Metabolic changes, hypothalamo-pituitary-adrenal axis and oxidative stress after short-term starvation in healthy pregnant women

Aim: To compare metabolic effects and oxidative stress in pregnant and non-pregnant women after 12h of fasting. Methods: Twenty-six healthy women with uncomplicated singleton pregnancies between the 24th and 28th gestational week were recruited. After an overnight fast, venous blood samples and urine samples were tested for metabolic parameters characteristic for starvation, cortisol and oxidative stress products. Healthy non-pregnant women matched by age, body mass index and length of fasting comprised the control group. Results: The metabolic parameters β-hydroxybutyrate and free fatty acids in blood and ketones in urine showed no differences in pregnant and non-pregnant women. However, the oxidative stress parameters, 8,12-iso-iPF2α-VI, isoprostanes and malondialdehyde were significantly higher in pregnant subjects, as was cortisol. Conclusion: Healthy pregnant women are exposed to oxidative stress and activation of the hypothalamo-pituitary-adrenal axis, but not to metabolic changes resembling starvation during short fasting periods in comparison to non-pregnant healthy wome

Puerperal symphysis fundus distance: normal values

Aim: To measure puerperal symphysis fundus distance (SFD) by two manual methods and to calculate individual normal values. Study design: Prospective cohort study including women after single pregnancy without special problems in uterine involution. Methods: SFD was daily measured on the 1st-5th postpartum days by counting the number of midwife's fingers put horizontally on the mother's abdomen and by a paper tape, respectively. Linear mixed model analysis was performed to determine SFD normal values. Results: Independent variables determining the SFD on different days after delivery were the gestational age and the delivery mode (finger method) and the maternal age, body mass index (BMI), delivery mode and birth weight (tape method). Individual normal values were calculated by regression equation including the coefficients for the independent variables. Conclusion: Puerperal SFD values measured by tape have more independent variables than those measured by fingers and reflect better the actual situation of the patient. It should be verified whether values deviating from normal values of tape measurements may prevent postpartum complication

Puerperal symphysis fundus distance: normal values

Aim: To measure puerperal symphysis fundus distance (SFD) by two manual methods and to calculate individual normal values. Study design: Prospective cohort study including women after single pregnancy without special problems in uterine involution. Methods: SFD was daily measured on the 1st-5th postpartum days by counting the number of midwife's fingers put horizontally on the mother's abdomen and by a paper tape, respectively. Linear mixed model analysis was performed to determine SFD normal values. Results: Independent variables determining the SFD on different days after delivery were the gestational age and the delivery mode (finger method) and the maternal age, body mass index (BMI), delivery mode and birth weight (tape method). Individual normal values were calculated by regression equation including the coefficients for the independent variables. Conclusion: Puerperal SFD values measured by tape have more independent variables than those measured by fingers and reflect better the actual situation of the patient. It should be verified whether values deviating from normal values of tape measurements may prevent postpartum complication

The impact of cocaine and heroin on the placental transfer of methadone

BACKGROUND: Methadone is the therapeutic agent of choice for the treatment of opiate addiction in pregnancy. The co-consumption (heroin, cocaine) which may influence the effects of methadone is frequent. Therefore, the impact of cocaine and heroin on the placental transfer of methadone and the placental tissue was investigated under in vitro conditions. METHODS: Placentae (n = 24) were ex-vivo perfused with medium (m) (control, n = 6), m plus methadone (n = 6), m plus methadone and cocaine (n = 6) or m plus methadone and heroin (n = 6). Placental functionality parameters like antipyrine permeability, glucose consumption, lactate production, hormone production (hCG and leptin), microparticles release and the expression of P-glycoprotein were analysed. RESULTS: Methadone accumulated in placental tissue. Methadone alone decreased the transfer of antipyrine from 0.60 +/- 0.07 to 0.50 +/- 0.06 (fetal/maternal ratio, mean +/- SD, P or= 49% after any drug (P < 0.05). All other measured parameters did not show any significant effect when methadone was combined with cocaine or heroine. CONCLUSION: The combination of cocaine or heroin with methadone increase antipyrine permeability. Changes of MPs resemble findings seen in oxidative stress of syncytiotrophoblast

Maternal serum interleukin-1β, -6 and -8 levels and potential determinants in pregnancy and peripartum

Aims: To measure maternal serum interleukins (IL) in pregnancy, delivery and early puerperium, and to identify their potential determinants. Methods: Prospective longitudinal measures of serum IL-1β, IL-6 and IL-8 in 38 healthy pregnant women at antenatal visits, through labor and delivery, with clinical correlates (infection, vaginal hemorrhage and anemia) recorded by questionnaire. Results: Pregnancy IL levels remained consistently low. IL-1β increased shortly before delivery, then returned to pregnant levels, except where blood loss exceeded 500 ml. IL-6 and IL-8 rose at labor onset and exceeded pregnancy levels through postpartum day three. Postpartum IL-6 was higher after non-elective cesarean section than after spontaneous delivery (P < 0.0001), and where blood loss exceeded 500 ml. IL-6 and IL-8 were higher with systemic infection during delivery (P < 0.0001) and on postpartum day one (P < 0.05); IL-8 was higher in anemia (delivery: P < 0.005; postpartum day 1: P < 0.05). Differences due to delivery mode and systemic infection remained significant after correction for other conditions. Conclusions: Labor-dependent inflammation increases all IL levels at delivery. Further studies with larger sample sizes are required to establish reference values differentiating physiology from pathology as an aid to peripartum managemen

Post-delivery oxidative stress in women with preeclampsia or IUGR

Aim: To compare oxidative stress in patients with preeclampsia (PE) or intrauterine growth restriction (IUGR) vs. normal pregnancy (controls) during 48h after delivery. Study design: Women with singleton pregnancies were recruited immediately after delivery (gestational age >26.0weeks). Women with PE or IUGR were matched with healthy controls by age, BMI, gestational age and delivery mode. Venous blood samples and urine samples were tested for oxidative stress products 24h and 48h after delivery. Results: Plasma malondialdehyde (MDA) concentration 24h after delivery was significantly higher in subjects with PE or IUGR (3.41±1.14μmol/L, n=20) than in controls (2.91±0.82μmol/L, n=38) (P=0.04). Urine iPF2α-VI declined from 24 to 48h after delivery significantly in controls (P=0.006) and not in subjects with PE or IUGR (P=0.71). Conclusion: Of the markers tested only MDA is indicating higher oxidative stress in women with PE/IUGR than in normal pregnancy and only at 24h after delivery. No consistent pattern of change in the oxidative stress markers exists between 24-48h after deliver

Vitamin D receptor genotype BB is associated with higher serum osteocalcin in first pregnancy

Aim: Serum osteocalcin was shown in a previous study on first trimester pregnant women to correlate with bone density and to distinguish between fast and slow bone losers. The objective of the present study is to examine whether serum osteocalcin is related to vitamin D receptor (VDR) BsmI polymorphism in pregnant women. Study design: We determined osteocalcin serum levels and VDR BsmI genotype in 97 healthy first trimester pregnant women consecutively recruited during six months. Results: BB (21%), Bb (38%) and bb (41%) genotypes showed similar osteocalcin serum levels. However, in primigravidas (n=38) the BB genotype was significantly associated with higher mean osteocalcin level (9.67 ng/mL) than the Bb (8.07ng/mL) and the bb genotype (8.14ng/mL), respectively (P<0.05). The VDR genotype was the only independent parameter to correlate with serum osteocalcin (P<0.05). Conclusion: Only primigravidas show in the first trimester a relation between the bone formation parameter serum osteocalcin and the VDR genotype BB which indicates a higher risk of fractures. For further clinical applications serum osteocalcin and VDR genotype should be tested on a cohort of primigravidas including measurements of bone densit

Pharmacovigilance in pregnancy: adverse drug reactions associated with fetal disorders

Objective: To provide the first update on drug safety profiles and adverse drug reactions (ADRs) associated with fetal disorders from the Swiss national ADR database. Methods: We conducted a retrospective study using data from 202 pharmacovigilance reports on drug-associated fetal disorders from the Swiss national ADR database from 1990 to 2009. Evaluated aspects included administrative information on the report, drug exposure, and disorders. Results: The ADR reporting frequency on the topic of fetal disorders has increased during the last 20 years, from only 1 report in 1991 to a maximum of 31 reports in 2008. Nervous system drugs were the most frequently reported drug group (40.2%) above all antidepressants and antiepileptics. The highest level of overall drug intake could be observed for the 1st trimester (85.4%), especially for the first 6 weeks of pregnancy. The most frequently reported types of fetal disorders were malformations (68.8%), especially those of the musculoskeletal and circulatory systems. A positive association was discovered between antiepileptics and malformations in general and in particular of the circulatory system and the eye, ear, face, and neck. Conclusions: The results suggest that the nervous system drug group bears an especially high risk for malformations. The most commonly identified drug exposures can help focus pharmacoepidemiologic efforts in drug-induced birth defect

Influence of organic diet on the amount of conjugated linoleic acids in breast milk of lactating women in the Netherlands

The aim of the present study was to find out whether the incorporation of organic dairy and meat products in the maternal diet affects the contents of the conjugated linoleic acid isomers (CLA) and trans-vaccenic acid (TVA) in human breast milk. To this purpose, milk samples from 312 breastfeeding mothers participating in the KOALA Birth Cohort Study have been analysed. The participants had documented varying lifestyles in relation to the use of conventional or organic products. Breast milk samples were collected 1 month postpartum and analysed for fatty acid composition. The content of rumenic acid (the main CLA) increased in a statistically significant way while going from a conventional diet (no organic dairy/meat products, 0.25 weight % (wt%), n 186) to a moderately organic diet (50–90 % organic dairy/meat, 0·29 wt%, n 33, P=0.02) and to a strict organic diet (> 90 % organic dairy/meat, 0.34 wt%, n 37, P<=0.001). The levels of TVA were augmented among the participants with a moderately organic diet (0·54 wt%) and those with a strict organic diet (0.59 wt%, P<=0.001), in comparison with the conventional group (0·48 wt%). After adjusting for covariables (recruitment group, maternal age, maternal education, use of supplements and season), statistical significance was retained in the group of the strict organic dairy users (P<0.001 for rumenic acid). Hence, the levels of CLA and TVA in human milk can be modulated if breastfeeding mothers replace conventional dairy and/or meat products by organic ones. A potential contribution of CLA and TVA to health improvement is briefly discussed

«Travelling for two» – Reisen in Schwangerschaft und Stillzeit: Teil 1

Auch Schwangere und Stillende reisen in die (Sub)Tropen. Für Malaria-, Gelbfieber- oder Zikavirus-Risikogebiete ist eine reisemedizinische Beratung besonders wichtig. Teil 11 dieses Artikels fasst die geltenden Empfehlungen der Schweizerischen Gesellschaft für Tropen- und Reisemedizin zusammen. Während einer unkomplizierten Schwangerschaft ist das Reisen nicht generell kontraindiziert. Am besten geeignet ist das zweite Trimenon (nach der 16. bis einschliesslich 24. Schwangerschaftswoche [SSW]), da sich die Schwangere in diesem Zeitraum meist am wohlsten fühlt und das Risiko für Komplikationen am geringsten ist. Zu bedenken ist, dass die medizinische Versorgung am Reiseziel bei Schwangerschaftskomplikationen, geburtshilflichen und insbesondere neonatologischen Notfällen unzureichend sein kann