Bone health in children and adolescents with perinatal HIV infection

The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD) appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.     

The Human Neurosecretory Neurones Under Perinatal Hypoxia: A Quantitative Immunohistochemical Study of the Supraoptic Nucleus in Autopsy Material

In the rat, experimental manipulations that cause activation of the magnocellular neurosecretory neurones result in the synthesis, in addition to vasopressin (AVP) and oxytocin (OXY), of other neurotransmitters or peptides, including tyrosine hydroxylase (TH), the first and rate limiting enzyme for catecholamine biosynthesis. In the human neonate, our previous study showed that TH was selectively increased in AVP neurones of subjects that died from prolonged perinatal hypoxia. The purpose of the present study was to quantitatively investigate the expression of TH, AVP, OXY and neurophysin in magnocellular neurones of the human neonate in relation to the severity/duration of perinatal hypoxia, as estimated by neuropathological criteria. Autopsy was performed after obtaining parental written consent for diagnostic and research purposes. The intensity of the immunohistochemical reactions and the cellular/nuclear size were measured in the dorsolateral supraoptic nucleus using a computerised image analysis system. We showed that prolonged perinatal hypoxia resulted in the activation of the magnocellular neuroendocrine neurones of the human neonate, as indicated by their increased neuronal and nuclear size. OXY neurones appeared larger than the AVP ones at birth, possibly indicating an active role of foetal OXY during labour or even earlier. The gradual increase in the duration of the insult resulted in the reduction of intracellular AVP content, in parallel with a dramatic increase in the expression of TH, indicating a functional interaction of these peptides under neuronal activation. Ιsolated evidence in our series, obtained from an infant of a diabetic mother, raises the probability that in the case of hyperglycaemia the above pathogenetic mechanisms are diversified.     

Moderate and severe perinatal asphyxia induces differential effects on cocaine sensitization in adult rats

Perinatal asphyxia (PA) increases the likelihood of suffering from dopamine‐related disorders, such as ADHD and schizophrenia. Since dopaminergic transmission plays a major role in cocaine sensitization, the purpose of this study was to determine whether PA could be associated with altered behavioral sensitization to cocaine. To this end, adult rats born vaginally (CTL), by caesarean section (C+), or by C+ with 15 min (PA15, moderate PA) or 19 min (PA19, severe PA) of global anoxia were repeatedly administered with cocaine (i.p., 15 mg/kg) and then challenged with cocaine (i.p., 15 mg/kg) after a 5‐day withdrawal period. In addition, c‐Fos, FosB/ΔFosB, DAT, and TH expression were assessed in dorsal (CPu) and ventral (NAcc) striatum. Results indicated that PA15 rats exhibited an increased locomotor sensitization to cocaine, while PA19 rats displayed an abnormal acquisition of locomotor sensitization and did not express a sensitized response to cocaine. c‐Fos expression in NAcc, but not in CPu, was associated with these alterations in cocaine sensitization. FosB/ΔFosB expression was increased in all groups and regions after repeated cocaine administration, although it reached lower expression levels in PA19 rats. In CTL, C+, and PA15, but not in PA19 rats, the expression of TH in NAcc was reduced in groups repeatedly treated with cocaine, independently of the challenge test. Furthermore, this reduction was more pronounced in PA15 rats. DAT expression remained unaltered in all groups and regions studied. These results suggest that moderate PA may increase the vulnerability to drug abuse and in particular to cocaine addiction. Synapse 67:553–567, 2013. © 2013 Wiley Periodicals, Inc.     

Safety of vaginal delivery in very low birthweight vertex singletons: a meta-analysis

Objective: The objective of this study is to assess the safety of vaginal delivery in VLBW singletons in the vertex presentation.

Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for studies on mode of delivery and neonatal outcome in VLBW singletons in the vertex presentation. A total of 28 studies met our inclusion criteria.

Results: Vaginal delivery was not associated with an increase in overall neonatal mortality compared with cesarean delivery (OR 0.87, 95% CI 0.72–1.04). Vaginal delivery was associated with a significant decrease in mortality for the 1250–1500?g birthweight category (OR 0.57, 95% CI 0.36–0.92), while an increase in mortality in the 500–750?g category was not significant (OR 1.5, 95% CI 0.86–2.61). Severe intraventricular hemorrhage (IVH) was not associated with mode of delivery (OR 1.05, 95% CI 0.85–1.29), but the only two high quality study that assessed IVH of all grades found an increase in risk for IVH in vaginal delivery (OR 1.33, 95% CI 1.16–1.51).

Conclusions: Vaginal delivery does not appear to increase the risk for neonatal mortality. However, current available data on neonatal morbidity are limited. More high-quality studies are needed to assess the association between mode of delivery and neonatal morbidity.     

Perinatal trauma with and without loss experiences

Objective: The present study explored differences in mental health between women who experienced a trauma which involved a loss of fetal or infant life compared to women whose trauma did not involve a loss (difficult childbirth). Method: The sample consisted of 144 women (mean age = 31.13) from the UK, USA/Canada, Europe, Australia/New Zealand, who had experienced either stillbirth, neonatal loss, ectopic pregnancy, or traumatic birth with a living infant in the last 4 years. Results: The trauma without loss group reported significantly higher mental health problems than the trauma with loss group (F (1,117) = 4.807, p = .03). This difference was observed in the subtypes of OCD, panic, PTSD and GAD but not for major depression, agoraphobia and social phobia. However, once previous mental health diagnoses were taken into account, differences between trauma groups in terms of mental health scores disappeared, with the exception of PTSD symptoms. Trauma groups also differed in terms of perceived emotional support from significant others. Conclusion: The findings illustrate the need for a change in the focus of support for women’s birth experiences and highlighted previous mental health problems as a risk factor for mental health problems during the perinatal period.     

Prediction of perinatal outcome in preeclampsia using middle cerebral artery and umbilical artery pulsatility and resistance indices

Objective: In preeclampsia, changes in fetal hemodynamics can be detected 2–3 weeks earlier than any changes in cardiotocogram. Thus, these Doppler changes can be used to predict perinatal outcome. The present study is planned to assess the accuracy of the middle cerebral artery to umbilical artery (UA) pulsatility index (PI) and resistance index (RI) in predicting adverse perinatal outcome in pregnancies complicated by preeclampsia. Methods: Total of 115 and 108 pregnant women were included in preeclampsia and control group, respectively. Weekly Doppler study was done in both groups starting from 30 weeks till 36 weeks or delivery, whichever is later. Results: Mean gestational age at delivery was 250 ± 13 and 273 ± 8 days, respectively, in preeclampsia and control group (p < 0.01). Thirty-four babies in preeclampsia group had been admitted to nursery; out of which three died (p < 0.01). On receiver operating characteristic analysis, MCA /UmA PI ratio and MCA /UmA RI ratio had sensitivity of 9% and 9.7% and specificity of 98% and 96.6%, respectively, for predicting adverse perinatal outcome. Conclusion: Doppler indices of MCA and Um A are significantly abnormal in preeclampsia. But on diagnostic statistical analysis they have good specificity but low sensitivity for detecting adverse perinatal outcome.     

Borderline amniotic fluid index and perinatal outcomes in the uncomplicated term pregnancy

Objective: To determine perinatal outcomes in uncomplicated term pregnancies with a borderline amniotic fluid index (AFI).

Methods: A retrospective review was conducted of uncomplicated singleton pregnancies at term (>37 weeks). Borderline and normal AFI were defined as 5.1?≤?AFI?≤?8.0?cm and 8.1?≤?AFI?≤?24?cm, respectively. Adverse perinatal outcomes, cesarean delivery for non-reassuring fetal heart rate testing, meconium-stained amniotic fluid, a 5-min Apgar score of <7, admission to the neonatal intensive care unit (NICU), and whether the neonate was small for gestational age were compared between the borderline and normal AFI groups.

Results: Borderline AFI was not significantly associated with cesarean delivery for non-reassuring fetal heart rate testing (p?=?0.513), meconium-stained amniotic fluid (p?=?0.641), admission to the NICU (p?=?0.368), or a 5-min Apgar score of <7 (p?=?1.00). However, the number of neonates who were small for gestational age (p?=?0.021) and rates of induction of labor (p?<?0.001) were significantly higher in the borderline group. Multiple logistic regression analysis showed that borderline AFI was not associated with cesarean delivery for non-reassuring fetal heart rate testing (odds ratio [OR]?=?0.72, 95% confidence interval [CI] 0.27–1.91, p?=?0.52).

Conclusion: In uncomplicated term pregnancies, a borderline AFI does not increase the risk of adverse perinatal outcomes.     

1237例胚胎移植术后母儿的围产结局分析

目的 回顾性分析西南医院生殖医学中心1 237例胚胎移植术后母儿的围产结局.方法 收集整理2011年1月至2014年7月在我中心行体外受精/卵胞浆内单精子显微注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)助孕技术成功妊娠的孕妇1 237例(助孕组),其中鲜胚移植周期711例,冻融胚胎移植周期(frozen thawed embryo transfer,FET)526例,以同期我院收治的自然妊娠孕妇(5040例)作为对照,分组比较母亲围产期情况及新生儿出生结局.结果 助孕组年龄为(30.4±4.2)岁,明显高于对照组(P＜0.05);助孕组多胎率及剖宫产率较对照组明显升高(P＜0.05);助孕组孕周及新生儿平均体质量较对照组明显偏小(P＜0.05);助孕组妊娠期高血压(pregnancy-induced hypertension,PIH)、前置胎盘、妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)、产后出血、母亲入ICU、新生儿住院、低体质量儿、早产以及新生儿入ICU(neonatal ICU,NICU)发生率较对照组明显升高(P＜0.05),而胎盘早剥、胎膜早破(premature rupture of fetal membranes,PROM)、先兆子痫、死胎、新生儿死亡及新生儿畸形的发生率两组比较差异无统计学意义.在助孕组内,鲜胚组孕周及新生儿体质量较FET组小(P＜0.05),鲜胚组ICP、PROM和产后出血的发生率较FET低,低体质量儿出生率较FET高(P＜0.05),而PIH、前置胎盘、先兆子痫、胎盘早剥、母亲入ICU、死胎、新生儿死亡、新生儿住院、新生儿畸形、NICU以及早产的发生率两组间比较差异无统计学意义.结论辅助生殖助孕者的PIH、前置胎盘、ICP、产后出血、母亲入ICU、新生儿住院、低体质量儿、早产以及NICU的发生率较自然妊娠孕妇高.