Insulin-Like Growth Factor (IGF)-I and Insulin in Normal and Growth-Restricted Mother/Infant Pairs

Insulin-like growth factor (IGF)-I and insulin are essential for fetal growth. We investigated perinatal changes of both factors in 40 mothers and their 20 appropriate-for-gestational-age (AGA) and 20 intrauterine-growth-restricted (IUGR) fetuses and neonates on day 1 (N1) and day 4 (N4) postpartum. Fetal and N1, but not N4, IGF-I levels were increased in AGA (P < .001 and P = .037, resp.). N1 insulin levels were lower in IUGR (P = .048). Maternal, fetal, and N1 IGF-I, and fetal insulin levels positively correlated with customized centiles (r = .374, P = .035, r = .608, P < .001, r = .485, P = .006, and r = .654, P = .021, resp.). Female infants presented elevated fetal and N4 IGF-I levels (P = .023 and P = .016, resp.). Positive correlations of maternal, fetal, and neonatal IGF-I levels, and fetal insulin levels with customized centiles underline implication of both hormones in fetal growth. IUGR infants present gradually increasing IGF-I levels. Higher IGF-I levels are documented in females

Perinatal Plasma Monocyte Chemotactic Protein-1 Concentrations in Intrauterine Growth Restriction

Monocyte-chemotactic-protein-1 (MCP-1) plays vital roles in immune response, angiogenesis, and pregnancy outcome. We investigated plasma MCP-1 concentrations in 40 mothers and their 20 intrauterine-growth-restricted (IUGR) and 20 appropriate-for-gestational-age (AGA) fetuses and neonates on postnatal days 1 (N1) and 4 (N4). Maternal and fetal MCP-1 concentrations were decreased (P<001 and P = .018, resp.), whereas N1 MCP-1 concentrations were elevated in IUGR group (P = .012). In both groups, fetal MCP-1 concentrations were lower compared to N1 and N4 ones (P = .045, P = .012, resp., for AGA, P < .001 in each case for IUGR). Reduced maternal and fetal MCP-1 concentrations in IUGR may reflect failure of trophoblast invasion, suggesting that down-regulation of MCP-1 may be involved in the pathogenesis of IUGR. Increased MCP-1 concentrations in IUGR neonates and higher postnatal ones in all infants may be attributed to gradual initiation of ex utero angiogenesis, which is possibly enhanced in IUGR

Vascular Endothelial Growth Factor and Placenta Growth Factor in Intrauterine Growth-Restricted Fetuses and Neonates

The angiogenic factors vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF) are respectively up- and downregulated by hypoxia. We aimed to study circulating levels of the above factors in intrauterine growth restriction (IUGR) and to correlate their levels with the customized centiles of the infants. The study included 25 IUGR and 25 appropriate for gestational age (AGA) full-term, singleton infants and their mothers. Maternal (MS), fetal (UC), and neonatal day 1 (N1) and 4 (N4) blood was examined. MS and N1 PlGF, as well as UC VEGF levels correlated with the customized centiles of the infants (r = 0.39, P = .007, r = 0.34, P = .01, and r = −0.41, P = .004, resp). Furthermore, UC, N1, and N4 VEGF levels were higher in girls (r = 0.36, P = .01, r = 0.33, P = .02, and r = 0.41, P = .005 resp). In conclusion, positive and negative correlations of examined factors with the customized centiles of the infant could rely on placental function and intrauterine oxygen concentrations—both being usually lower in IUGR cases—while higher VEGF levels in girls should possibly be attributed to the stimulating action of estrogens

Blood visfatin concentrations in normal full-term pregnancies

Aim: To prospectively investigate blood visfatin concentrations during the perinatal period in normal pregnancies. Methods: Visfatin concentrations were determined in maternal, umbilical cord (representing the foetal state) and neonatal blood on day 1 (N1) and 4 (N4). Results: Maternal and foetal visfatin concentrations were similar (18.83 +/- 4.27 and 19.35 +/- 4.90 ng/mL, respectively). There were significant correlations between maternal and foetal (r = 0.742, p &lt; 0.001), as well as between N1 and N4 (r = 0.487, p = 0.029) visfatin concentrations. Foetal concentrations were significantly elevated compared to N1 (p = 0.032). There was no difference between N1 and N4 concentrations. However, there was a correlation between birth weight and neonatal visfatin concentrations: there was a mean increase in N1 and N4 visfatin concentrations by 0.221 ng/mL and 0.292 ng/mL, respectively, for every unit increase in customized centile (adjusted birth weight) (p = 0.021 and p = 0.005, respectively). No association was found between serum visfatin concentrations and gender, parity or mode of delivery. Conclusions: Expression in foetal membranes and placental transfer could be responsible for higher blood visfatin concentrations during intrauterine life. Customized centiles seem to be independent predictor variables for postnatal visfatin concentrations. This finding could be attributed to the production of visfatin in adipose tissue, a main contributor to birth weight and consequently to customized centiles

Alpha-Methyldopa-Induced Autoimmune Hemolytic Anemia in the Third Trimester of Pregnancy

Alpha-methyldopa has been demonstrated to be safe for use during pregnancy and is now used to treat gestational hypertension. In pregnancy, alpha-methyldopa-induced autoimmune hemolytic anemia does not have typical features and the severity of symptoms ranges from mild fatigue to dyspnea, respiratory failure, and death if left untreated. A case of alpha-methyldopa-induced autoimmune hemolytic anemia in a 36-year-old gravida 2, para 1 woman at 37+6 weeks of gestation is reported herein along with the differential diagnostic procedure and the potential risks to the mother and the fetus

Synchronous rectal and colon cancer caused by familial polyposis coli during pregnancy

The management of colon and rectal cancer during pregnancy is controversial and challenging. Rectal or colon cancer during pregnancy is a very rare event. A 29-year-old woman, pregnant with her second child, was diagnosed with rectal cancer causing bowel obstruction and synchronous colon cancer during the 27th week of gestation. Both cancers occurred as a result of familial polyposis. This is the first case of synchronous rectal and colon cancer caused by familial polyposis during pregnancy reported in the published literature. We discuss the therapeutic interventions and the surgical management of the cancer in relation to the gestation

Successful full-term pregnancy in a woman with Cogan&apos;s syndrome: a case report

Cogan’s syndrome (CS) is a chronic inflammatory disorder that most commonly affects young adults. Major clinical features are interstitial keratitis and vestibuloauditory dysfunction. Associations between CS and systemic vasculitis as well as aortitis also exist. The present report is the first case in the literature of pregnancy associated with Cogan syndrome, which posed a therapeutic challenge. There was a relapse of the ocular symptoms only during the first trimester of pregnancy, but the pregnancy was otherwise uneventful. The relevant literature is reviewed both with regard to the relationship of CS to pregnancy and the therapeutic approach in this situation

Clara Cell Protein in Full-Term Pregnancies: The Influence of Intrauterine Growth Restriction

Background: Clara cell protein (CC16) is an immunomodulatory/anti-inflammatory broncho-alveolar-derived molecule and a biomarker of pulmonary epithelial cells maturity and alveolo-capillary membrane injury. Intrauterine growth-restricted (IUGR) neonates may present with structural lung immaturity, impaired immunocompetence and increased risk for respiratory infections and chronic obstructive lung disease in later life. Objectives: To investigate circulating CC16 concentrations in maternal, fetal, and neonatal samples from IUGR and appropriate for gestational age (AGA) pregnancies. Methods: Serum CC16 concentrations were determined by EIA in 40 mothers and their 20 IUGR and 20 AGA singleton full-term fetuses neonates on postnatal days 1 (N1) and 4 (N4). Results: No significant differences in CC16 concentrations were observed between IUGR and AGA groups. In both groups, maternal CC16 concentrations were lower compared to N1 and N4 ones (P &lt; 0.001 in each case). Fetal CC16 concentrations were significantly lower compared to N1 and N4 ones (P &lt; 0.001 in each case). In the AGA group, N1 CC16 concentrations were significantly higher than N4 ones (P &lt; 0.001). Combining groups, N1 CC16 concentrations positively correlated with gestational age (r = 0.364, P = 0.021). Finally, the effect of gender, parity, and maternal age on CC16 concentrations was not significant. Conclusions: The lack of differences in CC16 concentrations between IUGR and AGA groups possibly suggests that the lung immaturity and later respiratory diseases, associated with the former, may not be related to early CC16 deficiency. CC16 concentrations increase with advancing gestational age and peak on the first day of life, possibly indicating a vital role of the protein in fetal lung maturation and extrauterine pulmonary adaptation. Pediatr Pulmonol. 2010; 00:1186-1191. (C) 2010 Wiley-Liss, Inc