Showing papers in "Journal of Maternal-fetal & Neonatal Medicine in 2008"
TL;DR: The objective of this study was to determine if changes in maternal plasma concentration of these angiogenic and anti-angiogenic factors differ prior to development of disease among patients with normal pregnancies and those destined to develop PE (preterm and term) or to deliver a small for gestational age (SGA) neonate.
Abstract: Introduction Accumulating evidence suggests that an imbalance between pro-angiogenic (i.e., vascular endothelial growth factor (VEGF) and placental growth factor (PlGF)) and anti-angiogenic factors (i.e., soluble VEGF receptor-1 (sVEGFR-1, also referred to as sFlt1)) is involved in the pathophysiology of preeclampsia (PE). Endoglin is a protein that regulates the pro-angiogenic effects of transforming growth factor beta, and its soluble form has recently been implicated in the pathophysiology of PE. The objective of this study was to determine if changes in maternal plasma concentration of these angiogenic and anti-angiogenic factors differ prior to development of disease among patients with normal pregnancies and those destined to develop PE (preterm and term) or to deliver a small for gestational age (SGA) neonate. Methods This longitudinal nested case-control study included 144 singleton pregnancies in the following groups: (1) patients with uncomplicated pregnancies who delivered appropriate for gestational age (AGA) neonates (n = 46); (2) patients who delivered an SGA neonate but did not develop PE (n = 56); and (3) patients who developed PE (n = 42). Longitudinal samples were collected at each prenatal visit, scheduled at 4-week intervals from the first or early second trimester until delivery. Plasma concentrations of soluble endoglin (s-Eng), sVEGFR-1, and PlGF were determined by specific and sensitive ELISA. Results (1) Patients destined to deliver an SGA neonate had higher plasma concentrations of s-Eng throughout gestation than those with normal pregnancies; (2) patients destined to develop preterm PE and term PE had significantly higher concentrations of s-Eng than those with normal pregnancies at 23 and 30 weeks, respectively (for preterm PE: p Conclusions (1) Changes in the maternal plasma concentration of s-Eng, sVEGFR-1, and PlGF precede the clinical presentation of PE, but only changes in s-Eng and PlGF precede the delivery of an SGA neonate; and (2) differences in the profile of angiogenic and anti-angiogenic response to intrauterine insults may determine whether a patient will deliver an SGA neonate, develop PE, or both.
652 citations
TL;DR: Changes in the maternal plasma concentrations of s-Eng, sVEGFR-1, and PlGF were compared among normal patients and those destined to develop PE or deliver an SGA neonate while adjusting for maternal age, nulliparity, and body mass index to determine if changes in the profile of angiogenic and anti-angiogenic factors in maternal plasma are associated with a high risk for the subsequent development of PE.
Abstract: Introduction. An imbalance between angiogenic and anti-angiogenic factors has been proposed as central to the pathophysiology of preeclampsia (PE). Indeed, patients with PE and those delivering small-for-gestational age (SGA) neonates have higher plasma concentrations of soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and the soluble form of endoglin (s-Eng), as well as lower plasma concentrations of vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) than do patients with normal pregnancies. Of note, this imbalance has been observed before the clinical presentation of PE or the delivery of an SGA neonate. The objective of this study was to determine if changes in the profile of angiogenic and anti-angiogenic factors in maternal plasma between the first and second trimesters are associated with a high risk for the subsequent development of PE and/or delivery of an SGA neonate.Methods. This longitudinal case–control study included 402 singleton pregnancies in the f...
282 citations
TL;DR: The current prevalence of obesity in both adults and children and associated disorders of blood pressure and lipid metabolism suggest a perpetuating cycle of increasing obesity, insulin resistance, and abnormal lipid metabolism, which has ominous consequences for future generations.
Abstract: Objective. To examine the risk of obesity and metabolic syndrome in women with a history of gestational diabetes mellitus and in offspring born to mothers with gestational diabetes mellitus.Methods. A review of studies examining the development of obesity, hypertension, metabolic abnormalities, metabolic syndrome, and type II diabetes in mothers with a history of gestational diabetes mellitus and control mothers, and offspring of mothers with a history of gestational diabetes and control mothers.Results. Longitudinal studies demonstrate that women with a prior history of gestational diabetes mellitus and obesity are at significantly greater risk of developing metabolic syndrome than mothers with no history of gestational diabetes or obesity. The development of metabolic syndrome in children with increasing age is related to maternal gestational diabetes mellitus, maternal glycemia in the 3rd trimester, maternal obesity, neonatal macrosomia, and childhood obesity.Conclusions. The current prevalence of obes...
180 citations
TL;DR: It is proposed that IL-10 has a role in the regulation of the immune response in vivo by initiating actions that dampen inflammation.
Abstract: Objective. The anti-inflammatory limb of the immune response is crucial for dampening inflammation. Spontaneous parturition at term and preterm labor (PTL) are mediated by inflammation in the cervix, membranes, and myometrium. This study focuses on the changes in the amniotic fluid concentrations of the anti-inflammatory cytokine interleukin (IL)- 10. The objectives of this study were to determine whether there is a relationship between amniotic fluid concentrations of IL-10 and gestational age, parturition (at term and preterm), and intra-amniotic infection/inflammation (IAI).Study design. A cross-sectional study was conducted including 301 pregnant women in the following groups: (1) mid-trimester of pregnancy who delivered at term (n = 112); (2) mid-trimester who delivered preterm neonates (n = 30); (3) term not in labor without IAI (n = 40); (4) term in labor without IAI (n = 24); (5) term in labor with IAI (n = 20); (6) PTL without IAI who delivered at term (n = 31); (7) PTL without IAI who delivered ...
125 citations
TL;DR: Whether plasma concentrations of sVEGFR-1 in mothers with SGA fetuses without preeClampsia at the time of diagnosis are different from those in patients with preeclampsia or normal pregnant women is determined and the relationship between plasma concentrations and Doppler velocimetry in uterine and umbilical arteries is examined.
Abstract: Objectives. The soluble form of vascular endothelial growth factor receptor-1 (sVEGFR-1), an antagonist to vascular endothelial growth factor and placental growth factor, has been implicated in the pathophysiology of preeclampsia. Preeclampsia and pregnancy complicated with small for gestational age (SGA) fetuses share some pathophysiologic derangements, such as failure of physiologic transformation of the spiral arteries, endothelial cell dysfunction, and leukocyte activation. The objectives of this study were to: (1) determine whether plasma concentrations of sVEGFR-1 in mothers with SGA fetuses without preeclampsia at the time of diagnosis are different from those in patients with preeclampsia or normal pregnant women, and (2) examine the relationship between plasma concentrations of sVEGFR-1 and Doppler velocimetry in uterine and umbilical arteries in patients with preeclampsia and those with SGA.Study design. A cross-sectional study was conducted to determine the concentrations of the soluble form of...
111 citations
TL;DR: Different respondent perceptions exist regarding the safety, accessibility, and necessity of prenatal dental treatments, and professional guidelines about oral health screening in pregnancy and the safety of dental procedures would benefit patients and colleagues.
Abstract: Objective. To compare the opinions of dentists, obstetricians, and patients on dental care in pregnancy: its necessity, accessibility, and safety.Methods. A 35-item questionnaire was distributed wi...
105 citations
TL;DR: The presence and concentration of caspase-1 in the amniotic fluid varies as a function of gestational age and most women with labor do not have intra-amniotic infection, it is proposed that cellular stress during labor accounts for activation of the inflammasome.
Abstract: Objective. Caspase-1 is a component of the NALP3 inflammasome, a cytosolic multiprotein complex that mediates the processing of pro-inflammatory caspases and cytokines. The inflammasome represents the first line of defense against cellular stress and is a crucial component of innate immunity. Caspase-1 is the enzyme responsible for the cleavage and activation of interleukin (IL)-1β, which is a potent pro-inflammatory cytokine, and plays a central role in the mechanisms leading to labor (preterm and term) particularly in the context of intrauterine infection/inflammation. In addition, caspase-1 cleaves IL-18 and IL-33. The objectives of this study were to determine whether there is a relationship between amniotic fluid concentrations of caspase-1 and gestational age, parturition (term and preterm), and intra-amniotic infection/inflammation (IAI).Study design. A cross-sectional study was conducted including 143 pregnant women in the following groups: (1) mid-trimester of pregnancy (n = 18); (2) term not in ...
103 citations
TL;DR: There was an inverse relationship between amniotic fluid concentration of HSP70 and the amniocentesis-to-spontaneous delivery interval (Spearman's Rho = −0.26; p = 0.02), and among patients with preterm labor with intact membranes and preterm PROM, those with IAI had a significantly higher median amniotics fluid H SP70 concentration than those without IAI.
Abstract: Objective. Heat shock protein (HSP) 70, a conserved member of the stress protein family, is produced in almost all cell types in response to a wide range of stressful stimuli, and its production has a survival value. Evidence suggests that extracellular HSP70 is involved in the activation of the innate and adaptive immune response. Furthermore, increased mRNA expression of HSP70 has been observed in human fetal membranes following endotoxin stimulation. This study was conducted to determine the changes in amniotic fluid HSP70 concentrations during pregnancy, term and preterm parturition, intra-amniotic infection (IAI), and histologic chorioamnionitis.Study design. A cross-sectional study was conducted in 376 pregnant women in the following groups: (1) women with a normal pregnancy who were classified into the following categories: (a) women in the mid-trimester (14–18 weeks) who underwent amniocentesis for genetic indications and delivered normal infants at term (n=72); (b) women at term not in labor (n =...
103 citations
TL;DR: E Epidemiological, clinical, as well as experimental data obtained by the group during the past two decades indicate that insulin itself, when occurring in elevated concentrations during perinatal life, may program the development of obesity and diabetes.
Abstract: Alterations of the intrauterine and early postnatal nutritional, metabolic and hormonal environment may cause a predisposition for disorders and diseases throughout later life. Studies in offspring of diabetic mothers (ODM) have decisively contributed to this perception and our understanding of causal mechanisms. Hormones in particular are environment-dependent organizers of the developing organism. When they are present in non-physiological concentrations during critical periods of early development, they can dose-dependently lead to a permanent malprogramming of fundamental regulatory systems. Worthy of note, fetal and neonatal hyperinsulinism is the pathognomic feature in ODM. Epidemiological, clinical, as well as experimental data obtained by our group during the past two decades indicate that insulin itself, when occurring in elevated concentrations during perinatal life, may program the development of obesity and diabetes. Similarly, this may occur due to general increase of fetal food supply, e.g., in overweight pregnant women and neonatal overfeeding. From a clinical point of view, universal screening and therapy for all types of diabetes during pregnancy as well as avoidance of early postnatal overfeeding, especially by promoting breast feeding, are, therefore, recommended. These measures might serve as causal approaches to a genuine primary prevention.
101 citations
TL;DR: Single dose ceftriaxone was as effective as a combination of ampiclox, gentamicin, and metronidazole in preventing post-elective cesarean section complications in a randomized clinical trial involving 200 pregnant women.
Abstract: Objective. To compare the effectiveness of single dose ceftriaxone versus multiple doses of ampiclox, gentamicin, and metronidazole to prevent infectious morbidity at elective cesarean section.Methods. This was a randomized clinical trial involving 200 pregnant women who had an elective cesarean section for various reasons during the study period. Outcome measures included endometritis, urinary tract infections, febrile morbidities, wound infections, duration of hospital stay, and cost of antibiotic therapy. Data were managed using SPSS.Results. There was no statistically significant difference in the mean duration of hospital stay between the two groups, but a significant statistical difference was found in the mean cost of antibiotic treatment ($15 for the combination and $9 for ceftriaxone; p = 0.000), with the group of patients taking a single dose of ceftriaxone (ROPHEX) having a lower mean cost of treatment than those taking a combination of ampiclox, gentamicin, and metronidazole. The study groups ...
71 citations
TL;DR: The findings of this cross-sectional study suggest that plasma sVEGFR-2 concentration could reflect endothelial cell function, and preeclampsia and SGA are associated with low plasma concentrations of this protein.
Abstract: Objectives. Preeclampsia is considered an anti-angiogenic state. A role for the anti-angiogenic factors soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and soluble endoglin in preeclampsia has been proposed. Soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) has been detected in human plasma, and the recombinant form of this protein has anti-angiogenic activity. There is a paucity of information about maternal plasma sVEGFR-2 concentrations in patients with preeclampsia and those without preeclampsia with small for gestational age (SGA) fetuses. This study was conducted to determine whether: (1) plasma sVEGFR-2 concentration changes throughout pregnancy; and (2) preeclampsia and SGA are associated with abnormalities in the maternal plasma concentration of sVEGFR-2.Study design. This cross-sectional study included non-pregnant women (n = 40), women with normal pregnancies (n = 135), women with an SGA fetus (n = 53), and women with preeclampsia (n = 112). SGA was defined as an...
TL;DR: There was significant differences in the incidence of IHPS in the seven European populations as the populations also differed in relation to trend over time with both significant increases and decreases over time.
Abstract: Objective. The objective of this study was to present epidemiologic data on infantile hypertrophic pyloric stenosis (IHPS) from seven well-defined European regions, and to compare incidence and changes in incidence over time between these regions. Methods. This was a population-based study using data from registries of congenital malformations (EUROCAT) for a period of more than two decades (1980-2002). Results. A total of 2534 infants were diagnosed with IHPS during the study period, giving an overall incidence of IHPS of 2.0 per 1000 live births (LB), ranging from 0.86 per 1000 LB to 3.96 per 1000 LB in the seven regions. A significant decrease in incidence was observed in two regions and a significant increase in incidence was observed in two other regions. Young maternal age (<20 years) significantly increased the risk of IHPS by 29% (adjusted by region; p < 0.01), and at maternal age of 30 years and older the risk decreased significantly (p < 0.01). Conclusions. There were significant differences in the incidence of IHPS in the seven European populations. No uniform pattern of change in incidence was observed as the populations also differed in relation to trend over time with both significant increases and decreases over time. There is evidence that young maternal age is a risk factor for IHPS.
TL;DR: Placental galectin-1 expression is higher in severe PE than in normal pregnancy regardless of the presence of SGA, and the protein is abundantly present in third trimester human placentas, suggesting it may be implicated in maternal–fetal immune tolerance in humans.
Abstract: Objective. Galectin-1 is a major anti-inflammatory protein expressed by the placenta and immune cells that can bias the character of inflammatory responses toward the Th2 type. Galectin-1 is expressed in immune privileged sites, it can facilitate immune tolerance and tumor immune escape, and it has been successfully used for the suppression of experimental autoimmune diseases as well as graft-versus-host disease in murine models. We propose that an abnormal immune response in some pregnancy complications may be associated with changes in placental expression of galectin-1. To test this hypothesis, we studied placental galectin-1 mRNA and protein expression and localization in women with preeclampsia (PE) and in those who delivered a small-for-gestational age (SGA) neonate.Study design. This cross-sectional study included pregnant women matched for gestational age at delivery in the following groups: (1) severe PE (n = 10), (2) severe PE complicated with SGA (n = 10), (3) SGA without PE (n = 10), and (4) c...
TL;DR: Observations suggest that PGs increase prior to the onset of labor and contradict the claim that an increase in PG concentrations is the consequence of labor.
Abstract: Objectives. The role of prostaglandins (PGs) in the onset of human parturition has been controversial. Specifically, some investigators have proposed that PGs are the consequence rather than the cause of labor. An important question is whether or not amniotic fluid (AF) PG concentrations increase before the onset of labor in humans.Methods. The concentrations of PGs were determined in AF obtained from 167 singleton pregnant women with intact membranes. Patients were divided into four groups: (1) preterm not in labor (gestational age 15–36 weeks, n = 65); (2) term not in labor (n = 68); (3) spontaneous labor at term with cervical dilatation <4 cm (n = 25); (4) spontaneous labor at term with cervical dilatation ≥4 cm (n = 9). AF was obtained by transabdominal amniocentesis or collected at the time of cesarean delivery. All patients met the following criteria: (1) normal pregnancy outcome; (2) clear AF; (3) no significant medical or obstetric complications such as diabetes mellitus, preeclampsia, preterm bir...
TL;DR: The prevalence of postpartum depression among immigrant Pakistani women seems to be low compared with the prevalence reported in immigrant populations elsewhere, it was however only slightly lower than the study of ethnic Norwegians (8.9%).
Abstract: Objective. To assess the prevalence of and risk factors for postpartum depression among Pakistani women in Norway. Methods. A total of 207 pregnant Pakistani women living in Norway participated in a questionnaire study. The author interviewed the women face to face during pregnancy and 6 to 12 weeks after delivery. The Edinburgh postnatal depression scale was used to identify the risk cases. Results. Only 7.6% of the immigrant Pakistani women were depressed postpartum. High scores on the life event scale, a history of prior depression, single marital status, a poor relationship to one’s partner and an age of 30 years or more were found to be significant risk factors for postpartum depression. Conclusions. The prevalence of postpartum depression among immigrant Pakistani women seems to be low compared with the prevalence reported in immigrant populations elsewhere, it was however only slightly lower than the study of ethnic Norwegians (8.9%). The risk factors were similar to results from international reports; moreover, there were few cultural differences in risk factors between ethnic Norwegian and Pakistani immigrants.
TL;DR: A combination of techniques involving 2D chromatography, mass spectrometry, and immunoassays allows identification of proteins that are differentially regulated in the amniotic fluid of patients with preterm labor.
Abstract: Objective. Simultaneous analysis of the protein composition of biological fluids is now possible. Such an approach can be used to identify biological markers of disease and to understand the pathophysiology of disorders that have eluded classification, diagnosis, and treatment. The purpose of this study was to analyze the differences in protein composition of the amniotic fluid of patients in preterm labor.Study design. Amniotic fluid was obtained by amniocentesis from three groups of women with preterm labor and intact membranes: (1) women without intra-amniotic infection/inflammation (IAI) who delivered at term, (2) women without IAI who delivered a preterm neonate, and (3) women with IAI. Intra-amniotic infection was defined as a positive amniotic fluid culture for microorganisms. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin (IL)-6 (≥2.3 ng/mL). Two-dimensional (2D) chromatography was used for analysis. The first dimension separated proteins by isoelectric point, wh...
TL;DR: Proteomic analysis of amniotic fluid allowed the identification of mass spectrometry features, which can distinguish patients with preterm labor with IAI from those with pre term labor without inflammation or infection who subsequently delivered at term.
Abstract: Objective. Examination of the amniotic fluid proteome has been used to identify biomarkers for intra-amniotic inflammation as well as those that may be useful in predicting the outcome of preterm labor. The purpose of this study was to combine a novel computational method of pattern discovery with mass spectrometric proteomic profiling of amniotic fluid to discover biomarkers of intra-amniotic infection/inflammation (IAI).Methods. This cross-sectional study included patients with spontaneous preterm labor and intact membranes who delivered at term (n = 59) and those who delivered preterm with IAI (n = 60). Proteomic profiling was performed using surface-enhanced laser desorption/ionization (SELDI) mass spectrometry. A proteomic profile was acquired through multiple simultaneous SELDI conditions, which were combined in a single proteomic ‘fingerprint’ using a novel computational approach. Classification of patients based on their associated surface-enhanced laser desorption/ionization–time of flight (SELDI...
TL;DR: Patients with preeclampsia and those with SGA fetuses have lower median plasma concentrations of soluble Tie-2 than women with normal pregnancies, and Plasma sTie-2 concentrations in normal pregnancy changed significantly as a function of gestational age.
Abstract: Objective. An anti-angiogenic state has been described in patients with preeclampsia, small-for-gestational age (SGA) fetuses and fetal death, and changes in the concentration of circulating angiogenic and anti-angiogenic factors can precede the clinical recognition of preeclampsia and SGA by several weeks. Gene deletion studies demonstrate that a selective group of endothelial growth factors are required for vascular development, including members of the vascular endothelial growth factor (VEGF) family, as well as angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2), both ligands for the tyrosine kinase endothelial cell receptor Tie-2. These angiogenic factors have been proposed to promote angiogenesis in a coordinated and complementary fashion. Soluble Tie-2 (sTie-2) is the soluble form of the Tie-2 receptor, which is detectable in biological fluids. The purpose of this study was to determine whether patients with preeclampsia and mothers who deliver a SGA neonate have changes in the plasma concentrations ...
TL;DR: It is proposed that resistin may play a role in the innate immune response against intra-amniotic infection and change with gestational age, in the presence of labour, and in IAI in patients with spontaneous preterm labour and patients with clinical chorioamnionitis.
Abstract: Objective. Intra-amniotic infection/inflammation (IAI) is one of the most important mechanisms of disease in preterm birth. Resistin is an adipocytokine that has been linked to insulin resistance, diabetes, obesity and inflammation. The objective of this study was to determine if resistin is present in amniotic fluid (AF) and if its concentration changes with gestational age, in the presence of labour, and in IAI in patients with spontaneous preterm labour (PTL) and intact membranes, preterm prelabour rupture of membranes (PPROM) and clinical chorioamnionitis.Study design. This cross-sectional study included 648 patients in the following groups: (1) women in the mid-trimester of pregnancy (14–18 weeks) who underwent amniocentesis for genetic indications and delivered a normal neonate at term (n = 61); (2) normal pregnant women at term with (n = 49) and without (n = 50) spontaneous labour; (3) patients with an episode of PTL and intact membranes who were classified into: (a) PTL who delivered at term (n = ...
TL;DR: It is concluded that although microarray technology may represent a powerful tool in generating new hypothesis in complex fields, it may not be sensitive enough to detect subtle changes in gene expression.
Abstract: Objective. To compare the placental pathology associated with pre-eclampsia (PE) and/or fetal growth restriction, the transcriptomes of placental tissues from PE and small-for-gestational-age (SGA) pregnancies were explored. In addition, a targeted analysis of angiogenesis-regulating gene expression was performed. Methods. Whole-genome microarray analysis was performed on placental tissue from gestational age-matched PE (n ¼ 10), SGA (n ¼ 8) and PE þ SGA (n ¼ 10) pregnancies. The expression of genes regulating angiogenesis (endoglin (ENG), fmsrelated tyrosine kinase 1 (FLT1), vascular endothelial growth factor (VEGF) and placental growth factor (PlGF)) was analyzed by quantitative real time reverse transcriptase polymerase chain reaction (qRT-PCR). Results. Microarray analysis did not reveal any significant differences between groups. However, an increased expression of ENG and FLT1 was detected by qRT-PCR in the PE þ SGA group. Conclusions. The placental transcriptome did not differ between groups, although an increased anti-angiogenic gene expression in PE þ SGA was observed with qRT-PCR analysis. Based on this, we conclude that although microarray technology may represent a powerful tool in generating new hypothesis in complex fields, it may not be sensitive enough to detect subtle changes in gene expression.
TL;DR: The placement of an intrauterine pressure catheter during induction of labor with oxytocin in two cases, one presenting with a singleton pregnancy and the other a twin pregnancy, with a small risk for serious fetal complications is described.
Abstract: Background. Uterine contractions during labor can be monitored by external tocodynamometry or by the use of an intrauterine pressure catheter (IUPC). Since an IUPC measures the frequency of contrac...
TL;DR: The purpose of this paper is to review and analyze the published literature on the use of 3D and 4D ultrasound in the assessment of fetal behavior and to establish the standards of embryonic and fetal peripheral and body movements and facial expression.
Abstract: The development of three-dimensional (3D) and four-dimensional ultrasound (4D) has provided new opportunities to study fetal and even embryonic behavior. These techniques enable simultaneous spatial imaging of the entire fetus and its movements. Recently, multicenter studies of fetal brain function have been carried out, the aim of which is to establish the standards of embryonic and fetal peripheral and body movements and facial expression as additional diagnostic criteria for prenatal brain development. Additional studies have been conducted in order to provide more information on specific movement patterns and quality of movement in the high-risk fetus. The purpose of this paper is to review and analyze the published literature on the use of 3D and 4D ultrasound in the assessment of fetal behavior.
TL;DR: Although the role of immunoreactive plasma TF in coagulation remains controversial, the observations suggest that changes are present in the context of complications of pregnancy.
Abstract: Objective Tissue factor (TF), the major activator of the extrinsic pathway of coagulation, is abundant in the placenta and decidua The aim of this study was to determine the maternal plasma concentrations of TF and its primary inhibitor, tissue factor pathway inhibitor (TFPI), in women who delivered small for gestational age (SGA) neonates, and in pre-eclampsiaStudy design A cross-sectional study included the following groups: 1) women with normal pregnancies (n = 86); 2) patients who delivered SGA neonates (n = 61) and 3) women with pre-eclampsia (n = 133) Maternal plasma concentrations of TF and TFPI were measured by a sensitive immunoassay Non-parametric statistics were used for analysisResults 1) Women with pre-eclampsia had a significantly higher median plasma concentration of TF than patients with a normal pregnancy (median: 1187 pg/mL; range: 69–11675 vs median: 2915 pg/mL; range: 63–26622; p < 00001, respectively); 2) Similarly, TFPI concentrations were higher in pre-eclampsia than in
TL;DR: The ability of MPA to modulate the immune response may be a critical mechanism by which progestins prevent preterm birth, though the response is divergent by time and tissue studied.
Abstract: Objective. These studies sought to determine whether a progestational agent, specifically medroxyprogesterone acetate (MPA) prevents inflammation-induced preterm birth, in a mouse model, through modulation of the host immune response.Study design. Using an established mouse model of inflammation-induced preterm birth, the activation of the immune response in maternal serum, uterus, cervix and placenta was assessed. In addition, the ability of MPA to modulate this response was investigated. Message RNA and protein expression were assessed by quantitative PCR and ELISAs respectively.Results. Intrauterine inflammation promotes a significant up-regulation of both TH1 and TH2 mediators in all tissues studies though the response is divergent by time and tissue studied. MPA significantly differentially regulates this immune response in the uterus, cervix and placenta.Conclusions. In the setting of inflammation-induced preterm birth, the host immune response is activated and not limited to a traditional TH1 bias....
TL;DR: Maternal HMW was the most prevalent adiponectin multimer regardless of gestational age or BMI status and there were no significant differences in the median concentration of total, MMW, and LMW adip onectin and their relative distribution with advancing gestation.
Abstract: Objective. Adiponectin is an anti-diabetic, anti-atherogenic, anti-inflammatory, and angiogenic adipokine that circulates in oligomeric complexes including: low molecular weight (LMW) trimers, medium molecular weight (MMW) hexamers, and high molecular weight (HMW) isoforms. The aim of this study was to determine whether there are changes in adiponectin multimers in pregnancy and as a function of maternal weight.Study design. In this cross-sectional study, plasma concentrations of total, HMW, MMW, and LMW adiponectin were determined in women included in three groups: (1) normal pregnant women of normal body mass index (BMI) (n = 466), (2) overweight pregnant women (BMI ≥25; n = 257), and (3) non-pregnant women of normal weight (n = 40). Blood samples were collected once from each woman between 11 and 42 weeks of gestation. Plasma adiponectin multimer concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Non-parametric statistics were used for analysis.Results. (1) The median HMW adip...
TL;DR: Whether CXCL13 is present in maternal serum, umbilical cord blood, and amniotic fluid, and to determine if AF concentration changes with intra-amniotic infection/inflammation (IAI); and to localize the production of CXCl13 in chorioamniotic membranes and umbILical cord.
Abstract: Objectives. CXCL13 is a potent chemokine, produced by mature and recently recruited macrophages to sites of inflammation, which has antimicrobial and anti-angiogenic properties. The purpose of this study was to: (1) determine whether CXCL13 is present in maternal serum, umbilical cord blood, and amniotic fluid (AF); (2) to determine if AF concentration changes with intra-amniotic infection/inflammation (IAI); and (3) to localize the production of CXCL13 in chorioamniotic membranes and umbilical cord.Study design. A cross-sectional study on maternal serum was performed including patients in the following groups: (1) non-pregnant women (n = 20), (2) normal pregnant women (n = 49), (3) patients at term not in labor (n = 30), and (4) patients in spontaneous labor at term (n = 29). Umbilical cord blood was collected from term neonates with (n = 30) and without labor (n = 28). Amniotic fluid was obtained from patients in the following groups: (1) midtrimester (n = 65); (2) term not in labor (n = 22); (3) term i...
TL;DR: Normal placental weights have increased over the last decades and this may correlate with increasing maternal obesity, and further studies with larger populations are needed to confirm these findings.
Abstract: Objective. Reference values of normal placental weights are many decades old. Recently, a trend of increasing weights of normal placentas has been noted. We aimed to confirm this observation and to find any associated fetal and maternal factors.Methods. Information on all live singleton deliveries that met our inclusion criteria was collected for the years 1995 and 2004 at Creighton University Medical Center in Omaha, Nebraska. This information was compared to the standards set forth in the older references. The Student's t-test and correlation-regression statistics were applied.Results. The mean weight of the mature, term (37–42 weeks of gestation) placenta has increased significantly from 1995 to 2004 (499 g to 537 g, p = 0.02), as well as from the older standards (27% increase at 40 weeks of gestation). There has also been a significant increase in the maternal body mass index (BMI) from 1995 to 2004 (25.2 to 26.5, p = 0.02), which correlates with maternal weight gain during pregnancy, and fetal and pl...
TL;DR: Viability judgment and reported earliest age for routine intervention both differ by physician characteristics, and obstetrician-gynecologists' judgment of viability threshold is consistent with standard estimates of 24 weeks.
Abstract: Objectives. To assess obstetrician-gynecologists' judgments of gestational age of viability and earliest age of medical intervention for preterm delivery, and to associate these practice decisions with physician characteristics.Methods. Questionnaires were mailed to 1193 members of the American College of Obstetricians and Gynecologists (ACOG).Results. The response rate was 59%. The majority of respondents considered 24 weeks the earliest age a fetus is potentially viable (57%) and at which they would routinely perform cesarean section for fetal distress (58%). Those respondents who judged viability as 23 weeks or less were more likely to have been in practice for a shorter period (p < 0.05), be a maternal-fetal medicine specialist (p < 0.005), and be from southern or central states (p < 0.005). Similarly, those respondents who would not intervene for fetal distress until 26 weeks gestation were more likely to have been in practice for longer (p < 0.01), to have performed fewer deliveries (p < 0.05), to b...
TL;DR: Placentas from pregnancies complicated by preterm PE had a significantly higher frequency of strong PAR-1 expression than placenta from women with spontaneous preterm labor, which is consistent with a role forPAR-1 as a mediator of the effect of thrombin on coagulation and inflammation in PE.
Abstract: Objective. Preeclampsia (PE) is characterized by excessive thrombin generation, which has been implicated in the multiple organ damage associated with the disease. The biological effects of thrombin on coagulation and inflammation are mediated by protease-activated receptor-1 (PAR-1), a G protein-coupled receptor. The aim of this study was to determine whether preterm PE is associated with changes in placental expression of PAR-1.Study design. This cross-sectional study included two groups matched for gestational age at delivery: (1) patients with preterm PE (<37 weeks of gestation; n = 26) and (2) a control group of patients with preterm labor without intra-amniotic infection (n = 26). Placental tissue microarrays were immunostained for PAR-1. Immunoreactivity of PAR-1 in the villous trophoblasts was graded as negative, weak-positive, or strong-positive.Results. (1) The proportion of cases with strong PAR-1 immunoreactivity was significantly higher in placentas of patients with PE than in placentas from ...
TL;DR: Perinatal outcomes were similar between women treated with both types of insulin and improved glycemic control and lower total insulin requirements during pregnancy compared to those receiving regular insulin.
Abstract: Objective. To describe perinatal outcomes of women with pregestational diabetes treated with short-acting, regular insulin and the short-acting insulin analogue, lispro.Study design. This was a prospective observational study of women with pregestational diabetes maintained on short-acting insulin regimens over a 3-year period. Clinical characteristics, aspects of diabetic therapy, and perinatal/neonatal outcomes were collected.Results. Of 107 women, 49 were maintained on regular insulin and 58 utilized the insulin analogue, lispro. Frequency of type 1 diabetes, maternal age, overweight/obese pregravid body mass index (≥25 kg/m2), preexisting hypertension, and presence of vascular disease were similar between groups. Women treated with lispro had a longer duration of diabetes (11.4 vs. 8.3 years, p = 0.04). Glycemic control was improved in women managed with lispro compared to regular insulin (HgbA1c 5.9 vs. 6.7, p = 0.009). Total insulin requirements were lower in the lispro group in the first (0.58 vs. ...