Tocolytic therapy in threatened preterm labor

Summary The most important benefit of tocolysis is a 48-hour prolongation of gestational age in order to administer corticosteroids to reduce perinatal mortality and morbidity, as well as, if necessary, to gain time for “in utero” transfer to a tertiary centre with neonatal facilities. The tocolytic agents used in clinical practice can be grouped into six classes, namely: calcium channel blockers, betamimetics, magnesium sulfate, cyclooxygenase inhibitors, oxytocin receptor antagonists and nitric oxide donors. The use of them should be individualized and based on tocolytic effectiveness, safety, gestational age as well as maternal, fetal and neonatal outcomes. Data from clinical trials suggests that nifedipine appears to be the drug of first choice in the management of preterm labor

Farmakoterapia chorób układu ruchu u kobiet w ciąży

Planowanie lub obecność ciąży ogranicza możliwości leczenia kobiet z reumatoidalnym zapaleniem stawów, innymi chorobami układowymi czy ortopedycznymi. Ciąża jest stanem, który należy omówić ze wszystkimi pacjentkami z chorobami układu ruchu, które są w wieku rozrodczym. Większość chorób układowych, które są dobrze kontrolowane przed ciążą, nie pogorszy się w czasie ciąży, pod warunkiem że pacjentka kontynuuje leczenie odpowiednio dobranymi preparatami. Jednak liczne leki powinny być wykluczone mimo swojej skuteczności. Niektóre z nich, takie jak metotreksat, leflunomid, abatacept i rytuksymab, powinny być odstawione w momencie planowania ciąży, inne — jak bisfosfoniany — mogą być stosowane do momentu zapłodnienia. Istnieją również preparaty dopuszczone do stosowania podczas ciąży (środki przeciwmalaryczne, sulfasalazyna, azatiopryna, cyklosporyna, kortykosteroidy, leki przeciwbólowe i antybiotyki), a więc mogą być podawane do czasu porodu. Niesteroidowe leki przeciwzapalne mogą być bezpiecznie podawane do 32. tygodnia ciąży. Najważniejszym czynnikiem przy planowaniu leczenia pacjentek z chorobami układowymi w okresie ciąży jest możliwość indywidualizacji zaleceń. Celem niniejszej pracy jest podsumowanie aktualnej wiedzy na temat możliwości stosowania preparatów wykorzystywanych w leczeniu chorób układu ruchu u kobiet ciężarnych oraz karmiących piersią

FABP4 in Gestational Diabetes—Association between Mothers and Offspring

Fetuses exposed to gestational diabetes mellitus (GDM) have a higher risk of abnormal glucose homeostasis in later life. The molecular mechanisms of this phenomenon are still not fully understood. Fatty acid binding protein 4 (FABP4) appears to be one of the most probable candidates involved in the pathophysiology of GDM. The main aim of the study was to investigate whether umbilical cord serum FABP4 concentrations are altered in term neonates born to GDM mothers. Two groups of subjects were selected—28 healthy controls and 26 patients with GDM. FABP4, leptin, and ghrelin concentrations in the umbilical cord serum, maternal serum, and maternal urine were determined via an enzyme-linked immunosorbent assay. The umbilical cord serum FABP4 levels were higher in the GDM offspring and were directly associated with the maternal serum FABP4 and leptin levels, as well as the prepregnancy body mass index (BMI) and the BMI at and after delivery; however, they correlated negatively with birth weight and lipid parameters. In the multiple linear regression models, the umbilical cord serum FABP4 concentrations depended positively on the maternal serum FABP4 and negatively on the umbilical cord serum ghrelin levels and the high-density lipoprotein cholesterol. There are many maternal variables that can affect the level of FABP4 in the umbilical cord serum, thus, their evaluation requires further investigation

Fatty Acid-Binding Protein 4—An “Inauspicious” Adipokine—In Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain and Gestational Diabetes Mellitus

The exact roles of adipokines in the pathogenesis of type 2 diabetes and obesity are still unclear. The aim of the study was to evaluate fatty acid binding protein 4 (FABP4) concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) and gestational diabetes mellitus (GDM) in the early post-partum period, with reference to their laboratory test results, body composition, and hydration status. The study subjects were divided into three groups: 24 healthy controls, 24 mothers with EGWG, and 22 GDM patients. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of FABP4, leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Healthy women were characterized by the lowest serum leptin concentrations and by a negative correlation between the serum and urine FABP4 levels. Serum FABP4 levels were the highest in the GDM group. Serum FABP4 and leptin concentrations correlated positively in the GDM group. The EGWG group had the highest degree of BIA disturbances in the early puerperium and positive correlations between the urine FABP4 and serum leptin and ghrelin concentrations. The physiological and pathological significance of these findings requires further elucidation