Effects of alcohol and smoking during pregnancy on infant autonomic control

Prenatal exposure to smoking and alcohol increases the risk for Sudden Infant Death Syndrome (SIDS). Physiological changes associated with these exposures are not well studied. Full‐term infants were tested within the first 3 days of life. We hypothesized that maternal alcohol consumption and/or smoking during pregnancy would alter autonomic nervous system function. Newborns whose mothers smoked during pregnancy had lower beat‐to‐beat heart rate variability in quiet sleep. Infants whose mothers consumed alcohol had lower global heart rate variability, but only in active sleep. Unexposed infants demonstrated increases in heart rate with head‐up tilt and decreases in heart rate with head‐down tilt, but smoking and alcohol‐exposed infants showed no significant responses. These results indicate that autonomic function is altered by prenatal exposure to alcohol and smoking. Such markers may provide early identification of infants at greatest risk for SIDS. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 234–242, 2009     

Treatment of phenylketonuria during pregnancy

A woman with apparently classic phenylketonuria (PKU) was treated from the sixth week of her pregnancy with a diet restricted in phenylalanine and supplemented with tyrosine. Serum phenylalanine levels were monitored weekly and documented good patient compliance. A female infant was born who was examined at age 8.5 months. Physical examination was notable for a heart murmur suggestive of patent ductus arteriosus. Developmental quotient was normal. It is important to continue to monitor the outcome of pregnancies in women with PKU whose diet is restricted in phenylalanine in an effort to better define risks and to optimize treatment.     

Age-related changes in cardiac autonomic control during sleep

Aging is commonly associated with decreased sleep quality and increased periodic breathing (PB) that can influence heart rate variability (HRV). Cardiac autonomic control, as inferred from HRV analysis, was determined, taking into account the sleep quality and breathing patterns. Two groups of 12 young (21.1 +/- 0.8 years) and 12 older (64.9 +/- 1.9 years) volunteers underwent electroencephalographic, cardiac, and respiratory recordings during one experimental night. Time and frequency domain indices of HRV were calculated in 5-min segments, together with electroencephalographic and respiratory power spectra. In the elderly, large R-R oscillations in the very-low frequency (VLF) range emerged, that reflected the frequency of PB observed in 18% of the sleep time. PB occurred more frequently during rapid eye movement sleep (REM) sleep and caused a significant (P < 0.02) increase in the standard deviation of normal R-R intervals (SDNN) and absolute low-frequency (LF) power. With normal respiratory patterns, SDNN, absolute VLF, LF, and high frequency (HF) power fell during each sleep stage (P < 0.01) compared with young subjects, with no significant sleep-stage dependent variations. An overall decrease (P < 0.01) in normalized HF/(LF + HF) was observed in the elderly, suggesting a predominant loss of parasympathetic activity which may be related to decreased slow-wave sleep duration. These results indicate that two distinct breathing features, implying different levels of autonomic drive to the heart, influence HRV in the elderly during sleep. The breathing pattern must be considered to correctly interpret HRV in the elderly.     

Negative emotionality and cortisol during adolescent pregnancy and its effects on infant health and autonomic nervous system reactivity

This research examined the relations among maternal emotionality, biology, and infant outcome and autonomic nervous system reactivity (cardiac vagal tone). The sample consisted of 27 pregnant adolescents and their 3-week-old infants. Measures of anxiety, depression, anger, and saliva cortisol were obtained from the adolescents both pre- and postnatally. Infant outcome measures consisted of gestational age at delivery, birth weight, number of risk factors at birth and at 24 hr, Apgar score at 1 and 5 min, abnormalities on newborn physical exam, number of resuscitation measures used on the infant, and cardiac vagal tone. Significant relations were found among the adolescent's emotionality, infant physical outcomes, and cardiac vagal tone. Higher concentrations of adolescent cortisol were associated with lower infant Apgar scores and an increased need for resuscitation measures performed on the infant. The positive association between negative emotions and better infant outcomes also was found and may reflect the sensitivity of the adolescents to their feelings and needs during pregnancy. Social support during pregnancy mediated the effects of maternal negative emotionality and infant cardiac vagal tone. © 1998 John Wiley & Sons, Inc. Dev Psychobiol 33: 163–174, 1998     

Depression symptoms during pregnancy

Summary Pregnancy impacts common symptoms of major depressive disorder (MDD), such as energy, appetite, weight change, and sleep and somatic complaints. However, it is not known whether the presentation of depression during pregnancy is different from that at other times in women’s lives. This study compares the severity of symptoms of depression in 61 pregnant women with MDD (PD), 50 nonpregnant women with MDD (D), and 41 pregnant women without MDD (P). Despite equivalent overall depression severity, PD women had lower scores on suicidality, guilt, and early insomnia and higher scores on psychomotor retardation than D women. The severity of other depressive symptoms was similar in the two depressed groups. As expected on the basis of the selection criteria, overall depression severity and the severity of individual symptoms were significantly higher in the PD group than in the P group but effect sizes for somatic symptoms were smaller than for psychological symptoms. The results suggest that the profile of depression symptoms of women with MDD who are pregnant does not differ much from that of depressed nonpregnant women. Depressive symptoms, particularly psychological symptoms of depression, during pregnancy should be taken seriously and not be dismissed as a normal part of the pregnancy experience. Correspondence: Rachel Manber, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road Suite 3301, Stanford, CA 94305, USA     

Parental smoking during pregnancy and head shape and size in school children

Background: Maternal smoking during pregnancy has been recognised as a detrimental factor associated with adverse perinatal outcomes; however, to date there is a dearth of information on how it affects post-natal head growth and shape.

Aim: To assess the relationship between parental smoking exposure during pregnancy and head dimensions and shape at age 7–10?years in boys and girls.

Methods: Body height and head length, breadth and circumference were measured. Birth weight and gestational age were obtained from the children’s medical record books. Parental smoking habits during pregnancy and maternal educational attainment were obtained by a questionnaire. The relationship between exposure to parental smoking during pregnancy and head dimensions was evaluated using analysis of covariance implemented in the Generalized Linear Model, separately for each sex.

Results: Maternal and parental smoking during pregnancy significantly altered head shape in boys by affecting head length, while neither head breadth nor circumference were affected. This phenomenon was not observed in girls.

Conclusion: Smoking-induced chronic hypoxic effects on the growing foetus, indicated that both active and passive smoking during pregnancy seems to have persistent negative effects on children, going beyond foetal development and pre-natal growth restrictions.     

Topography of the pelvic autonomic nerves in human fetuses between 21-29 weeks of gestation

Summary A topographical study concerning the autonomic nerves in the pelvis of human fetuses was performed by investigating 300–600 m thick sections through fetal pelves, impregnated with the epoxy resin E 12 and cut with a diamond wire-saw. In addition the inferior hypogastric plexus of a 26-week old male fetus was dissected by lateral approach. In 21–29-week old fetuses the pelvic autonomic nerves are relatively thick. Thus the nerves stand out well against surrounding structures and their topographical relationships can exactly be determined. The inferior hypogastric plexus of 21–29-week old fetuses is situated on a curved line between the rectum and the ventrally adjacent structure. It constitutes a rectangular plate, which cannot be subdivided into individual plexuses for the different pelvic organs. The fetal plexus is heavily ganglionated. Large ganglia, forming the so-called ganglion of Frankenhaeuser, are found in the female as well as in the male fetus. In the fetal pelvis the connective tissue compartments are still clearly arranged, because adipose tissue is not yet abundant. The greater part of the inferior hypogastric plexus is situated exactly at the border between a dense visceral tissue medially and a loose parietal tissue laterally. The plexus does not share a common connective tissue cover with the pelvic blood vessels. In fetuses the inferior hypogastric plexus lies in close vicinity to serveral organs, but the pelvic floor is the only region where the nerves can hardly be separated from the surrounding structures.     

孕期彩色多普勒超声重复照射对仔鼠行为发育的影响

目的探讨多普勒超声孕期重复照射是否会对仔鼠的行为发育造成影响，为产科超声安全应用提供理论依据。方法妊娠SD大鼠30只，随机分为重复照射0min组（对照组）、重复照射10min组、重复照射20min组3组。在妊娠第6、12、18天分别给予0、10、20min的（3．0MHz，MI=1．6，Tis=1．8）超声照射。生后采用动物行为学观察方法测试并评价其子代鼠生理发育及行为学能力。结果照射20min组与对照组相比，空中翻正、视觉定向的达标时间均较对照组延迟（P〈0．05），而张耳、开眼，以及平面翻正、听觉惊愕指标，3组相比无明显差异（P〉0．05）。结论孕期彩色多普勒超声20min重复照射可能对仔鼠的生后行为发育产生影响。     

The ontogeny of autonomic measures in 6- and 12-month-old infants

The purpose of this study was to develop a standardized protocol to measure preejection period (PEP), a measure of sympathetic nervous system, and respiratory sinus arrhythmia (RSA), a measure of parasympathetic nervous system, during resting and challenging states for 6- and 12-month-old infants and to determine developmental changes and individual stability of these measures. A 7-min reactivity protocol was administered to Latino infants at 6 months (n=194) and 12 months (n=181). Results showed: (1) it is feasible to measure PEP and RSA in infants, (2) the protocol elicited significant autonomic changes, (3) individual resting autonomic measures were moderately stable from 6 to 12 months, but reactivity measures were not stable, and (4) heart rate and RSA resting and challenge group means changed significantly from 6 to 12 months. Findings suggest that although infants' autonomic responses show developmental changes, individuals' rank order is stable from 6 to 12 months of age.     

Potential benefits of mindfulness during pregnancy on maternal autonomic nervous system function and infant development

Mindfulness is known to decrease psychological distress. Possible benefits in pregnancy have rarely been explored. Our aim was to examine the prospective association of mindfulness with autonomic nervous system function during pregnancy and with later infant social‐emotional development. Pregnant women (N = 156) completed self‐report mindfulness and emotional distress questionnaires, and had their autonomic function assessed in their first and third trimesters, including heart rate (HR), indices of heart rate variability (HRV), preejection period (PEP), and systolic (SBP) and diastolic blood pressure (DBP). The social‐emotional development of 109 infants was assessed at 4 months of age. More mindful pregnant women had less prenatal and postnatal emotional distress (p < .001) and higher cardiac parasympathetic activity: root mean square of successive differences (RMSSD: p = .03) and high‐frequency (HF) HRV (p = .02). Between the first and third trimesters, women's overall HR increased (p < .001), and HRV (RMSSD, HF HRV, and low‐frequency (LF) HRV: p < .001) and PEP decreased (p < .001). In more mindful mothers, parasympathetic activity decreased less (RMSSD: p = .01; HF HRV: p = .03) and sympathetic activity (inversely related to PEP) increased less (PEP: p = .02) between trimesters. Their offspring displayed less negative social‐emotional behavior (p = .03) compared to offspring of less mindful mothers. Mindfulness in pregnancy was associated with ANS changes likely to be adaptive and with better social‐emotional offspring development. Interventions to increase mindfulness during pregnancy might improve maternal and offspring health, but randomized trials are needed to demonstrate this.     

Cardiac autonomic dynamics during sleep are lost in patients with TIA and stroke

Ischaemic stroke is accompanied by important alterations of cardiac autonomic control, which have an impact on stroke outcome. In sleep, cardiac autonomic control oscillates with a predominant sympathetic modulation during REM sleep. We aimed to assess cardiac autonomic control in different sleep stages in patients with ischaemic stroke. Forty‐five patients enrolled in the prospective, multicentre SAS‐CARE study but without significant sleep‐disordered breathing (apnea–hypopnea index < 15/hr) and without atrial fibrillation were included in this analysis. The mean age was 56 years, 68% were male, 76% had a stroke (n = 34, mean National Institutes of Health Stroke Scale [NIHSS] score of 5, 11 involving the insula) and 24% (n = 11) had a transitory ischaemic attack. Cardiac autonomic control was evaluated using three different tools (spectral, symbolic and entropy analysis) according to sleep stages on short segments of 250 beats in all patients. Polysomnographic studies were performed within 7 days and 3 months after the ischaemic event. No significant differences in cardiac autonomic control between sleep stages were observed in the acute phase and after 3 months. Predominant vagal modulation and decreased sympathetic modulation were observed across all sleep stages in ischaemic stroke involving the insula. Patients with ischaemic stroke and transitory ischaemic attack present a loss of cardiac autonomic dynamics during sleep in the first 3 months after the ischaemic event. This change could represent an adaptive phenomenon, protecting the cardiovascular system from the instabilities of autonomic control, or a risk factor for stroke, which precedes the ischaemic event.     

病检资料Access数据库的建立和应用

目的利用Access数据库管理病检资料。方法计算机安装视窗操作系统和Office办公应用软件,使用Access软件创建病检资料数据库。结果系统的应用较大地提高了病理科的工作效率,不仅能对病检资料进行快速录入、永久贮存、规范分类、快速检索、查询和打印,还能进行统计分析;资料使用灵活,能为教学、科研工作提供强有力的支持。结论此系统组成简单,共享和兼容性好,数据处理功能强大,值得推广应用。     

子宫内膜息肉样腺肌瘤临床病理分析

目的:探讨子宫内膜息肉样腺肌瘤的临床病理特征。方法:对27例子宫内膜息肉样腺肌瘤的临床资料和病理特征进行回顾性分析。结果:27例子宫内膜息肉样腺肌瘤于宫腔镜下未能确诊,经病理检查明确诊断。其中息肉样腺肌瘤15例,由富含平滑肌组织的基质包绕大小和形态不等的子宫内膜腺体,但无不典型性改变;非典型性息肉样腺肌瘤12例,由杂乱无章的不规则腺体构成,具有明显的腺体结构复杂性和细胞非典型性,可见鳞状上皮化生。结论:子宫内膜息肉样腺肌瘤具有特异的病理特征,为良性病变,但是非典型性息肉样腺肌瘤存在低度恶性潜能,需完整切除肿物,防止复发,且应严密随诊。     

Neuroendocrine and immune markers of maternal stress during pregnancy and infant cognitive development

Antenatal exposure to maternal stress is a factor that may impact on offspring cognitive development. While some evidence exists of an association between maternal antenatal depressive or anxiety symptoms and infants' cognitive outcomes, less is known about the role of biological indices of maternal antenatal stress in relation to infant cognitive development. The current study investigated the association between maternal depressive and anxiety symptoms, stress and inflammatory markers during pregnancy and infant's cognitive development in a sample of 104 healthy pregnant women (mean gestational age = 34.76; SD = 1.12) and their 12-week-old infants (mean postnatal weeks = 11.96; SD = 1.85). Maternal depressive and anxiety symptoms were evaluated during pregnancy, alongside measurements of serum Interleukin-6 (IL-6), C-Reactive Protein (CRP), salivary cortisol, and alpha amylase (sAA) concentrations. Infant cognitive development, maternal caregiving and concurrent anxiety or depressive symptoms were assessed 12 weeks after delivery. Hierarchical linear regressions indicated that higher maternal diurnal cortisol and CRP levels were independently associated with lower infant cognitive development scores, while adjusting for infant gender and gestational age, maternal IQ, caregiving, depressive, or anxiety symptoms. Though correlational, findings seem suggestive of a role for variation in maternal biological stress signals during pregnancy in influencing infants' early cognitive development.     

Potential interactions among linguistic, autonomic, and motor factors in speech

Though anecdotal reports link certain speech disorders to increases in autonomic arousal, few studies have described the relationship between arousal and speech processes. Additionally, it is unclear how increases in arousal may interact with other cognitive-linguistic processes to affect speech motor control. In this experiment we examine potential interactions between autonomic arousal, linguistic processing, and speech motor coordination in adults and children. Autonomic responses (heart rate, finger pulse volume, tonic skin conductance, and phasic skin conductance) were recorded simultaneously with upper and lower lip movements during speech. The lip aperture variability (LA variability index) across multiple repetitions of sentences that varied in length and syntactic complexity was calculated under low- and high-arousal conditions. High arousal conditions were elicited by performance of the Stroop color word task. Children had significantly higher lip aperture variability index values across all speaking tasks, indicating more variable speech motor coordination. Increases in syntactic complexity and utterance length were associated with increases in speech motor coordination variability in both speaker groups. There was a significant effect of Stroop task, which produced increases in autonomic arousal and increased speech motor variability in both adults and children. These results provide novel evidence that high arousal levels can influence speech motor control in both adults and children.     

Features of autonomic cardiovascular control during cognition in major depressive disorder

Previous research has suggested reduced parasympathetic cardiac regulation during cognitive activity in major depressive disorder (MDD). However, little is known about possible abnormalities in sympathetic control and cardiovascular reactivity. This study aimed to provide a comprehensive analysis of autonomic cardiovascular control in the context of executive functions in MDD. Thirty six MDD patients and 39 healthy controls participated. Parameters of sympathetic (pre‐ejection period, PEP) and parasympathetic control (high and low frequency heart rate variability, HF HRV, LF HRV; and baroreflex sensitivity, BRS) as well as RR interval were obtained at rest and during performance of executive function tasks (number‐letter task, n‐back task, continuous performance test, and Stroop task). Patients, as compared to controls, exhibited lower HF HRV and LF HRV during task execution and smaller shortenings in PEP and RR interval between baseline and tasks. They displayed longer reaction times during all conditions of the tasks and more omission errors and false alarms on the continuous performance test. In the total sample, on‐task HF HRV, LF HRV and BRS, and reactivity in HF HRV, LF HRV, and PEP, were positively associated with task performance. As performance reduction arose independent of executive function load of the tasks, the behavioral results reflect impairments in attention and processing speed rather than executive dysfunctions in MDD. Abnormalities in cardiovascular control during cognition in MDD appear to involve both divisions of the autonomic nervous system. Low tonic parasympathetic control and blunted sympathetic reactivity imply reduced physiological adjustment resources and, by extension, provide suboptimal conditions for cognitive performance.     

Characterization of type 1 and type 2 cytokine production profile in physiologic and pathologic human pregnancy

Antigen- and mitogen-stimulated cytokine production by peripheral blood mononuclear cells (PBMC) of 50 pregnant women and 31 age- and sex-matched non-pregnant controls were analysed to determine whether changes in cytokine production occur during normal and pathologic human gestation. The pregnant women, consecutively enrolled during a 3-month period, were undergoing a normal, non-pathologic pregnancy at the time of entry into the study, and underwent ultrasound examination to ascertain the exact week of pregnancy and the vitality of the fetus. Forty of the 50 pregnancies (80%) terminated physiologically with the birth of normal babies. Spontaneous abortions were observed in 5/50 (10%) women, and five women gave birth to newborns small for gestational age (SGA). A decrease in the production of IL-2 and interferon-gamma (IFN-γ) accompanied by an increase in production of IL-4 and IL-10, was observed in normal pregnancy, with the lowest quantities of IL-2 and IFN-γ and the highest quantities of IL-4 and IL-10 present in the third trimester of pregnancy. Statistically significant increased production of both IL-2 and IFN-γ and reduced production of IL-10 characterized pathologic pregnancies and distinguished them from normal pregnancies. These preliminary data suggest that a type 2 cytokine profile may be associated with normal human pregnancy, whereas the lack of a dominant type 2 cytokine profile may be indicative of a pathologic pregnancy.