclin D1 was reduced and the expression of the α1 isoform of the Na(+), K(+)-ATPase was increased. In addition, the elevation of proliferation signals including ERK1/2, p-90RSK, Akt, PCNA, and Ki-67, and a reduction in apoptotic factors such as Bax, caspase-3, and TUNEL were detected. During human pregnancy, the circulating maternal ouabain level increased and the highest concentration of the steroid was found in the placenta. Furthermore, circulating ouabain levels in women with small-for-gestational age neonates were significantly lower than the levels in women with normal-for-gestational age newborns. These results support the notion that ouabain is a growth factor and suggest that a reduction in the concentration of this hormone during pregnancy may increase the risk of impaired growth and kidney development.

[Can we improve the content and quality of information delivered prior to amniocentesis?].

INTRODUCTION: Amniocentesis is a procedure often used for pregnant women, as an important tool to identify chromosomal abnormalities, trisomy 21 being the main one. Amniocentesis may involve certain possible complications, the most prevalent is miscarriage. In order to make an informed decision, a woman must understand some statistical information regarding the risks and benefits of management options. OBJECTIVES: The objective of this work was to examine women's understanding of risks and benefits before amniocentesis and the effect of an educational intervention on this understanding. METHODS: Women applying for amniocentesis at Hadassah Ein-Kerem clinics were handed a questionnaire. The questionnaire examined several aspects of knowledge relevant to an informed decision about the amniocentesis. An intervention was designed to improve women's understanding before amniocentesis: an information handout was sent home to 48 women who had signed up for amniocentesis. The level of knowledge was compared between women who did and did not receive the information handout. RESULTS: There was no difference in the level of general understanding between the two groups. When the level of understanding was broken down to its specific components, it became apparent that the only improvement achieved was concerning the risk of miscarriage from the amniocentesis. CONCLUSIONS: Information delivered before amniocentesis is challenging and further research is needed in order to develop educational material that would improve women's understanding of risks and benefits of the procedure.