Oxidative stress (OS), a state characterized by an imbalance between pro-oxidant molecules including reactive oxygen and nitrogen species, and antioxidant defenses, has been identified to play a key role in the pathogenesis of subfertility in both males and females. The adverse effects of OS on sperm quality and functions have been well documented. In females, on the other hand, the impact of OS on oocytes and reproductive functions remains unclear. This imbalance between pro-oxidants and antioxidants can lead to a number of reproductive diseases such as endometriosis, polycystic ovary syndrome (PCOS), and unexplained infertility. Pregnancy complications such as spontaneous abortion, recurrent pregnancy loss, and preeclampsia, can also develop in response to OS. Studies have shown that extremes of body weight and lifestyle factors such as cigarette smoking, alcohol use, and recreational drug use can promote excess free radical production, which could affect fertility. Exposures to environmental pollutants are of increasing concern, as they too have been found to trigger oxidative states, possibly contributing to female infertility. This article will review the currently available literature on the roles of reactive species and OS in both normal and abnormal reproductive physiological processes. Antioxidant supplementation may be effective in controlling the production of ROS and continues to be explored as a potential strategy to overcome reproductive disorders associated with infertility. However, investigations conducted to date have been through animal or in vitro studies, which have produced largely conflicting results. The impact of OS on assisted reproductive techniques (ART) will be addressed, in addition to the possible benefits of antioxidant supplementation of ART culture media to increase the likelihood for ART success. Future randomized controlled clinical trials on humans are necessary to elucidate the precise mechanisms through which OS affects female reproductive abilities, and will facilitate further explorations of the possible benefits of antioxidants to treat infertility.

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The effects of oxidative stress on female reproduction: a review

A review of research on prenatal depression effects on the fetus and newborn suggests that they experience prenatal, perinatal and postnatal complications. Fetal activity is elevated, prenatal growth is delayed, and prematurity and low birthweight occur more often. Newborns of depressed mothers then show a biochemical/physiological profile that mimics their mothers' prenatal biochemical/physiological profile including elevated cortisol, lower levels of dopamine and serotonin, greater relative right frontal EEG activation and lower vagal tone. Elevated prenatal maternal cortisol is the strongest predictor of these neonatal outcomes. Moderate pressure massage can alleviate these effects including reducing prematurity.

Prenatal depression effects on the fetus and newborn : a review

Immune mechanisms have been implicated in placental dysfunction in patients with recurrent miscarriages and intrauterine growth restriction (IUGR), but the mediators are undefined. Here we show that complement activation, particularly C5a, is a required intermediary event in the pathogenesis of placental and fetal injury in an antibody-independent mouse model of spontaneous miscarriage and IUGR, and that complement activation causes dysregulation of the angiogenic factors required for normal placental development. Pregnancies complicated by miscarriage or growth restriction were characterized by inflammatory infiltrates in placentas, functional deficiency of free vascular endothelial growth factor (VEGF), elevated levels of soluble VEGF receptor 1 (sVEGFR-1, also known as sFlt-1; a potent anti-angiogenic molecule), and defective placental development. Inhibition of complement activation in vivo blocked the increase in sVEGFR-1 and rescued pregnancies. In vitro stimulation of monocytes with products of the complement cascade directly triggered release of sVEGFR-1, which sequesters VEGF. These studies provide the first evidence linking the complement system to angiogenic factor imbalance associated with placental dysfunction, and identify a new effector of immune-triggered pregnancy complications.

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Complement activation induces dysregulation of angiogenic factors and causes fetal rejection and growth restriction

Until now oligonephropathy to indicate “too few nephrons” has been associated with intrauterine growth restriction and experimentally induced abnormalities of renal development. The purpose of this study was to determine whether there is evidence of abnormal postnatal glomerulogenesis in extremely low birth weight preterm infants. Renal autopsy tissue was studied by computer-assisted morphometry from 56 extremely premature infants (birth weight ≤ 1000 g) and 10 fullterm infants as controls. Preterm infants were divided into two groups (short survival < 40 days vs. long survival ≥40 days). Each group was subdivided into those with renal failure (RF) and those with normal renal function. Forty-two of 56 preterm infants (75%) were adequate for gestational age. Glomerulogenesis as measured by radial glomerular counts (RGC) was markedly decreased in all preterm infants as compared to term controls and correlated significantly with gestational age (r = 0.87; P < 0.001). Active glomerulogenesis with “basophilic S-shaped bodies” was absent in longer surviving preterm and all term infants. RGC of preterm infants surviving ≥40 days with RF were significantly less than RGC of those with long survival and no RF (P < 0.001). Only this latter group demonstrated increased glomerular size as measured by mesangial tuft area and Bowman’s capsule area compared to all other groups (P < 0.001). The kidney continues to form postnatally in preterm neonates, but glomerulogenesis ceases after 40 days. Moreover, it is further inhibited by RF. Compensatory mechanisms in longer surviving preterm infants include glomerular hypertrophy and mesangial proliferation that could lead to hyperfiltration.

Histomorphometric analysis of postnatal glomerulogenesis in extremely preterm infants.

Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.

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Maternal Preeclampsia and Neonatal Outcomes

Intrauterine growth restriction (IUGR) is found in 1-10% of all pregnancies, and among women with risk factors even twice often. It is connected to worse obstetric results, and its complications can arise long time after delivery. In the paper we described etiology, diagnostics and monitoring of IUGR and its consequences for the child and for the course of neonatal periode.

Intrauterine growth restriction

UNLABELLED The aim of the study was to evaluate cardiac function in foetuses with IUGR, using the Tei Index. MATERIAL AND METHODS Prenatal echocardiographic examination was performed in 64 foetuses with intrauterine growth retardation between 25-27, 30-32, and 34-37 weeks of gestation. The control group included 30 healthy foetuses. Flow velocity waveforms of mitral and tricuspid valve and flow velocity waveforms of the aortic and pulmonic valves were obtained. The Tei Index for left and right ventricle was calculated. The heart rate was measured in all foetuses. RESULTS The Tei Index for left ventricle in foetuses with intrauterine growth retardation was significantly higher than in healthy foetuses (25-27 hbd - 0.6 vs. 0.58; p<0.05: 30-32 hbd -0.59 vs. 0.52; p<0.05: 34-36 hbd - 0.58 vs. 0.48; p<0.001). The Tei Index for right ventricle was also significantly higher in foetuses with intrauterine growth retardation than in the control group. The Tei Index decreased gradually with advancing gestational age and is independent of heart rate. CONCLUSIONS l. Foetuses with intrauterine growth retardation have abnormal cardiac function in later part of gestation. 2. The Tei Index may be applied to evaluate cardiac function in foetuses.

Assessment of cardiac function in fetuses with intrauterine growth retardation using the Tei Index

OBJECTIVE The aim of this study was to verify clinical diagnosis of cervical incompetence by the use of transvaginal sonography. MATERIAL AND METHODS 101 pregnant women hospitalized at the Pathological Pregnancy Department, Medical University of Lodz in years 2000-2002 because of suspicion of cervical incompetence were analysed. The mean age of examined group was 24 +/- 3.24 yr. All pregnant women underwent ultrasound cervical assessment at the 18-30 week of gestation by using Hitachi EUB 515C system. Sonographic measurements of cervical length and width were performed. The cervical length below 30 mm and width at least 6 mm were sonographic criteria of cervical incompetence. RESULTS In 63 pregnant women cervical incompetence was not confirmed by ultrasound examination. In 38 patients sonographic features of cervical incompetence were established. 38 pregnant women were underwent elective cervical cerclage for cervical incompetence. Because of poor previous history 8 women with normal ultrasound examination were treated by cervical cerclage. CONCLUSIONS We conclude, that clinical diagnosis of cervical incompetence should be verified by the use of transvaginal sonography to provide an objective diagnosis.

Ultrasonographic diagnosis of cervical incompetence

OBJECTIVES The problem of leiomyomas founded in pregnancy is reported DESIGN Diagnostic methods, indications and contraindications for the myomectomy and surgical technique are presented MATERIALS AND METHODS In years 1991-2000--185 pregnant women with leiomyomas diagnosed during pregnancy or caesarean section were treated RESULTS There were indications for the myomectomy during pregnancy in the group of 26 women, in next 55 women leiomyomas were diagnosed in the course of pregnancy but myomectomy was performed during caesarean section In the other group of 104 pregnant women leiomyomas were found and enucleated first during caesarean section made on the other indications CONCLUSIONS It was observed that myomectomy during caesarean section and also in the course of pregnancy is a safe procedure when the indications and surgical technique are correctly made

Elzbieta Lipecka-Kidawska

Papers

Intrauterine growth restriction

Assessment of cardiac function in fetuses with intrauterine growth retardation using the Tei Index

Ultrasonographic diagnosis of cervical incompetence

Leiomyomas in pregnancy