Serum pregnancy-associated plasma protein A levels in the first, second and third trimester of pregnancy: relation to newborn anthropometric parameters and maternal tobacco smoking.

INTRODUCTION: The purpose of this study was to evaluate the associations of the first, second and third trimester serum pregnancy-associated plasma protein A (PAPP-A) concentrations with neonatal anthropometric parameters. The effect of tobacco smoking during pregnancy on PAPP-A level was also studied. MATERIAL AND METHODS: One hundred and fifty healthy pregnant women were divided into smoking and tobacco-abstinent groups. Serum PAPP-A level was measured with the KRYPTOR rapid random-access immunoassay analyzer. The relationship between PAPP-A and newborn related outcome as well as markers of estimated intensity of cigarette smoking was evaluated by univariate and multivariate linear regression. RESULTS: Pregnancy-associated plasma protein A concentration was positively correlated with birth weight in the first (ß = 31.6; p < 0.001), second (ß = 10.6; p < 0.05), and third (ß = 4.6; p < 0.001) trimester of gestation. A significant association between PAPP-A and birth body length and head circumference in the second (ß = 0.02; p < 0.05) and third trimester (ß = 0.01; p < 0.01) was also found. The serum PAPP-A levels were significantly lower in the smoking than in the tobacco-abstinent group in each trimester of pregnancy (p < 0.001). The largest impact of the number of cigarettes smoked per day on PAPP-A level was found in the second (ß = -1.2; p = 0.004) and third trimester (ß = -2.6; p = 0.001). CONCLUSIONS: Maternal serum PAPP-A levels during gestation might be significant predictors for birth weight. Increased PAPP-A concentrations in the second and third trimester appeared to also be predictive for newborn body length and head circumference. Smoking alters maternal PAPP-A levels in all trimesters, with the greatest impact related to the number of cigarettes smoked per day.

Tobacco smoke exposure during pregnancy increases maternal blood lead levels affecting neonate birth weight.

To assess the effect of lead exposure from cigarette smoke on fetal growth, blood lead concentrations were measured using inductively coupled plasma mass spectrometry in 150 healthy pregnant women. Mean lead concentrations in plasma and whole blood were significantly higher in the smoking group compared with the nonsmoking group in each trimester of pregnancy (p < 0.001). Logistic regression analysis showed the highest impact of the number of cigarettes smoked per day for serum lead concentration (ß = 0.238; p < 0.05), while in whole blood, it was duration of smoking before conception (ß = 0.297; p < 0.001). Birth weight of the smoking mothers' infants was significantly lower (mean ± SEM, 3,192 ± 50.8 and 3,569 ± 49.6 g, respectively; p < 0.001) and negatively correlated with lead levels in plasma (r = -0.38; p < 0.001) and in whole blood (r = -0.27; p < 0.001). Therefore, it is suggested that smoking during pregnancy increases lead concentrations in maternal blood. Fetal exposure to low doses of lead in utero may be a serious risk factor causing lower birth weight.

The pregnancy-associated plasma protein A and insulin-like growth factor system in response to cigarette smoking.

OBJECTIVE: Maternal smoking during pregnancy is associated with a reduction in birth size but the mechanism by which this occurs still remains unclear. The purpose of this study was to evaluate the effect of tobacco smoking on concentrations of pregnancy-associated plasma protein A (PAPP-A), insulin-like growth factor I (IGF-I), II (IGF-II) and binding proteins BP-3 and BP-4 in pregnant women and correlations between these parameters. METHODS: Sixty healthy pregnant women were divided into smoking and tobacco-abstinent group according to results of serum cotinine concentration. The current smokers were defined as those who had smoked five or more cigarettes per day during pregnancy. RESULTS: The mean serum concentrations of PAPP-A, IGF-I and IGF-II were significantly lower in smoking than in non-smoking pregnant women (p < 0.01). The level of PAPP-A correlated positively with the IGF-II concentration in both studied group (non-smoking: r = 0.54; p < 0.001; smoking: r = 0.40; p < 0.05). In tobacco-abstinent group negative correlation between IGF-II and IGFBP-4 concentrations was found (r = -0.35; p < 0.05). CONCLUSION: Tobacco smoking during pregnancy decreases the pregnancy-associated plasma protein A and insulin growth factors I and II levels. The correlation between PAPP-A and IGF-II may suggest function of this protein as a protease and regulator in the IGF system.

[Effect of cigarette smoking on blood lead levels in pregnant women]. / Wplyw palenia tytoniu na poziom olowiu we KRWI kobiet ciezarnych.

UNLABELLED: Tobacco smoking creates health problems which apply not only to individuals and the family but also to different ages and social groups, as well as the national economy. Epidemiologic studies conducted at the Institute of Mother and Child indicated that in Poland 25-30% women smoke during pregnancy. Lead exposure from cigarette smoke may have a negative effect on the transplacental flow of micronutrients and have an adverse influence on the growth and development of the fetus, and then on children. The aim of this study was to estimate the effect of smoking cigarettes on plasma and whole blood lead levels in pregnant women. MATERIAL AND METHODS: Eighty healthy pregnant women, patients of the Clinical Department of the Obstetrics and Gynecology Institute of Mother and Child and Warsaw Medical University, were divided into two groups: group I - tobacco smokers and group II- tobacco abstainers according to questionnaire declaration and serum cotinine concentration. Current smokers were defined as those who had smoked 5 cigarettes per day for 2 years before conception and continued smoking during pregnancy. The women exposed to environmental tobacco smoke (smoking spouse or other family members, co-workers) were excluded from the non-smoking group. All pregnant volunteers signed a written, informed consent form, approved by the Institute's Ethical Committee. The concentrations of lead in plasma and whole blood were analyzed using inductively coupled plasma mass spectrometry on spectrometer analyzer ICP MS Elan 6100 (Perking Elmer, Germany). Levels of cotinine in serum were determined by Cotinine Direct ELISA test (Calbiotech Inc. Canada). RESULTS: In the group of smoking mothers the mean serum cotinine concentration was 69.1 µg/L, whereas in the group of tobacco abstainers it was present only in trace amount. In group I we observed a significant positive correlation between serum cotinine and the number of cigarettes smoked daily (r=0.74; p<0.001), as well as the period of smoking before conception (r=0.60; p<0.001). The concentrations of lead in the plasma of smoking women were significantly higher than in the group of tobacco abstainers in each trimester of pregnancy (I trimester: 0.22 µg/dL vs 0.12 µg/dL p<0.01; II trimester: 0.19 µg/L vs 0.10 µg/L p<0.001; III trimester 0.28 µg/ dL vs 0.13 µg/dL p<0.0001). Tobacco smoking mothers also had a higher concentration of lead in whole blood as compared to pregnant non-smoking women. These differences were statistically significant and amounted to 2.15 µg/dL vs 1.28 µg/L in the first, 1.99 µg/dL vs 1.19 µg/dL in the second and 2.11 µg/dL vs 1.58 µg/dL in the third trimester of pregnancy. We observed that the level of lead was correlated with cotinine in blood, as well as with the number of cigarettes and the length of time women smoked before conception. Such an effect was observed in every trimester of gestation. A strong correlation between the number of cigarettes/day and lead concentration in plasma (r=0.57; p<0.001) and whole blood (r=0.54; p<0.001) was found in the third trimester of pregnancy. CONCLUSIONS: Tobacco smoking during pregnancy increased the concentrations in maternal blood lead. The level of lead in plasma and whole blood correlated with the degree of intensity of cigarette smoking in the pregnant women studied. It may be a result of influencing the mobilization of calcium from the bone with simultaneous release of lead deposited in the bone. Further studies are required to characterize the effect of higher lead level in the blood of mothers on the risk of premature labor, low birth weight of newborns and their inferior development.

The effect of tobacco smoking during pregnancy on plasma oxidant and antioxidant status in mother and newborn.

OBJECTIVE: The aim of the study was to estimate the effect of tobacco smoking during pregnancy on oxidative damage and antioxidant defence in matched samples of maternal blood and cord blood. STUDY DESIGN: Healthy, pregnant women (n=140) were divided into non-smoking and smoking groups according to the concentration of cotinine in serum and urine. Oxidative damage was measured through levels of malondialdehyde (MDA) and plasma antioxidant status was evaluated by measuring concentrations of total radical trapping parameters (TRAP) and selected antioxidants (ß-carotene, vitamin A, vitamin E, uric acid). Statistical analysis was done using the SAS System for Windows (SAS Institute, Cary, NC). RESULTS: In the course of pregnancy the concentration of MDA increased, but to higher values in smoking women than in non-smoking ones. It was accompanied by significantly lower TRAP in the smoking group than in the controls (p<0.05). Plasma concentration of uric acid (p<0.05) and antioxidant vitamins E (p<0.01), A and ß-carotene (p<0.0001) were all reduced in smokers as compared with non-smoking pregnant women especially in the third trimester. Concentration of MDA in plasma of cord blood of newborns of smoking mothers was significantly higher (p<0.01) but the antioxidant defence was lower (p<0.0001) than in non-smoking ones. It was particularly pronounced for ß-carotene (32%; p<0.0001) and vitamin A (28%; p<0.001). A significant negative correlation was found between MDA and TRAP levels of maternal plasma (non-smoking and smoking: r=-0.50, p<0.0001) and cord plasma (non-smoking: r=-0.54, p=0.0057; smoking: r=-0.71, p=0.0004) in all the study subjects. Total antioxidant status positively correlated with concentrations of uric acid and vitamin E in non-smoking and smoking mothers as well as their newborns. CONCLUSION: Tobacco smoke enhances lipid peroxidation and depletes antioxidant potential in the plasma of pregnant women and umbilical cord blood. Therefore smoking during pregnancy may stimulate free radical damage in the mother and the growing fetus.

[Evaluation of iron balance in healthy pregnant women and their newborns]. / Badanie gospodarki zelazem u kobiet w przebiegu ciazy niepowiklanej oraz we krwi pepowinowej ich dzieci.

AIM OF THE STUDY: The aim of this study was to evaluate the iron status markers in normal healthy pregnancy as well as the influence of maternal diet on iron concentration in their newborns. MATERIAL AND METHODS: A longitudinal prospective study was conducted in a sample of 69 healthy non-smoking pregnant women under prenatal care of The Institute of Mother and Child. Blood samples were collected in the first, second and third trimesters and from the umbilical vein. Concentrations of ferritin and transferrin were assessed using turbidimetric technique, the concentration of iron--with ferrozine colorimetric method. Pentra 120 analyzer was used to define hematological parameters. Maternal diet was assessed by means of a weekly questionnaire, processed with computer software Dietetyk 2. RESULTS: Hematological parameters in the analyzed blood were normal. The average hematocrit values in the first trimester of pregnancy was 36.7%, in the second--34.92%, in the third--35.95%. The concentration of hemoglobin was 27.82 g/dl, 28.55 g/dl, 27.27 g/dl in the respective trimesters of pregnancy. In the umbilical blood it was 25.84 g/dl (5.2% less than in the maternal blood). The number of erythrocytes was the highest in the first (4.16 mln/mm3), and the lowest in the second trimester (3.92 mln/mm3). The average concentration of iron was the highest in the first trimester--99.61 microg/dl. In the second and third trimester it decreased by 25% and 2% respectively. The concentration was 76.34% higher in the umbilical blood than in maternal blood at the time of labor. The concentration of ferritin in the first trimester was 43.96 microg/l, in the second and the third trimester it was lower by 46% and 29% respectively. It was 126.4 microg/l in the umbilical blood (fourfold higher than in maternal blood). The concentration of transferrin was 321.01 mg/dl in the first trimester and it increased in consecutive trimesters by 36.14% and 5.12%; it was 219.92 mg/dl in the umbilical blood--48% of the concentration of transferrin in the maternal blood at the time of labor. The analysis of an average daily food ration revealed that the supply of iron was 80% of the recommended dose in the first half and only 41% of the recommended dose in the second half of the pregnancy. Fat consumption was 99% and 95% of the recommended dose, respectively. There was a 30%-decrease in the protein and carbohydrates consumption in comparison with the recommended dose in the second half of the pregnancy. CONCLUSIONS: In spite of normal hematological parameters, we observed insufficient supply of iron in the diet of pregnant women, which was demonstrated by a decreased level of ferritin. It should be reason enough to issue dietary recommendations and guidelines for pregnant women in each stage of pregnancy.

[Levels of immunoreactive cytokines in serum of women with preeclampsia or severe pregnancy hypertension]. / Stezenie immunoreaktywnych cytokin w surowicy krwi u kobiet ze stanem przed- rzucawkowym i ciezka postacia nadcisnienia ciazowego.

OBJECTIVE: The purpose of the study was to compare concentrations of inflammatory and Th1/Th2 cytokines in serum obtained from women with preeclampsia or severe pregnancy hypertension versus normotensive controls. MATERIAL AND METHODS: The study group consisted of 34 pregnant women with hypertension over 140/90mmHg and proteinuria over 0.3 g/day or severe pregnancy hypertension. 16 healthy pregnant women comprised the control group. The concentration of IL-2, IL-4, IL-6, IL-10, TNFalpha and IFNgamma was measured with Cytometric Bead Array Human Th1/Th2 Cytokine Kit II (Becton Dickinson). U-Mann Whitney test was used for the comparison of the results. RESULTS: We found statistically significantly increased concentrations of IFNgamma: 8.4 +/- 5.3 pg/ml vs. 4.2 +/- 3.2 pg/ml (p = 0.02), TNFalpha: 1.5 +/- 0.7 pg/ml vs. 0.7 +/- 0.3 pg/ml (p = 0.04) and IL-2: 1.3-0.6 pg/ml vs. 0.6 +/- 0.4 pg/ml (p = 0.01) in the studied group. The level of IL-6 35.5 +/- 21.0 pg/ml vs. 19.8 +/- 12.3 pg/ml was also increased but the difference did not reach statistical significance. Concentrations of IL-4 and IL- 10 were similar in both groups. CONCLUSION: Increased concentrations of Th1 cytokines (IFNgamma, IL-2) in the serum of women with preeclampsia suggests an exaggerated cytotoxic activity of blood in this pathology accompanied by an increase in the levels of inflammatory cytokines TNFalpha and IL-6.

Pro-hepcidin concentration in serum of women in uncomplicated pregnancy, pregnancy complicated by premature rupture of membranes and in pregnancy induced hypertension.

UNLABELLED: Pro-hepcidin, mainly synthesized in hepatocytes is the pro-hormone of hepcidin which demonstrates antimicrobial activity and is the body's main regulator of iron homeostasis. THE AIM: The estimation of serum pro-hepcidin concentrations in uncomplicated pregnancy and complicated by premature rupture of membranes (PROM) and in pregnancy induced hypertension (PIH). MATERIAL AND METHODS: The studies were performed in 24 women in pregnancy complicated by premature rupture of membranes, 31 women in pregnancy with induced hypertension and 35 healthy women in corresponding weeks of gestation (third trimester). Concentration of pro-hepcidin, C-reactive protein, white blood cell count, haemoglobin and haematocrit were studied using commercially available kits. RESULTS: Levels of serum pro-hepcidin in studied pregnant women were similar and amounted respectively to 99.6 microg/L, 93.7 microg/L and 98.2 microg/L in PIH, PROM and in the uncomplicated pregnancy group. In the group of patients with PROM and PIH, concentration of haemoglobin was significantly lower than in healthy pregnant women, but remains in the physiological range. In the studied groups values of C-reactive protein and leucocytes count were normal. We did not observe any correlation between the concentration of serum pro-hepcidin and iron status measurements. CONCLUSION: In pregnancies complicated by premature rupture of membranes and pregnancy induced hypertension with normal values of haemoglobin and haematocrit serum pro-hepcidin concentrations are similar to those observed in healthy pregnant women with normal course of pregnancy.

[The influence of lead on concentration of the pregnancy-associated plasma protein A (PAPP-A) in pregnant women smoking tobacco--preliminary study]. / Wplyw olowiu na stezenie osoczowego bialka ciazowego A (PAPP-A) u kobiet ciezarnych palacych tyton--badania wstepne.

The epidemiology studies conduct in Institute of Mother and Child indicated that in Poland 25-30% women smoke during pregnancy. Lead exposure from cigarette smoke may have a negative effect on transplacental transpire of micronutrients and if coexists with low concentration of pregnancy. associated plasma protein A (PAPP-A) resulting in adverse influence on growth and fetal development. Literature date points, those clinical symptoms of high blood level of lead and insufficiency of PAPP-A are similar. Therefore the aim of the study was to estimate the effect of lead from cigarettes on plasma PAPP-A levels in smoking pregnant women. Healthy, pregnant women (n = 30), patients of Clinical Department of Obstetrics and Gynaecology, Institute of Mother and Child were divided into groups nonsmoking and smoking according to questionnaire declaration. Plasma concentrations of lead were analysed using inductively coupled plasma mass spectrometry (ICP-MS) on spectrometer analyser ICP MS Elan 6100 (Perkin Elmer, Germany). Plasma level of PAPP-A was measured by immunofluorescence method using BRAHMS (Germany) kits on KRYPTOR (BRAHMS, Germany) analyser. We observed that in plasma of smoking pregnant women the concentration of lead was 2.55 microg/l (range: 0.78-14.6 mg/l) and was higher by 30% than in tobacco abstinent (1.78 microg/l; range: 0.0-4.69 microg/l). In group of smoking mothers level of PAPP-A was lower by 20% than in nonsmoking ones (2.80 IU/L; range: 1.3-9.3 IU/L vs 3.2 IU/L. range: 1.7 - 6.8 IU/L). Our results indicate that tobacco smoking during pregnancy affect in maternal blood lead and plasma protein A values. In smoking women lower concentrations of PAPP-A co-exist with higher than in tobacco abstinent level of lead which may suggest correlation between these parameters. Further studies will be continued in larger group of women in all trimesters of pregnancy to confirm of this association.

[Concentrations of pro-hepcidin in serum of pregnant women and in umbilical cord blood]. / Stzenia pro-hepcydyny w surowicy kobiet ciezarnych oraz krwi pepowinowej.

OBJECTIVES: The aim of the study was to detect the presence of pro-hepcidin in the serum of pregnant women and in umbilical cord blood. Additionally, correlations between pro-hepcidin and other iron parameters were analyzed. MATERIAL AND METHODS: Our study consisted of 32 healthy, pregnant women, patients of Clinical Department of Obstetrics and Gynaecology, Institute of Mother and Child (IMC). Serum concentrations of pro-hepcidin were determined with the use of immunoenzymathic method, levels of ferritin and transferrin with immunoturbidimetric method and iron with photometric test. Hemoglobin and hematocrite were determined on hematological analyzer Pentra 60. The study was conducted at the Department of Biochemistry IMC. RESULTS: The mean concentration of pro-hepcidin in the serum of pregnant women was 102.0+/-30.7 ng/ml and ranged from 51.5 to 187.1 ng/ml. Level of pro-hepcidin in the serum of the umbilical cord blood was 77.05+/-21.2 ng/ml (range: 41.9-125.9 ng/ml), which amounted up to about 75% of that found in mothers, thus making the differences were statistically significant (p<0.01). We observed a positive correlation between concentrations of that prohormone in the serum of mothers and cord blood (r=0.60; p<0.01). Our analysis revealed no correlations between the serum pro-hepcidin levels and other studied parameters of iron status, both in the mothers and children groups. CONCLUSIONS: Our results indicate that concentrations of pro-hepcidin are detectable in the serum of mothers, as well as in the umbilical cord blood, and positively correlate with each other. No anemia or subclinical iron deficiency that could explain no correlation with others parameters of iron status was observed.

[Concentration of ferritin, transferrin and iron as a markers of iron deficiency in healthy women in reproductive age]. / Stezenia ferytyny, transferyny i zelaza w ocenie niedoborów tego pierwiastka u zdrowych kobiet w wieku reprodukcyjnym.

UNLABELLED: Iron deficiency anemia in pregnancy continues to be a clinical problem, which contributes to maternal and fetal morbidity. Iron store deficiency leads to iron deficient erythropoiesis and to negative iron balance when the iron supply is insufficient to maintain normal concentration of hemoglobin. The aim of this study was aimed to establish concentration of ferritin, transferrin and iron as a markers of iron deficiency in healthy women in reproductive age came for control examination to Institute of Mother and Child in Warsaw. MATERIAL AND METHODS: In serum of 108 healthy, multiparas in age up to 40 years from urban agglomerations, middle-class non-pregnant women concentration of iron, ferritin, transferrin and transferrin saturation were determined by commercially available kits (Hoffman-La Roche, Switzerland). RESULTS: Mean concentration of iron, ferritin and transferrin were among normal values. Low level of iron (below 49 microg/dl) was observed in serum of 12%, this of ferritin (below 20 ng/ml) in 22% and of transferrin (below 252 mg/dl) in 15% of studied women. Transferrin saturation lower than 15% was observed in 9 patients. The obtained values were age dependent. The lowest values of total iron were observed in the youngest group I (below 25 years old) and were accompanied with ferritin level below 20 ng/ml in 26% of women. Low ferritin values were also observed in serum of 22% patients of group II (25-35 years old) and only in 14% of women older than 35 years (group III). Saturation of transferrin lower than 15%, which indicated deficiency of iron for erythropoiesis, was observed in 26%, 13% and 19% patients of group I, II and III respectively. CONCLUSIONS: Obtained results indicated that in population of studied women in reproductive age, subclinical iron deficiency in 20% and negative iron balance in 10% could be observed. Therefore, iron status, especially store ferritin, should be assessed very carefully as a component of medical care.

[The effect of tobacco smoking during pregnancy on concentration of uric acid in matched-maternal cord pairs]. / Wplyw palenia tytoniu przez kobiety ciezarne na stezenie kwasu moczowego we krwi matki i we krwi pepowinowej noworodka.

Intensity of oxidative stress caused by prooxidant-antioxidant imbalance may have a pathophysiological effect in fetus of women smoking during pregnancy. Uric acid is the main contributor (60%) to TRAP (total radical trapping antioxidant parameters) which is markers of the plasma total antioxidants capacity. Therefore the aim of the study was to estimate the effect of tobacco smoking on concentration of uric acid in blood of pregnant women and in umbilical cord blood. Correlations between uric acid and total plasma antioxidant capacity in mothers and their babies were also studied. Healthy, pregnant women (n=147) were divided into groups non-smoking and smoking according to questionnaire declaration and concentration of cotinine in serum and urine. Concentration of uric acid in plasma was measured by enzymatic method using available kits from bioMERIEUX (France). We observed that, in both of studied group plasma concentration of uric acid increased during pregnancy. In group of smoking women level of uric acid was lower by 20% in I, by 25% in II and by 15% in III trimester than in group of tobacco abstinent. The differences were statistically significant, although the range concentrations in individual patients in both studied groups were similar (from 102.0 micromol/l to 408.0 micromol/l). In umbilical cord blood of children of smoking mothers mean level of uric acid was lover by 18% than in control group. Plasma concentration of uric acid was significantly correlated with total plasma antioxidant capacity both in smoking (r=0.75; p<0.001) and tobacco abstinent (r=0.60; p<0.05) pregnant women. The similar correlation was observed in umbilical cord blood in both groups (smoking: r=0.74; p<0.001, non-smoking: r=0.60; p<0.05). Reduced concentration of uric acid in plasma of women smoking tobacco during pregnancy suggest, that utilization of this antioxidant for neutralization of free radical present in cigarette smoking is enhanced and may have a negative effect on total plasma antioxidant capacity in mothers and their babies.

[The effect of tobacco smoking during pregnancy on concentration of vitamin E in blood of mothers and their newborns in umbilical cord blood]. / Wplyw palenia tytoniu w przebiegu ciazy na stezenie witaminy E we krwi matki i we krwi pepowinowej noworodka.

OBJECTIVES: Cigarette smoking during pregnancy generates free radicals and has been implicated in oxidative cellular damage. Vitamin E is natural factor protecting cells from damaging influence of free oxygen species. DESIGN: The aim of the study was to estimate the effect of tobacco smoking during pregnancy on concentration of vitamin E in blood of mother and newborns. MATERIALS AND METHODS: 147 healthy, pregnant women were divided into non-smoking (n = 85) and smoking group (n = 62) according to the concentration of cotinine in serum and urine. Level of vitamin E was measured by HPLC (high pressure liquid chromatography) method in plasma and erythrocytes of mothers and umbilical cord blood. RESULTS: We observed that, in group of women smoking during pregnancy concentration of vitamin E was lower in plasma and in erythrocytes as compared with group of non-smoking women. Also in cord blood of newborns of smoking mothers level of vitamin E was significantly lower in plasma (p < 0.01) as well as in erythrocytes (p < 0.0001) than in control group. CONCLUSION: Reduced concentration of plasma and erythrocytes vitamin E during pregnancy suggest that consumption of this antioxidant for neutralization of free radicals present in cigarette smoking is enhanced.

[Prenatal diagnosis of Crouzon syndrome--actual diagnostic possibilities]. / Prenatalne rozpoznanie zespolu Crouzona-- wspólczesne mozliwosci diagnostyczne.

Crouzon syndrome is a cranio-facial dysostosis with autosomal dominant transmission and a birth prevalence of 16.5 per million newborns. Up till now there is no publications in polish medical journals about ultrasonic diagnosis of Crouzon syndrome or of any other craniostenosis. The development of ultrasonography, three-dimensional ultrasonography and in the last years also MRI, allows earlier detection and diagnosis of fetal malformation and enables precise evaluation of his anatomy. The aim of the study is presentatoin Crouzon syndrom diagnosed prenatally by ultrasonography and confirmed moleculary by DNA analysis. We would like to stress the diagnostic problems and the difficult decisions that we encountered.

[The effect of tobacco smoking during pregnancy on concentration of vitamin A and beta-carotene in matched-maternal cord pairs]. / Wpllyw palenia tytoniu przez kobiety ciezarne na stezenia witaminy A i beta-karotenu w krwi matki i w krwi pepowinowej noworodka.

Tobacco smoking causes oxidant stress in pregnant women and may have a similar effect in fetus. Vitamin A and beta-carotene are natural factors protecting cells from damaging influence of free oxygen species.Therefore the aim of the study was to estimate the effect of tobacco smoking during pregnancy on concentration of vitamin A and beta-carotene in blood of mother and newborn. Healthy women in III trimester of pregnancy were divided into non-smoking (n = 40) and smoking group (n = 35) according to the concentration of cotinine in serum and urine. Level of carotenoids was measured by HPLC (high pressure liquid chromatography) method in plasma of matched-maternal cord pairs. We observed that, in smoking women group concentration of vitamin A was lower in plasma of mothers as well as in cord blood of newborn (p < 0.001) and amounted respectively only 80% and 70% of that observed in non-smoking mother and their child. In smoking group plasma level of beta-carotene was significantly lower (by 30%; p < 0.0001) as compared with non-smoking matched-maternal cord pairs. Plasma level of vitamin A was significantly correlated with concentration of pcarotene both in smoking and non-smoking pregnant women (r = 0.70, p < 0.001; r = 0.57, p < 0.001). The similar correlation was observed in umbilical cord blood in both groups (r = 0.81 and r = 0.82; p < 0.001). Reduced concentration of vitamin A and beta-carotene in matched-maternal cord pairs suggest that consumption of this antioxidant for neutralization of free radicals present in cigarette smoking is enhanced.

[Activities of superoxide dismutase, catalase, glutathione peroxidase and reductase in umbilical cord blood of newborns from mothers smoking during pregnancy]. / Aktywnosc dysmutazy ponadtlenkowej, katalazy, peroksydazy i reduktazy glutationowej w krwi pepowinowej noworodków matek palacych tyton podczas ciazy.

In pregancy complicated by cigarette smoking prooxidant-antioxidant imbalance may have a pathomorphological and pathophysiological effect in fetus. Efficient enzymatic antioxidant systems are natural factors protecting cells from damaging by free oxygen species. Therefore the aim of the study was to estimate the effect of tobacco smoking during pregnancy on activities of superoxide dismutase, catalase, glutathione peroxidase and reductase in umbilical cord blood of newborns. Healthy matched-maternal cord pairs (65) were divided into non-smoking (n = 35) and smoking group (n = 30) according to the concentration of cotinine in serum and urine. We observed that, in umbilical cord blood from newborns of smoking women activities of catalase, glutathione peroxidase and reductase were lower by 30%, 15% and 37% respectively than in non-smoking. The differences were statistically significant (p < 0.0001; p < 0.01; p < 0.0001). Activity of superoxide dismutase was similar in both studied group. In erythrocytes of newborns from smoking mothers activity of superoxide dismutase was significantly correlated with concentration of cotinine (r = 0.61; p < 0.01). The similar correlation was not observed in red blood cells of non-smoking ones. Our results indicate that tobacco smoking during pregnancy may have a negative effect on enzymatic antioxidant systems in umbilical cord blood.

[Concentrations of cotinine in serum and urine of smoking pregnant women and in placenta and umbilical cord blood]. / Stezenia kotyniny w surowicy krwi i moczu palacych kobiet ciezarnych oraz w lozysku i krwi pepowinowej noworodka.

Concentration of cotinine, the major metabolite of nicotine in body fluids, is commonly accepted as the method which may better reflect tobacco smoke exposure than the questionnaire. In order to assess adverse fetal health effects caused by cigarette smoking it is important to study the relation between maternal and fetal exposure to tobacco smoke compounds. We determined serum and urine cotinine levels in the course of pregnancy, as well as its concentration in placenta and umbilical cord blood. In group of smoking women serum cotinine concentration was high (above 1050 microg/l) and stable in I, II and III trimester. It was correlated with amount of cotinine (about 2000 microg/g creatinine) in urine (r=0.8; p<0.0001). In serum of umbilical cord blood level of cotinine was half (range: 300-600 microg/ I) of that observed in maternal blood and was correlated with it (r=0.67; p<0.01). In placenta of smoking women mean concentration of cotinine was 57.5 ng/g tissue. In serum of non-smoking pregnant women and in blood of their babies we found trace amount of cotinine in 50% of mothers and 30% of infants. In this group concentration of cotinine in urine as well as in placenta was not detectable. The obtained results indicate that assay of cotinine by specific and inexpensive methods may be useful for monitoring of exposure to tobacco smoke both of mothers and newborns.

[The effect of tobacco smoking during pregnancy on concentration of malondialdehyde in blood of mothers and in umbilical cord blood]. / Wplyw palenia tytoniu w przebiegu ciazy na stezenia dialdehydu malonowego we krwi matki i we krwi pepowinowej noworodka.

OBJECTIVES: Maternal smoking during pregnancy is known to be associated with not only intrauterine fetal growth retardation or low birth weight but also causes disturbances in postnatal growth and development. The prime role of oxidative stress in the pathogenesis of adverse pregnancy outcomes is almost universally accepted. DESIGN: The aim of the study was to estimate the effect of tobacco smoking during pregnancy on concentration of lipid peroxidation products (malondialdehyde - MDA) in blood of mother and newborns. MATERIALS AND METHODS: 147 healthy, pregnant women were divided into non-smoking (n = 85) and smoking group (n = 62) according to questionnaire declaration and confirmed by cotinine concentration in serum and urine. Level of MDA was measured by fluorimetric method in plasma and in erythrocytes of mothers and umbilical cord blood. RESULTS: We found that, in group of women smoking during pregnancy concentration of malondialdehyde was higher in plasma and in erythrocytes when compared to group of tobacco abstinent. Also in cord blood of newborns of smoking mothers level of MDA was significantly higher in plasma (p < 0.05) as well as in erythrocytes (p < 0.01) than in control group. CONCLUSION: The presented results indicate that smoking during pregnancy may promotes free radical damage in growing fetus and newborns therefore stimulates metabolic disorders dependent on oxidative stress.

[Twin pregnancies and their outcome at the Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, in the period of 1993-2000]. / Przebieg ciazy i porodu w przypadkach ciaz mnogich w materiale Kliniki poloznictwa i Ginekologii Instytutu Matki i Dziecka w latach 1993-2000.

OBJECTIVE: The aim of this study was to analyse the course of twin pregnancies delivered at the Department of Obstetrics and Gynaecology, Institute of Mother and Child in Warsaw, from 1993 to 2000. MATERIALS AND METHODS: The medical documentation of women with twin pregnancy was looked into. Such parameters as mode of conception, maternal age and parity were taken into account. The data concerning the duration of pregnancy, mode of delivery, birth weight and condition of newly born infants were retrospectively reviewed. RESULTS: There a total of 232 (1.46%) twin pregnancies out of 15,869 births. A gradual increase in absolute number of twin deliveries and a relative increase of multiple pregnancies due to the use of assisted reproduction techniques was observed. The tendency to end twin pregnancies by caesarean section was detected. Although the perinatal care improved over the years, a small decrease of mean gestational age at delivery was observed. No significant difference in neonatal outcome in relation to the mode of delivery in researched material was noticed. CONCLUSIONS: The number of twin pregnancies due to the use of assisted reproduction techniques is on the increase. A percentage of women delivering for the first time has risen among women with twin pregnancy. Twin pregnancies are often ended by caesarean section and the frequency of caesarean sections has increased over time.