Effect of maternal hydration on the increase of amniotic fluid index

The objective of this study was to determine the effect of maternal hydration with oral isotonic solution and water on the amniotic fluid (AF) index of women with normohydramnios. Women with a normal AF index and gestational age between 33 and 36 weeks without maternal complications were randomized into three groups [isotonic solution (Gatorade®), water, control]. The isotonic solution and water groups were instructed to drink 1.5 L of the respective solution and the control group was instructed to drink 200 mL water over a period of 2 to 4 h. AF index was measured before and after hydration by Doppler ultrasonography. The investigator performing the AF index measurement was blind to the subject’s group. Ninety-nine women completed the study without any adverse maternal effects. The median increase in AF index after hydration was significantly greater for the isotonic solution and water groups than for the control group. There was no significant difference between the isotonic solution and water groups. Hydration with isotonic solution and water caused a 10-fold (95%CI: 2.09-49.89) and 6-fold (95%CI: 1.16-30.95) increase in the chance of a 20% increase of AF index, respectively. Maternal hydration with isotonic solution or water increased the AF index in women with normohydramnios

Plasma concentrations and placental immunostaining of interleukin-10 and tumornecrosis factor-α as predictors of alterations in the embryo-fetal organism and the placental development of diabetic rats

Interleukin-10 (IL-10) appears to be the key cytokine for the maintenance of pregnancy and inhibits the secretion of inflammatory cytokines such as tumor necrosis factor-α (TNF-α). However, there are no studies evaluating the profile of these cytokines in diabetic rat models. Thus, our aim was to analyze IL-10 and TNF-α immunostaining in placental tissue and their respective concentrations in maternal plasma during pregnancy in diabetic rats in order to determine whether these cytokines can be used as predictors of alterations in the embryo-fetal organism and in placental development. These parameters were evaluated in non-diabetic (control; N = 15) and Wistar rats with streptozotocin (STZ)-induced diabetes (N = 15). At term, the dams (100 days of life) were killed under anesthesia and plasma and placental samples were collected for IL-10 and TNF-α determinations by ELISA and immunohistochemistry, respectively. The reproductive performance was analyzed. Plasma IL-10 concentrations were reduced in STZ rats compared to controls (7.6 ± 4.5 vs 20.9 ± 8.1 pg/mL). The placental scores of immunostaining intensity did not differ between groups (P > 0.05). Prevalence analysis showed that the IL-10 expression followed TNF-α expression, showing a balance between them. STZ rats also presented impaired reproductive performance and reduced plasma IL-10 levels related to damage during early embryonic development. However, the increased placental IL-10 as a compensatory mechanism for the deficit of maternal regulation permitted embryo development. Therefore, the data suggest that IL-10 can be used as a predictor of changes in the embryo-fetal organism and in placental development in pregnant diabetic rats

Plasma concentrations and placental immunostaining of interleukin-10 and tumornecrosis factor-α as predictors of alterations in the embryo-fetal organism and the placental development of diabetic rats

Interleukin-10 (IL-10) appears to be the key cytokine for the maintenance of pregnancy and inhibits the secretion of inflammatory cytokines such as tumor necrosis factor-α (TNF-α). However, there are no studies evaluating the profile of these cytokines in diabetic rat models. Thus, our aim was to analyze IL-10 and TNF-α immunostaining in placental tissue and their respective concentrations in maternal plasma during pregnancy in diabetic rats in order to determine whether these cytokines can be used as predictors of alterations in the embryo-fetal organism and in placental development. These parameters were evaluated in non-diabetic (control; N = 15) and Wistar rats with streptozotocin (STZ)-induced diabetes (N = 15). At term, the dams (100 days of life) were killed under anesthesia and plasma and placental samples were collected for IL-10 and TNF-α determinations by ELISA and immunohistochemistry, respectively. The reproductive performance was analyzed. Plasma IL-10 concentrations were reduced in STZ rats compared to controls (7.6 ± 4.5 vs 20.9 ± 8.1 pg/mL). The placental scores of immunostaining intensity did not differ between groups (P > 0.05). Prevalence analysis showed that the IL-10 expression followed TNF-α expression, showing a balance between them. STZ rats also presented impaired reproductive performance and reduced plasma IL-10 levels related to damage during early embryonic development. However, the increased placental IL-10 as a compensatory mechanism for the deficit of maternal regulation permitted embryo development. Therefore, the data suggest that IL-10 can be used as a predictor of changes in the embryo-fetal organism and in placental development in pregnant diabetic rats

Levels Of Selected Persistent Organic Pollutants In Blood From Delivering Women In Seven Selected Areas Of São Paulo State, Brazil

Persistent organic pollutants (POPs) present in the living environment are thought to have detrimental health effects on the population, with pregnant women and the developing foetus being at highest risk. We report on the levels of selected POPs in maternal blood of 155 delivering women residing in seven regions within the São Paulo State, Brazil.The following selected POPs were measured in the maternal whole blood: 12 polychlorinated biphenyls (PCBs) congeners (IUPAC Nos. 99, 101, 118, 138, 153, 156, 163, 170, 180, 183, 187, 194); dichlordiphenyltrichloroethane p,p'-DDT, diphenyldichloroethylene p,p'-DDE and other pesticides such as hexachlorocyclohexanes (α-HCH, β-HCH, γ-HCH), hexachlorobenzene (HCB), chlordane derivatives cis-chlordane, trans-chlordane, oxy-chlordane, cis-nonachlor and trans-nonachlor.Statistical comparisons between regions were performed only on compounds having concentrations above LOD in 70% of the samples. PCB118 congener was found to be highest in the industrial site (mean 4.97. ng/g lipids); PCB138 congener concentration was highest in the Urban 3 site (mean 4.27. ng/g lipids) and congener PCB153 was highest in the industrial and Urban 3 sites with mean concentration of 7.2. ng/g lipids and 5.89. ng/g lipids respectively. Large differences in levels of p,p'-DDE between regions were observed with the Urban 3 and industrial sites having the highest concentrations of 645. ng/g lipids and 417. ng/g lipids, respectively; β-HCH was found to be highest in the Rural 1 site; the γ-HCH in Rural 1 and industrial; the HCB in the Rural 1 and industrial sites and oxy-chlordane and t-NC in the Rural 2 sites. 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Toxic And Essential Elements In Blood From Delivering Women In Selected Areas Of São Paulo State, Brazil

This study was designed to evaluate the degree of environmental contamination and possible exposure of pregnant women to toxic elements in seven selected areas of São Paulo State, Brazil. The overall median concentration of Mo in maternal blood was 0.53 μg L -1, highly significant differences found between sites (p < 0.0001). Cd was found to be low overall - 0.09 μg L -1 (0.01-0.58 μg L -1) - with mothers from the Coastal and Rural 1 sites having the highest levels (p < 0.016). Median Hg concentration was 0.60 μg L -1 (0.06 μg L -1-4.35 μg L -1); median Pb level was 16.2 μg L -1 (3.5-57.7 μg L -1) and no differences between sites were observed for both metals. Median Mn level was 16.7 μg L -1 (7.0-39.7 μg L -1), being highest in Urban 2 site (p<0.016). Concentrations of maternal Co were found to range between 0.06 μg L -1 and 1.1 μg L -1 (median 0.25 μg L -1) and As level was 0.60 μg L -1 (0.10-3.8 μg L -1) overall, with no statistical significance between sites for Co and As. Median Se concentrations were found to be 64 μg L -1 (36-233 μg L -1), with the highest median levels found in Urban 3 site; site differences were statistically significant (p < 0.0001). Correlation for each element (between paired maternal and cord blood) was measured only in Rural site 1; significant correlation was shown for Hg, Pb, Mn and Co (p<0.05). These findings may be interpreted as indicating low environmental contamination in São Paulo State, Brazil. These findings could also indicate that pregnant women have little or no contact with pollutants, possibly due to awareness campaigns carried out by public health practitioners. © 2011 The Royal Society of Chemistry.133563571Jarup, L., (2003) Br. Med. Bull., 68, pp. 167-182Mathee, A., Röllin, H., Von Schirnding, Y., Levin, J., Naik, I., (2006) Environ. Res., 100, pp. 319-322Odland, J.O., Nieboer, E., Romanova, N., Thomassen, Y., (2004) Int. J. 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Health, 22, pp. 383-39

Morphological changes in rat rectus abdominis muscle induced by diabetes and pregnancy

The urethral muscle of diabetic pregnant rats is affected by long-term mild diabetes and short-term severe diabetes, which plays a crucial role in the pathogenesis of pelvic floor disorders. We hypothesized that muscles outside the pelvis are subject to similar changes. The current study aimed at analyzing the effects of long-term mild and short-term severe diabetes on the structure and ultrastructure of fiber muscles and collagen in rats' rectus abdominis (RA) muscle. Therefore, the RA muscle of virgin, pregnant, long-term mild diabetic, short-term severe diabetic, long-term mild diabetic pregnant and short-term severe diabetic pregnant 3-month-old Wistar rats were collected. The structure was analyzed by picrosirius red staining, immunohistochemistry for fast and slow muscle fibers and transmission electron microscopy. We investigated two levels of STZ- induced diabetes: long-term mild diabetes (blood glucose level: 120–200 mg/dL) and short-term severe diabetes (blood glucose level >300 mg/dL). Long-term mild diabetic pregnant and short-term severe diabetic pregnant rats had decreased fast fibers and increased slow fibers, disrupted areas of sarcomere, intermyofibrillar mitochondria and myelin figures in the RA muscle. Both groups enabled us to analyze the specific influence of pregnancy, separately from diabetes. The current study demonstrated that diabetes and pregnancy induced intramuscular transformation and reorganization of RA muscle with a switch of fiber type adjusting their architecture according to intensity and duration of hyperglycemic insult within pregnancy

The Impact Of Prior Preeclampsia On The Risk Of Superimposed Preeclampsia And Other Adverse Pregnancy Outcomes In Patients With Chronic Hypertension

Objective: We sought to compare the rates of superimposed preeclampsia and adverse outcomes in women with chronic hypertension with or without prior preeclampsia. Study Design: We conducted secondary analysis of 369 women with chronic hypertension (104 with prior preeclampsia) enrolled at 12-19 weeks as part of a multisite trial of antioxidants to prevent preeclampsia (no reduction was found). Outcome measures were rates of superimposed preeclampsia and other adverse perinatal outcomes. Results: Prepregnancy body mass index, blood pressure, and smoking status at enrollment were similar between groups. The rates of superimposed preeclampsia (17.3% vs 17.7%), abruptio placentae (1.0% vs 3.1%), perinatal death (6.7% vs 8.7%), and small for gestational age (18.4% vs 14.3%) were similar between groups, but preterm delivery <37 weeks was higher in the prior preeclampsia group (36.9% vs 27.1%; adjusted risk ratio, 1.46; 95% confidence interval, 1.052.03; P = .032). Conclusion: In women with chronic hypertension, a history of preeclampsia does not increase the rate of superimposed preeclampsia, but is associated with an increased rate of delivery at <37 weeks. © 2011 Published by Mosby, Inc.2044345.e1345.e6Sibai, B.M., Chronic hypertension in pregnancy (2002) Obstetrics and Gynecology, 100 (2), pp. 369-377. , DOI 10.1016/S0029-7844(02)02128-2, PII S0029784402021282Powrie, R.O., A 30-year-old woman with chronic hypertension trying to conceive (2007) Journal of the American Medical Association, 298 (13), pp. 1548-1558. , http://jama.ama-assn.org/cgi/reprint/298/13/1548, DOI 10.1001/jama.298.13.1548Rey, E., Couturier, A., The prognosis of pregnancy in women with chronic hypertension (1994) American Journal of Obstetrics and Gynecology, 171 (2), pp. 410-416McCowan, L.M.E., Buist, R.G., North, R.A., Gamble, G., Perinatal morbidity in chronic hypertension (1996) British Journal of Obstetrics and Gynaecology, 103 (2), pp. 123-129Giannubilo, S.R., Dell'Uomo, B., Tranquilli, A.L., Perinatal outcomes, blood pressure patterns and risk assessment of superimposed preeclampsia in mild chronic hypertensive pregnancy (2006) Eur J Obstet Gynecol Reprod Biol, 126, pp. 63-67Ananth, C.V., Peltier, M.R., Kinzler, W.L., Smulian, J.C., Vintzelieas, A.M., Chronic hypertension and risk of placental abruption: Is the association modified by ischemic placental disease? (2007) Am J Obstet Gynecol, 197, pp. 273e1-273e7Sibai, B.M., Lindheimer, M., Hauth, J., Caritis, S., Vandorsten, P., Klebanoff, M., Macpherson, C., McNellis, D., Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension (1998) New England Journal of Medicine, 339 (10), pp. 667-671. , DOI 10.1056/NEJM199809033391004Chappell, L.C., Enye, S., Seed, P., Briley, A.L., Poston, L., Shennan, A.H., Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: A prospective study (2008) Hypertension, 51, pp. 1-8Barton, J.R., Sibai, B.M., Prediction and prevention of recurrent preeclampsia (2008) Obstet Gynecol, 112, pp. 359-372England, L., Zhan, J., Smoking and risk of preeclampsia: A systematic review (2007) Front Biosci, 12, pp. 2471-2483Spinnato II, J.A., Freire, S., Pinto E Silva, J.L., Cunha Rudge, M.V., Martins-Costa, S., Koch, M.A., Goco, N., Sibai, B.M., Antioxidant therapy to prevent preeclampsia: A randomized controlled trial (2007) Obstetrics and Gynecology, 110 (6), pp. 1311-1318. , DOI 10.1097/01.AOG.0000289576.43441.1f, PII 0000625020071200000017Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States National reference for fetal growth (1996) Obstetrics and Gynecology, 87 (I2), pp. 163-168. , DOI 10.1016/0029-7844(95)00386-XKuritz, S.J., Landis, J.R., Koch, G.G., A general overview of Mantel-Haenszel methods: Applications and recent developments (1988) Annual Review of Public Health, 9, pp. 123-160Hosmer, D.W., Lemeshow, S., (2000) Applied Logistic Regression, , 2nd ed. John Wiley & Sons Inc New Yor

Serum Inhibin A And Angiogenic Factor Levels In Pregnancies With Previous Preeclampsia And/or Chronic Hypertension: Are They Useful Markers For Prediction Of Subsequent Preeclampsia?

Objective: Our objective was to determine whether measurement of placenta growth factor (PLGF), inhibin A, or soluble fms-like tyrosine kinase-1 (sFlt-1) at 2 times during pregnancy would usefully predict subsequent preeclampsia (PE) in women at high risk. Study Design: We analyzed serum obtained at enrollment (120/7 to 196/7 weeks) and follow-up (24-28 weeks) from 704 patients with previous PE and/or chronic hypertension (CHTN) enrolled in a randomized trial for the prevention of PE. Logistic regression analysis assessed the association of log-transformed markers with subsequent PE; receiver operating characteristic analysis assessed predictive value. Results: One hundred four developed preeclampsia: 27 at 37 weeks or longer and 77 at less than 37 weeks (9 at less than 27 weeks). None of the markers was associated with PE at 37 weeks or longer. Significant associations were observed between PE at less than 37 weeks and reduced PLGF levels at baseline (P = .022) and follow-up (P &lt; .0001) and elevated inhibin A (P &lt; .0001) and sFlt-1 (P = .0002) levels at follow-up; at 75% specificity, sensitivities ranged from 38% to 52%. Using changes in markers from baseline to follow-up, sensitivities were 52-55%. Associations were observed between baseline markers and PE less than 27 weeks (P ≤ .0004 for all); sensitivities were 67-89%, but positive predictive values (PPVs) were only 3.4-4.5%. Conclusion: Inhibin A and circulating angiogenic factors levels obtained at 120/7 to 196/7 weeks have significant associations with onset of PE at less than 27 weeks, as do levels obtained at 24-28 weeks with onset of PE at less than 37 weeks. However, because the corresponding sensitivities and/or PPVs were low, these markers might not be clinically useful to predict PE in women with previous PE and/or CHTN. © 2008 Mosby, Inc. All rights reserved.1993268.e1268.e9Sibai, B.M., Diagnosis and management of gestational hypertension and preeclampsia (2003) Obstet Gynecol, 102, pp. 181-192Poston, L., Briley, A.L., Seed, P.T., Kelly, F.J., Shennan, A.H., Vitamins in preeclampsia (VIP) trial consortium. Vitamin C and vitamin E in pregnant women at risk for preeclampsia (VIP trial): randomized placebo-controlled trial (2006) Lancet, 367, pp. 1145-1154Spinnato, J.P., Friere, S., e Silva, J.L.P., Antioxidant therapy to prevent preeclampsia: A randomized controlled trial (2007) Obstet Gynecol, 110, pp. 1311-1318Conde-Agudelo, A., Villar, J., Lindheimer, M., World Health Organization systematic review of screening tests for preeclampsia (2004) Obstet Gynecol, 104, pp. 1367-1391Flario, P., Reis, F.M., Pezzani, I., Luisi, S., Severi, F.M., Petraglia, F., The addition of activin A and inhibin A measurement to uterine artery Doppler velocimetry to improve early prediction pre-eclampsia (2003) Ultrasound Obstet Gynecol, 21, pp. 165-169Spencer, K., Yu, C.K.H., Savvidou, N., Papageorghiou, A.T., Nicolaides, K.H., Prediction of pre-eclampsia by uterine artery Doppler ultrasonography and maternal serum pregnancy-associated plasma protein-A, free B-human chorionic gonadotropin, activin A and inhibin A at 22+0 to 24+6 weeks' gestation (2006) Ultrasound Obstet Gynecol, 27, pp. 658-663Chaiworapongsa, T., Romero, R., Espinoza, J., Evidence supporting a role for blockade of the vascular endothelial growth factor system in the pathophysiology of preeclampsia (2004) Am J Obstet Gynecol, 190, pp. 1541-1550Levine, F.J., Maynard, S.E., Qian, C., Circulating angiogenic factors and the risk of preeclampsia (2004) N Engl J Med, 350, pp. 672-683Levine, R.J., Lam, C., Qian, C., Soluble endoglin and other circulating angiogenic factors in preeclampsia (2006) N Engl J Med, 355, pp. 992-1005Widmer, M., Villar, J., Benigni, A., Mapping the theory of preeclampsia and the role of angiogenic factors: A systemic review (2007) Obstet Gynecol, 109, pp. 168-180Wathen, K.A., Tuutti, E., Stenman, U.H., Maternal serum-soluble vascular endothelia growth factor receptor-1 in early pregnancy ending in preeclampsia or intrauterine growth retardation (2006) J Clin Endocrinol Metab, 91, pp. 180-184Vatten, L.J., Eskild, A., Nilsen, T.I.L., Changes in circulating level of angiogenic factors from the first to second trimester as predictors of preeclampsia (2007) Am J Obstet Gynecol, 196, p. 239. , e1-6Smith, G.C.S., Crossley, J.A., Aitken, D.A., Circulating angiogenic factors in early pregnancy and the risk of preeclampsia, intrauterine growth restriction, spontaneous preterm birth, and stillbirth (2007) Obstet Gynecol, 109, pp. 1316-1324Espinoza, J., Romero, R., Nien, J.K., Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor (2007) Am J Obstet Gynecol, 196, p. 326. , e1-13Stepan, H., Unversucht, A., Wessel, N., Faber, R., Predictive value of maternal angiogenic factors in second trimester pregnancies with abnormal uterine perfusion (2007) Hypertension, 49, pp. 818-824Rana, S., Karumanchi, A., Levine, R.J., Sequential changes in antiangiogenic factors in early pregnancy and risk of developing preeclampsia (2007) Hypertension, 50, pp. 137-142Unal, E.R., Robinson, C.J., Johnson, D.D., Chang, E.Y., Second-trimester angiogenic factors as biomarkers for future-onset preeclampsia (2007) Am J Obstet Gynecol, 197, p. 211. , e1-4Moore Simas, T.A., Crawford, S.L., Solitro, M.J., Angiogenic factors for the prediction of preeclampsia in high-risk women (2007) Am J Obstet Gynecol, 197, p. 244. , e1-8Hosmer, D.W., Lemeshow, S., (2000) Applied logistic regression. 2nd ed, , John Wiley & Sons, New York (NY)Ruttimann, U.E., Statistical approaches to development and validation of predictive instruments (1994) Crit Care Clin, 10, pp. 19-3