孕期炎症刺激对子代大鼠血脂水平的影响

目的研究孕期炎症刺激对子代大鼠血脂水平的影响。方法 8只SD孕鼠随机分为对照组和脂多糖刺激组,分别在孕第8、10、12天腹腔注射生理盐水或脂多糖(0.79 mg/kg)。子代出生1天及每周测体重;检测8周龄雄性仔鼠血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)水平;组织切片观察子代肝脏病理形态学变化;透射电镜观察肝、胸主动脉超微结构;免疫荧光检测仔鼠肝脏8-OHd G表达情况;TMRE染色检测线粒体膜电位。结果与对照组子代相比,脂多糖刺激组子代1天、1周龄体重下降(P0.01),而后体重显著增加(P0.01)。脂多糖刺激组子代8周龄外周血TG、TC、LDL及AST水平与对照组子代相比显著升高(P0.05或P0.01);肝脏病理改变明显,线粒体结构显著损伤,8-OHd G表达增多,肝脏线粒体膜电位较对照组子代明显降低(P0.01);胸主动脉表现出内皮脱落、平滑肌细胞迁移为特征的损伤。结论孕期炎症刺激导致子代线粒体损伤,可能与脂质代谢障碍并最终导致动脉粥样硬化发生相关。     

Fetal Sex and Maternal Asthma Control in Pregnancy

Many elderly patients in nursing homes in the United States use metered-dose inhaler (MDI) medications for a variety of lung diseases. We wondered how much the nursing support staff knew about correct MDI inhaler technique. Thirty-eight nursing home support staff were asked to demonstrate correct use of a placebo MDI inhaler on themselves. The staff completed an average of 6.9 steps out of 8 correctly. The most common error demonstrated was the staff did not hold their breath for 10 seconds at full inspiration after inhaling the medication. The results suggest that the support staff have incorrect MDI inhaler technique.     

Maternal Cytokine Production During Pregnancy and the Development of Childhood Wheezing and Allergic Disease in Offspring Three Years of Age

Allergic diseases are multifactorial; they develop from complex interactions between genes and the environment. The immunological bias toward atopy and asthma might be established during in utero development of the fetal immune system. We prospectively investigated the association between maternal cytokine changes during pregnancy and the development of childhood wheezing and atopy at three years of age. Blood samples from 90 pregnant women were assayed for TNF-α, TGF-β, IFN-γ, IL-4, IL-6, and IL-2 at 18 weeks of gestation and at 6 weeks after delivery. Telephone interviews were performed and a questionnaire administered to assess wheezing and allergic disease in the children. The serum total IgE and specific IgE to eggs, milk and dust mites were measured. Maternal IFN-γ, TNF-α and TGF-β levels significantly decreased during pregnancy compared to the levels after delivery. However, the IL-4 levels did not change. Maternal TNF-α and IFN-γ levels were decreased both before and after delivery in children with reported wheezing. Individual maternal IL-4 levels, before delivery, were higher than after delivery in the children that developed wheezing. There were no significant differences in maternal cytokine levels between children with and without asthma. In children with atopy, the maternal IFN-γ /IL-4 ratio, during the first trimester, had a tendency to decrease compared to the children without atopy, whereas the maternal IL-2 levels at 6 weeks after delivery were increased. A first pregnancy showed higher concentrations of IL-4 before and after delivery than did women with multiple pregnancies. Maternal cytokine levels begin to change toward a Th2 immunity starting in the first trimester. A stronger Th2 immune response during the first trimester of pregnancy is associated with childhood wheezing and atopy at three years of age, and a first pregnancy.     

Maternal Blood Pressure During Pregnancy and Early Childhood Blood Pressures in the Offspring: The GUSTO Birth Cohort Study

Although epidemiological studies suggest that offspring of women with preeclampsia are at increased risk to higher blood pressures and cardiovascular disease, little is known about the nature of blood pressures between the mother and her offspring. As blood pressures comprise of both pulsatile (systolic blood pressure [SBP] and pulse pressure [PP]) and stable (diastolic blood pressure [DBP]) components, and they differ between central and peripheral sites, we sought to examine maternal peripheral and central blood pressure components in relation to offspring early childhood blood pressures.A prospective birth cohort of 567 Chinese, Malay, and Indian mother–offspring with complete blood pressure information were studied. Maternal brachial artery SBP, DBP, and PP were measured at 26 to 28 weeks gestation; and central SBP and PP were estimated from radial artery waveforms. Offspring brachial artery SBP, DBP, and PP were measured at 3 years of age. Associations between continuous variables of maternal blood pressures (peripheral SBP, DBP, PP, central SBP, and PP) and offspring blood pressures (peripheral SBP, DBP, and PP) were examined using multiple linear regression with adjustment for maternal characteristics (age, education level, parity, smoking status, alcohol consumption and physical activity during pregnancy, and pre-pregnancy BMI) and offspring characteristics (sex, ethnicity, BMI, and height at 3 years of age).In the multivariate models, offspring peripheral SBP increased by 0.08 (95% confidence interval 0.00–0.17, P = 0.06) mmHg with every 1-mmHg increase in maternal central SBP, and offspring peripheral PP increased by 0.10 (0.01–0.18, P = 0.03) mmHg for every 1-mmHg increase in maternal central PP. The relations of maternal-offspring peripheral blood pressures (SBP, DBP, and PP) were positive but not statistically significant, and the corresponding values were 0.05 (−0.03 to 0.13; P = 0.21), 0.03 (−0.04 to 0.10; P = 0.35), and 0.05 (−0.02 to 0.13; P = 0.14), respectively.Maternal central pulsatile blood pressure components (SBP and PP) during pregnancy are associated with higher blood pressures in the offspring. This positive correlation is already evident at 3-years old. Studies are needed to further evaluate the effects of maternal central pulsatile blood pressure components during pregnancy and long-term cardiovascular health in the offspring.     

Maternal and Fetal Hemodynamic Adaptations to Pregnancy and Clinical Outcomes in Maternal Cardiac Disease

BackgroundAlthough insufficient maternal cardiac output (CO) has been implicated in poor outcomes in mothers with heart disease (HD), maternal-fetal interactions remain incompletely understood. We sought to quantify maternal-fetal hemodynamics with the use of magnetic resonance imaging (MRI) and explore their relationship with adverse events.MethodsPregnant women with moderate or severe HD (n = 22; mean age 32 ± 5 years) were compared with healthy control women (n = 21; 34 ± 3 years). An MRI was performed during the third trimester at peak output (maternal-fetal) and 6 months postpartum with return of maternal hemodynamics to baseline (reference). Phase-contrast MRI was used for flow quantification and was combined with T1/T2 relaxometry for derivation of fetal oxygen delivery/consumption.ResultsThird-trimester CO and cardiac index (CI) measurements were similar in HD and control groups (CO 7.2 ± 1.5 vs 7.3 ± 1.6 L/min, P = 0.79; CI 4.0 ± 0.7 vs 4.3 ± 0.7 L/min/m,² P = 0.28). However, the magnitude of CO/CI increase (Δ, peak pregnancy − reference) in the HD group exceeded that in the control group (CO 46 ± 24% vs 27 ± 16% [P = 0.007]; CI 51 ± 28% vs 28 ± 17% [P = 0.005]). Fetal growth and oxygen delivery/consumption were similar between groups. Adverse cardiovascular outcomes (nonmutually exclusive) in 6 HD women included arrhythmia (n = 4), heart failure (n = 2), and hypertensive disorder of pregnancy (n = 1); premature delivery was observed in 2 of these women. The odds of a maternal cardiovascular event were inversely associated with peak CI (odds ratio 0.10, 95% confidence interval 0.001-0.86; P = 0.04) and Δ,CI (0.02, 0.001-0.71; P = 0.03).ConclusionsMaternal-fetal hemodynamics can be well characterised in pregnancy with the use of MRI. Impaired adaptation to pregnancy in women with HD appears to be associated with development of adverse outcomes of pregnancy.     

Fetal Effects of Coumadin Administered During Pregnancy

The safest and most practical method ofadministering long-term anticoagulantsin pregnancy is uncertain because treatment of the mother with vitamin Kantagonists may be complicated byhemorrhage in the fetus. The effects onthe fetus of giving coumadin in pregnancy was evaluated in rabbits. Whencoumadin was given from early pregnancy until term, all of the fetuses werestillborn with widespread hemorrhages.However, the fetuses were born aliveand without hemorrhage when (1) coumadin was stopped 4-5 days before delivery, at which time the level of coagulation factors had almost returned tonormal and (2) when delivery was performed by cesarean section at a timewhen the fetal coagulation defect wassevere. It is suggested that the risk offetal hemorrhage is high only whenfetuses with a severe coagulation defectare exposed to the trauma of delivery.

Submitted on May 1, 1970 Revised on June 14, 1970 Accepted on June 15, 1970     

Fetal Growth and Insulin Resistance in Adult Life: Role of Plasma Triglyceride and Non-esterified Fatty Acids

Reduced fetal growth is associated with insulin resistance and a high prevalence of glucose intolerance in adult life. Because babies who are growth retarded have elevated levels of triglyceride and non-esterified fatty acids (NEFA), and because similar abnormalities are observed in subjects with the insulin resistance syndrome, impaired regulation of lipid metabolism could be one of the mechanisms explaining the link between reduced fetal growth and insulin resistance. We have, therefore, measured fasting plasma triglyceride and NEFA, and the insulin-mediated suppression of NEFA during an oral glucose tolerance test in 93 men and women aged 50, born in Preston, whose birthweight and body size at birth had been recorded. Elevated fasting plasma triglycerides and reduced NEFA suppression during the oral glucose tolerance test were associated with the male sex, glucose intolerance, central obesity as indicated by a high waist to hip ratio and insulin resistance as measured by a short insulin tolerance test. However there were no statistically significant relationships between the birth measurements and the circulating lipid levels. Moreover in regression analyses the relationships between thinness at birth and insulin resistance or glucose intolerance in adult life were unaffectived by the addition of triglyceride or NEFA in the models. These results suggest that the link between reduced fetal growth and insulin resistance in the adult is not mediated by an abnormal regulation of lipid metabolism.     

Maternal and Fetal Outcome After Colectomy for Fulminant Ulcerative Colitis During Pregnancy: Case Series and Literature Review

Purpose Previous studies have reported high morbidity and mortality in mothers and their offspring after colectomy for ulcerative colitis during pregnancy. This study was designed to assess the maternal and fetal outcomes of pregnant females undergoing colectomy for ulcerative colitis in the current era. Methods A retrospective analysis was performed at our institution of all pregnant females undergoing operation for ulcerative colitis between 1980 and 2004. To compare this data to that of past literature, a MEDLINE search from 1951 to 2004 reviewed all cases reported on this topic. Results Between 1980 and 2004, five females underwent an operation at our institution for fulminant ulcerative colitis while pregnant. All five patients underwent subtotal colectomy with Brooke ileostomy. Postoperative maternal morbidity included a superficial wound infection and a small asymptomatic intra-abdominal abscess. All females had successful pregnancies, and no maternal or fetal deaths occurred. Two patients went on to have an ileal pouch-anal anastomosis, one had a completion proctectomy and end ileostomy, oneis scheduled for an ileal pouch-anal anastomosis, andone patient is lost to follow-up. The literature review revealed 37 cases. The overall fetal and maternal mortality was 49 and 22 percent respectively. Postoperative maternal morbidity was reported in 24 percent. Conclusions In contrast to historic data, the maternal and fetal mortality from our series was zero and maternal morbidity was low. Subtotal colectomy and Brooke ileostomy for ulcerative colitis during pregnancy is safe. A multidisciplinary team that includes a gastroenterologist, high-risk obstetrician, and experienced surgeon is necessary for an optimal outcome. Presented at the meeting of the Minnesota Surgical Society, Saint Paul, Minnesota, May 16, 2003. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.     

Fetal Growth and Insulin Resistance in Adult Life: Relationship Between Glycogen Synthase Activity in Adult Skeletal Muscle and Birthweight

Growth retardation during fetal life is associated with insulin insensitivity and an increased prevalence of impaired glucose tolerance in adult life. Because insulin-mediated stimulation of glycogen synthase may be an important rate-limiting step for insulin action at the cellular level, we have sought to determine whether impaired activation of muscle glycogen synthase is linked with early growth retardation. Postprandial glycogen synthase activity was therefore measured in muscle biopsies from a group of 27 women with normal glucose tolerance aged around 50 who were born in Preston, Lancashire, whose birthweight and body size at birth were recorded. Glycogen synthase activity measured at 0.1 mmol 1⁻¹ glucose-6-phosphate correlated with insulin sensitivity as measured by a short insulin tolerance test (r = 0.42, p < 0.05) and the waist to hip ratio (r = −0.48, p < 0.01), but not body mass index, body fat percentage or age. Within the group of women with normal glucose tolerance there was no relationship between intra-uterine growth as evidenced by birthweight or body size at birth and the response to insulin of skeletal muscle glycogen synthase in adult life. Thus we found no evidence for a direct link between fetal growth and insulin sensitivity in this pathway.     

Effects of Diet and Exercise on Insulin Resistance during Pregnancy

Current evidence suggests that both diet and exercise can alter the usual increase in insulin resistance seen in Western societies during mid and late pregnancy. A low-glycemic diet combined with a low-volume exercise regimen during pregnancy decreases the glucose and insulin response to both mixed caloric intake and exercise, and probably lowers both 24-h blood glucose concentrations and the maternal substrate utilization ratio of carbohydrate/fat. The end result is a marked decrease in both maternal weight gain and size at birth. Regular weight-bearing exercise alone lowers markers of insulin resistance and lowers blood glucose concentration during and immediately after exercise during pregnancy. Changes in diet and/or physical activity appear to prevent the onset of gestational diabetes mellitus in at-risk women and may be of value in the treatment of those who develop gestational diabetes.     

非糖尿病急性心肌梗死患者子代胰岛素抵抗的情况研究

目的探讨非糖尿病急性心肌梗死患者子代的胰岛素抵抗情况及其与心血管危险因素的相关性。方法回顾性分析非糖尿病急性心肌梗死患者子代84例,并选择同期的非冠心病患者子女90例作为对照组。测量患者体质量指数(body mass index,BMI)、空腹血糖(fasting blood glucose,FBG)、高密度脂蛋白(high density lipoprotein,HDLC)、血清总胆固醇(total cholesterol,TC)、低密度脂蛋白(low density lipoprotein,LDL-C)、甘油三酯(glycerin three fat,TG)、空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数。结果两组研究对象即子代的年龄、性别比例、患高血压比例和吸烟者比例比较差异无统计学意义(P 0. 05)。非糖尿病急性心肌梗死患者子代的BMI、血脂异常者比例高于对照组(t=4. 30、11. 14,P 0. 05,P 0. 01)。在血脂指标的检测中,非糖尿病急性心肌梗死患者子代的血清TG和LDL-C相比对照组高,HDL-C相比对照组低,差异有统计学意义(t=3. 18、2. 78、2. 57,P 0. 05,P 0. 01),非糖尿病急性心肌梗死患者子代的胰岛素和胰岛素抵抗指数明显高于对照组(t=6. 97、4. 54,P 0. 01)。Pearson相关分析显示BMI、TG、胰岛素呈显著正相关(P 0. 05)。结论非糖尿病急性心肌梗死患者子代胰岛素抵抗增强,BMI、血脂异常者比例高,提示其患心血管疾病的风险可能增加。     

Maternal Fish Consumption During Pregnancy and Risk of Early Childhood Asthma

Maternal fish consumption during pregnancy may affect children's asthma risk by modulating early-life immune development. Type of fish intake may be important because of differences in fatty acid content. To test this hypothesis, we conducted a nested case-control study, selecting subjects from the Children's Health Study, a population-based study of school-aged children in southern California. Cases had physician-diagnosed asthma and controls were asthma-free by age 5 years. Mothers or guardians provided information on fish consumption during pregnancy in telephone interviews. We computed odds ratio (OR) and 95% confidence interval (CI) by using conditional logistic regression models that accounted for the sampling. In children born to mothers with a history of asthma, the OR of asthma was 0.20 (95% CI = 0.06-0.65) when mothers ate oily fish at least monthly during pregnancy compared with no consumption (p_trend = 0.006). Maternal oily fish consumption during pregnancy did not benefit children of non-asthmatic mothers. In contrast, fish stick (a source of trans-fats) consumption during pregnancy increased asthma risk in children (OR = 2.04; 95% CI = 1.18-3.51). Our results suggest that maternal oily fish intake during pregnancy may protect offspring from asthma; however, eating fish sticks during pregnancy may increase asthma risk in children.     

The Safety of Fetal Exposure to Proton-Pump Inhibitors During Pregnancy

Background  

Proton-pump inhibitors (PPIs) are often needed in pregnancy due to the high rates of acid reflux. Previous studies did not include medical pregnancy terminations data, which may cause a bias toward the null hypothesis. We assessed the fetal safety of PPIs following exposure during gestation including data from medical pregnancy terminations.     

Fertility and Offspring of Alcoholic Women: An Unsuccessful Search for the Fetal Alcohol Syndrome

Forty married women in a psychiatric hospital with a diagnosis of alcoholism were interviewed to obtain details of their pregnancies and outcome of pregnancies with particular reference to spontaneous abortions, stillbirths, deaths, mental handicap and congenital abnormalities. Forty controls matched by age and with a diagnosis of endogenous depression were also interviewed. No significant differences were found in the fertility, outcome of pregnancy or state of the children. The probable reasons for this are discussed briefly and the introduction contains a review of some of the literature on the Fetal Alcohol Syndrome.     

Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome

Therapeutic apheresis (TA) is a complex extracorporeal procedure for the treatment of several acute and chronic diseases. TA in pregnancy is considered safe for both mother and fetus and has the same indications of non‐pregnant patients. TA can be used during the entire course of the pregnancy with the following purposes: (i) to treat several maternal acute and chronic conditions; (ii) to treat fetal conditions; (iii) to avoid administration of drugs potentially harmful to the fetus; and (iv) to reach a more advanced gestational age in order to prevent fetal prematurity. We report three successfully treated patients throughout pregnancy, for differential indications: thrombotic thrombocytopenic purpura, red blood cells alloimmunization and ulcerative colitis. Multiple courses of TA have been performed without any complications for the mother and the fetus. A review and a discussion on the particular TA implications related to maternal‐fetal medicine have been reported. When approaching TA in pregnancy, clinicians have to consider the severity of disease, the strength of the indications, and the gestational age. Each case must be evaluated individually on the basis of existing evidence since, despite the increasing use, specific guidelines for apheresis in pregnancy are still lacking.