Selected trace elements concentrations in pregnancy and their possible role — literature review

The aim of this study was to review the role of selected trace elements in pregnancy and fetal development. Citations related to the role of iron (Fe), zinc (Zn), manganese (Mn), copper (Cu) and selenium (Se) during pregnancy were searched in PubMed, Medline, Web of Science, using keywords and MeSH terms. Inadequate supply of trace elements can cause abnormalities of fetal development and predispose a child to disorders later on in life. Trace elements are the key elements of complex enzymes responsible for the modulation of the antioxidant defense system of the organism. It has been suggested that there is a correlation between reduced levels of trace elements essential for antioxidant function in the body of pregnant women, and an increased risk of developing preeclampsia. Trace elements are components of numerous regulatory enzymes and hormones essential to the division and differentiation of fetal cells and their further development. Mineral deficiencies in pregnant women can cause birth defects of the central nervous system, and growth disorders. Future research should be directed to explain the interaction between trace elements, and establish the optimum levels of macro and micronutrients supplementation, as well as determine the reference values for trace elements in the maternal serum, umbilical cord blood and amniotic fluid

Seroprevalence of cytomegalovirus infection in the population of Polish pregnant women

Objectives: Human cytomegalovirus is a common etiological agent of infections and is the most common cause of intrauterine infections. Due to the scale and importance of infections during pregnancy, in this study we investigated the incidence of specific IgG and IgM antibodies directed against HCMV in population of Polish pregnant women. Material and Methods: The retrospective study included 1332 pregnant women who were hospitalized at the DFMMG in Lodz between 1999 and 2009. In this group, 117 women had serological features of acute cytomegalovirus infections (study group) and 51 women were seronegative for IgG, IgM and IgA antibodies (control group). HCMV infections in pregnant women were diagnosed by serological assays (IgG, IgM, IgA, IgG avidity) and clinical symptoms. Results: Seroprevalence of CMV IgG was estimated to be 76.7% (n=985). Anti-HCMV immunoglobulin M antibodies were detected in 13% of pregnant women (n = 179). Conclusions: There was no significant correlation between the prevalence of IgG and IgM antibodies and factors such as maternal age, parity, a number of births, place of residence and marital status

Ocena wrażliwości na wybrane leki przeciwgrzybicze szczepów grzybów wyizolowanych od kobiet ciężarnych z cukrzycą oraz zdrowych

Abstract Objectives: An increase in the frequency of fungal infections is related with progress in mycology and decreased susceptibility of fungal strains to commonly used antifungal agents. Diabetes and pregnancy are two independent factors believed to be responsible for an increased risk of mycoses. The aim: The aim of the study was to assess the susceptibility of fungal strains isolated from pregnant women with diabetes as well as healthy pregnant women to ten antifungal agents. Material and methods: In the study 106 diabetic pregnant women and 102 healthy pregnant women were included. Susceptibility of the fungal strains was assessed in vitro by disk diffusion test. Results: Fungal strains were detected in 190 (30.4%) out of 624 samples obtained from vagina, rectum and oral cavity of 208 women. Fungi were found in 42.1% of pregnant women with diabetes and in 41.5% of health pregnant patients. Strains isolated from the diabetic women showed the highest susceptibility to pimaricin (34.4%), nystatin (31.3%) and tioconazole (31.3%) while those from healthy pregnant women were mostly susceptible to itraconazole (59.6%) and miconazole (53.2%). The comparison of the susceptibility of fungi to antifungal agents revealed that the strains isolated form healthy women were significantly more susceptible to clotrimazole (p=0.003), itraconazole (pStreszczenie Wstęp: Obserwowany wzrost częstości zarażeń grzybami jest związany z postępem diagnostyki mikologicznej oraz ze zmniejszona wrażliwością szczepów grzybów na powszechnie używane leki przeciwgrzybicze. Cukrzyca i ciąża są rozpatrywane jako niezależne czynniki zwiększające ryzyko zarażeń grzybami. Cel pracy: Celem pracy była ocena wrażliwości szczepów grzybów, wyizolowanych od kobiet ciężarnych z cukrzycą i zdrowych, na dziesięć leków przeciwgrzybiczych. Materiały i metody: Badania przeprowadzono wśród 102 ciężarnych z cukrzycą oraz 106 losowo wybranych zdrowych ciężarnych. Oznaczenia wrażliwości grzybów na leki dokonano metodą dyfuzyjno-krążkową. Wyniki: Spośród 624 próbek pobranych z pochwy, odbytu i jamy ustnej od 208 kobiet, grzyby wykryto łącznie w 190 (30,4%) próbkach, w tym u 42,1% ciężarnych z cukrzycą oraz u 41,5% zdrowych ciężarnych. Szczepy wyizolowane od ciężarnych z cukrzycą wykazywały największą wrażliwość na pimarycynę (34,4%), nystatynę (31,3%) oraz tiokonazol (31,3%), natomiast szczepy izolowane od zdrowych ciężarnych były najbardziej wrażliwe na itrakonazol (59,6%) i mikonazol (53,2%). Porównanie stopnia wrażliwości szczepów na poszczególne leki w obu badanych grupach wykazało, że grzyby izolowane od zdrowych ciężarnych wykazywały większą wrażliwość na działanie klotrimazolu (p=0,003), itrakonazolu (

Successful treatment of fetal bilateral primary chylothorax – report of the two cases

Primary fetal chylothorax is an uncommon complication, associated with high perinatal morbidity and mortality. In our report, we describe two cases of fetal bilateral primary chylothorax successfully treated with pleuro-amniotic In both cases, ultrasound scans showed bilateral, hypoechoic fluid in the pleural space without any associated structural malformations and features of infection and aneuploidy. Laboratory analysis of pleural fluids revealed 79% and 92% of lymphocytes, respectively, confirming chylothorax in both fetuses. In the first case, pleuro-amniotic shunts were successfully inserted at 31 weeks and 6 days of gestation. Ultrasound scan after two weeks showed expansion of the left lung and lack of fluid in both pleural cavities. At 39 weeks of gestation, a 2660 g baby boy was delivered by cesarean section (Apgar score: 9). The child did not require surgical intervention and was discharged home on day 16 of life. In the second case, the insertion of shunts (at 24 weeks and 6 days of gestation) also significantly reduced the amount of the fluid in the pleural cavities, but one shunt had to be surgically removed after birth. At 30 weeks and 2 days of gestation, a cesarean section was performed due to maternal cholestasis. A female weighing 1400 g was delivered (Apgar score: 7). The chest X-ray revealed only a small amount of fluid in the left pleural cavity. The infant was discharged on postnatal day 26, in good condition and with body weight of 2150g. Pleuro-amniotic shunt insertion is a method of choice in the treatment of confirmed primary fetal chylothorax

Ocena związku poziomu wiremii HCMV u matki z przebiegiem ciąży i stanem urodzeniowym noworodków

Congenital cytomegaly is caused by intrauterine mother-to-fetus HCMV transmission and constitutes the most common vertical infection. Objectives: The aim of the study was to analyze the viremia level in maternal blood and its influence on the course and duration of pregnancy, as well as newborn condition. Material and methods: The material included blood samples collected from 117 pregnant women with serological features of HCMV infection and from 29 neonates hospitalized at DFMMG in Lodz between 1999 and 2009. The presence of HCMV DNA in the maternal and fetal blood was tested using real-time PCR. Results: Prevalence of maternal viremia was observed to increase the risk of viremia in neonates, as compared to children born to mothers with no viremia. However, lack of HCMV DNA in maternal blood does not exclude fetal infection in utero. Newborn condition assessed by Apgar scores was significantly lower in the group of infants born to mothers with serological features of acute cytomegaly (pWrodzona cytomegalia wywołana transmisją wirusa cytomegalii (HCMV) od matki do płodu, jest najczęstszym zakażeniem wertykalnym. Cel pracy: Celem pracy była ocena poziomu wiremii u kobiet ciężarnych i jej wpływu na przebieg i czas trwania ciąży oraz stan urodzeniowy noworodków. Materiał i metody: Materiałem do badań była krew pobrana od 117 ciężarnych z serologicznymi cechami zakażenia HCMV oraz 29 noworodków hospitalizowanych w Klinice Medycyny Matczyno-Płodowej i Ginekologii Instytutu Centrum Zdrowia Matki Polki w latach 1999-2009. Liczba kopii DNA HCMV we krwi matek i dzieci oznaczana była metodą PCR w czasie rzeczywistym (real-time PCR). Wyniki: Stwierdzono, że występowanie wiremii HCMV u matki zwiększa ryzyko występowania wiremii u noworodków w porównaniu z ryzykiem u dzieci matek bez wiremii, jednakże brak DNA HCMV we krwi matki nie wyklucza zakażenia płodu in utero. Stan urodzeniowy noworodków oceniany w skali Apgar był istotnie niższy w grupie noworodków urodzonych przez matki z serologicznymi cechami ostrej cytomegalii (

Częstość występowania zarażeń grzybami u kobiet ciężarnych i nieciężarnych z cukrzycą i bez cukrzycy

Abstract Diabetes and pregnancy are thought to be independent factors increasing the risk of fungal infections. Objectives: The aim of the study was to evaluate the occurrence of fungal infection of the vagina, rectum and oral cavity in pregnant and non-pregnant women with and without diabetes. Material and methods: 627 women were included in the study, among them healthy non-pregnant women (HN), healthy pregnant women (HP), pregnant women with diabetes (PD) and non-pregnant women with diabetes (ND). In total, 1881 samples obtained from the vagina, rectum and oral cavity were tested. For species identification API 20 C i API C AUX tests were used. Results: Fungi in at least one locus were detected in 62,4% of all women, among them in 69,8% of HN, 58,5% of HP, 62,5% of PD and 62,7% of ND. Strains were isolated from vaginal samples of HP (16%) less often than in HN (27%) (95% CI 0,29-0,85; OR=0,5); in ND (31%) and PD (25%) there were no differences in the occurrence of fungi in the vagina (95% CI 0,37-1,38; OR= 0,71). Similar rates of prevalence of fungi in rectum were found in HN (30%) and HP (23%) (95% CI 0,43-1,16; OR=0,7) as well as in ND (27%) and PD (24%) (95% CI 0,41-1,64; OR=0,82). Strains have been isolated from oral cavity of 57% of HN and 54% of HP (95% CI 0,58-1,42; OR=0,9) as well as from 55% ND and 59% of PD (95% CI 0,65-2,21; OR=1,2). Conclusions: Lower prevalence of fungi in the vagina of HP, in comparison to HN, suggests a protective effect of pregnancy on the risk of vaginal mycosis. Pregnancy and diabetes independently have no influence on the prevalence of fungi in oral cavity and rectum.Streszczenie Wstęp: Uważa się, że ciąża i cukrzyca mogą stanowić niezależne od siebie czynniki zwiększające ryzyko zarażenia grzybami, chociaż ich dokładny wpływ nie jest w pełni poznany. Cel pracy: Celem pracy była ocena częstości występowania zarażeń grzybami pochwy, jamy ustnej i odbytu u kobiet ciężarnych i nieciężarnych z cukrzycą i bez cukrzycy. Materiał i metody: Badaniami objęto łącznie 627 kobiet, w tym zdrowe nieciężarne (ZN), zdrowe ciężarne (ZC), ciężarne z cukrzycą (CC) oraz nieciężarne z cukrzycą (NC). Materiał do badań stanowiło 1881 próbek pobranych z pochwy, odbytu i jamy ustnej. Identyfikację gatunków grzybów wykonano za pomocą testów API 20 C i API C AUX. Wyniki: Grzyby w przynajmniej jednej ontocenozie wykryto u 61,6% badanych, w tym u 67,2% ZN, 57,8% ZC, 62,5% CC i u 62,7% NC. Grzyby w pochwie stwierdzano istotnie rzadziej w grupie ZC (16%), niż u ZN (27%) (95% CI 0,29-0,85; OR=0,5); u NC (31%) i CC (25%) nie było istotnych różnic w częstości (95% CI 0,37-1,38; OR= 0,71). Zbliżoną częstość występowania grzybów w odbycie wykazano u ZN (30%) i ZC (23%) (95% CI 0,43-1,16; OR=0,7) oraz NC (27%) i CC (24%) (95% CI 0,41-1,64; OR=0,82). Grzyby w jamie ustnej wyizolowano u 57% ZN i 54% ZC (95% CI 0,58-1,42; OR=0,9) oraz u 55% NC i 59% CC (95% CI 0,65-2,21; OR=1,2). Wnioski: Rzadsze występowanie grzybów w ontocenozie pochwy kobiet w ciąży w porównaniu do kobiet nieciężarnych z cukrzycą i bez cukrzycy sugeruje ochronne działanie ciąży. Ciąża i cukrzyca niezależnie nie wpływają na prewalencję grzybów w jamie ustnej i odbycie

TLR9 2848 GA heterozygotic status possibly predisposes fetuses and newborns to congenital infection with human cytomegalovirus.

Some single nucleotide polymorphisms (SNP), located in Toll-like receptor (TLR) genes, were reported to be associated with human cytomegalovirus (HCMV) infections. The study was aimed to assess the correlation of SNPs at TLR4 and TLR9 genes with the occurrence of congenital cytomegaly, based on available samples.Reported case-control study included both HCMV infected and non-infected fetuses and newborns. The specimens were classified to the molecular analyses, based on serological features of the recent infection and HCMV DNAemia in body fluids. TLR SNPs were studied, using multiplex nested PCR-RFLP assay, and determined genotypes were confirmed by sequencing. Hardy-Weinberg equilibrium was assessed for the identified genotypes. The linkage disequilibrium was also estimated for TLR4 SNPs. A relationship between the status of TLR genotypes and congenital cytomegaly development was estimated, using a logistic regression model.Hardy Weinberg equilibrium was observed for almost all SNPs, both infected and non-infected patients, with exception of TLR4 896 A>G polymorphism in the control group (P≤0.050). TLR4 896 A>G and 1196 C>T SNPs were found in linkage disequilibrium in both study groups (P≤0.050). The CC genotype at TLR4 1196 SNP and the GA variant at TLR9 2848 G>A SNP were significantly associated with HCMV infection (P≤0.050). The risk of congenital cytomegaly was higher in heterozygotes at TLR9 SNP than in the carriers of other genotypic variants at the reported locus (OR 4.81; P≤0.050). The GC haplotype at TLR4 SNPs and GCA variants at TLR4 and TLR9 SNPs were significantly associated with HCMV infection (P≤0.0001). The ACA variants were more frequent among fetuses and neonates with symptomatic, rather than asymptomatic cytomegaly (P≤0.0001).TLR4 and TLR9 polymorphisms may contribute to the development of congenital infection with HCMV in fetuses and neonates. The TLR9 2848 GA heterozygotic status possibly predisposes to HCMV infection, increasing the risk of congenital cytomegaly development

Oxidative Stress in Women Treated with Atosiban for Impending Preterm Birth

Preterm birth is defined as delivery before 37 completed weeks of pregnancy, and it is the leading cause of neonatal morbidity and mortality. Oxidative stress is recognized as an important factor in the pathogenesis of premature labor. We conducted this analysis to investigate the safety of administration of the tocolytic drug Atosiban—a reversible, competitive antagonist of the oxytocin receptor in the treatment of preterm birth and its impact on the level of oxidative stress in pregnant women after 48 hours of tocolytic treatment. This prospective study was conducted between March 2016 and August 2017 at the Obstetric Clinic of the Polish Mother’s Memorial Hospital Research Institute. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) values as well as 3-nitrotyrosine, carbonyl, and thiol group levels were measured using an ELISA test in serum and plasma of 56 pregnant women before and after 48 hours of continuous administration of Atosiban. We found that TAS levels decreased almost twice after the 48-hour drug administration (0.936 ± 0.360 mmol/L vs. 0.582 ± 0.305 mmol/L, P<0.001) while TOS increased from 18.217 ± 16.093 μmol/L to 30.442 ± 30.578 μmol/L (P<0.001). We also found a significant increase in OSI index—almost a threefold increase from 0.022 ± 0.022 to 0.075 ± 0.085, P<0.001. In addition, statistically significant differences in the level of carbonyl groups were found. It increased from 65.358 ± 31.332 μmol/L to 97.982 ± 38.047 μmol/L (P<0.001), which indicates increased oxidation of plasma proteins. Furthermore, patients who gave birth prematurely had higher levels of TOS after a 48-hour drug administration than the second group with labor after 37 weeks of pregnancy (42.803 ± 34.683 μmol/L vs. 25.792 ± 27.821 μmol/L, P<0.031). The obtained results clearly indicate that pregnant women during tocolytic treatment with Atosiban are in a state of increased oxidative stress and occurrence of preterm birth can be associated with this phenomenon. This trial is registered with NCT03570294