Acute atherosis and oxidative stressin preeclampsia

Preeclampsia is complicating 3.5% of pregnancies in Norway, and is associated with increased mortality and morbidity for both mother and offspring. Deficient placentation with release of substances from the placenta to the maternal circulation is believed to cause hypertension and proteinuria, which are diagnostic of the disease. The uterine endometrium (decidua) contains blood vessels that are important for placental nutritional transport to the fetus. The walls of these spiral arteries often contain lipid depositions (acute atherosis), causing reduced blood flow to the placenta, hypoxia and oxidative stress. Gynecologist Nina Kittelsen Harsem demonstrated that a new method for collecting decidual tissue after delivery was better than traditional knife biopsies from the uterine endometrium, as more spiral arteries were collected for demonstration of lipid deposition in morphological investigations. The lipid depositions in the spiral artery walls were more frequent in women with preeclampsia than in women with normal pregnancies, but not all women with preeclampsia demonstrated these vascular changes. In addition, some few women with apparently healthy pregnancies also demonstrated similar evidence of arterial lipid deposition. Among circulating substances found in increased concentration in preeclampsia are oxidized lipids, including isoprostanes, which could result in a state of increased oxidative stress. In the preeclampsia group there was evidence of augmented oxidative stress in the maternal circulation. In the fetal umbilical cord blood there was not found any difference between preeclampsia and controls. She then explored whether there is an association between the lipid deposition in the spiral arterial wall and signs of augmented oxidative stress in maternal blood, but no such association were demonstrated. This study supports the concept that preeclampsia is a heterogeneous disease that does not affect all women, fetuses or placentas similarly

Cardiac morphology in neonates with fetal growth restriction

Objective: Assess effects of fetal growth restriction (FGR) on cardiac modelling in premature and term neonates. Study design: Prospective echocardiographic study of a cohort of FGR neonates (n = 21) and controls (n = 41) with normal prenatal growth and circulation. Results: Unadjusted for gestational age, birth weight, sex, and twin/singleton, Late-FGR neonates had smaller hearts than controls, with globular left ventricles and symmetrical right ventricles. Adjusted estimates showed smaller left ventricles and similarly sized right ventricles, with symmetrical left and right ventricles. Early-FGR (compared with Late-FGR) had smaller hearts and globular left ventricles in unadjusted estimates, but after adjustment, sizes and shapes were similar. Conclusion: FGR had significant impact on cardiac modelling, seen in both statistical models unadjusted and adjusted for gestational age, birth weight, sex, and twin/singleton. The adjustments, however, refined the results and revealed more specific effects of FGR, thus underscoring the importance of statistical adjustments in such studies.acceptedVersio