Docosahexaenoic acid (DHA) and the developing central nervous system (CNS) - Implications for dietary recommendations

The accretion of docosahexaenoic acid (DHA) in membranes of the central nervous system is required for the optimum development of retina and brain functions. DHA status is determined by the dietary intake of n-3 polyunsaturated fatty acids (PUFA), both the metabolic precursor α-linolenic acid (α-LNA) and DHA. Clinical studies have shown that feeding term or premature infants with formula low in total n-3 PUFA may alter the maturation of visual acuity. Moreover, feeding infants over the first 6 mon of life with formula containing adequate α-LNA, but no DHA, did not sustain the same cerebral accretion of DHA as that of breast-fed infants. Whether lower DHA accretion in brain of formula-fed term infants impairs neurophysiological performances is not clearly established. Contradictory data have been published, possibly owing to confounding factors such as maternal intakes and/or genetic variations in PUFA metabolism. Nevertheless, a large corpus of data is in favor of the recommendation of regular dietary intakes of DHA (during at least the first 6 mon of life) and suggest that DHA should be added in formulas at the level generally found in human milk (0.2-0.3 wt% of total fatty acids). The maternal intake of n-3 PUFA during pregnancy and lactation is also crucial, since the n-3 PUFA are provided during perinatal development through placental transfer and maternal milk, which determines the DHA status of the newborn and consequently impacts on post-natal development of brain and visual functions. Whether more clinical studies are needed to control and improve the impact of DHA maternal intakes on the progeny’s neurodevelopment, several commissions recommended by precaution that DHA average intake for pregnant and lactating women should be of 200-300 mg/day.     

一只长江江豚妊娠期昼间行为及其时间分配

长江江豚(Neophocaena phocaenoides asiaeorientalis Pilleri and Gihr,1972)属于哺乳纲(Mammalia)、鲸目(Cetacea),是仅分布于长江中下游及其附属湖泊中的惟一且相对独立的一个江豚淡水亚种(高安利和周开亚,1995),也是中国水域中三个江豚种群中最为濒危的一个亚种,<中国濒危动物红皮书·兽类>也将其列为濒危级(汪松,1998).     

孕期规律运动与妊娠期糖代谢异常关系的研究

目的探讨不同方式干预孕期运动与妊娠期糖代谢异常的关系及对妊娠结局的影响。方法将300例孕14周单胎孕妇按阶段分为两组各150例,干预组对孕妇进行评估,建立孕妇档案,孕期通过个体化运动干预,给予孕妇个体化、具体的适度运动处方及给予督导规律运动;对照组采用传统的产前检查及常规护理。观察比较两组孕妇血糖变化、体重增长及妊娠结局。结果干预组空腹,餐后2h血糖值,妊娠末期体重,发生糖代谢异常,早产儿、新生儿窒息、巨大儿以及剖宫产率均低于对照组,差异有统计学意义(P0.05)。结论通过个体化护理对孕期运动进行干预,有效控制血糖值,降低母婴并发症的发生。     

The reproductive tract microbiota in pregnancy

The reproductive tract microbiota plays a crucial role in maintenance of normal pregnancy and influences reproductive outcomes. Microbe–host interactions in pregnancy remain poorly understood and their role in shaping immune modulation is still being uncovered. In this review, we describe the composition of vaginal microbial communities in the reproductive tract and their association with reproductive outcomes. We also consider strategies for manipulating microbiota composition by using live biotherapeutics, selective eradication of pathogenic bacteria with antibiotics and vaginal microbiota transplantation. Finally, future developments in this field and the need for mechanistic studies to explore the functional significance of reproductive tract microbial communities are highlighted.     

母婴间菌群传递的研究进展

肠道菌群的结构对婴儿肠道系统发育及免疫系统构建具有重要的影响,研究表明最初的婴儿肠道菌群在母亲子宫内就已经存在并受分娩方式和喂养方式的影响。本研究从母亲怀孕、分娩、喂养三个阶段综述母婴间的菌群传递,为母婴间菌群传递机制及婴儿肠道菌群对其免疫系统构建的影响提供一定的理论依据。     

Estimation and reduction of the radiation dose to the fetus from external-beam radiotherapy

The appearance of a malignant disease during pregnancy is relatively rare. The use of external-beam radiation therapy is limited to non-pelvic tumors which are usually located above the diaphragm. However, supradiaphragmatic radiotherapy unavoidably exposes the fetus to secondary radiation due to head leakage, scatter from the machine and scatter produced inside the patient. This fetal exposure may be associated with an elevated risk for the development of deterministic harmful effects and/or carcinogenesis. The decision about the administration of radiotherapy in a pregnant patient is influenced by the fetal dose which must always be estimated before the patient’s treatment course. The methods employed for fetal dosimetry in external-beam radiotherapy are described in this review study. Direct dose measurements using thermoluminescent dosemeters or large ionization chambers placed on physical phantoms may be used. Monte Carlo simulations on computational phantoms may also provide accurate fetal dose calculations. The physical and/or computational phantoms need to simulate the full-scatter geometry of the pregnant patient. Typical fetal dose values attributable to radiation therapy for brain tumors, head and neck cancer, breast carcinoma and Hodgkin lymphoma at the first, second and third trimesters of gestation are presented. The effectiveness of different shielding devices for fetal dose reduction in radiotherapy is discussed. The effect of the dimensions and setup of the shielding material on the radiation dose received by the fetus is described. Moreover, practical methods for reducing the fetal dose by selecting the appropriate irradiation parameters are presented.     

妊娠合并乙肝病毒感染患者血清DNMT1、TIM-3与HBV-DNA病毒载量和妊娠结局的关系分析

摘要 目的：探讨妊娠合并乙肝病毒（HBV）感染患者血清脱氧核糖核酸甲基转移酶1（DNMT1）、T细胞免疫球蛋白粘蛋白-3（TIM-3）与乙型肝炎病毒-脱氧核糖核酸（HBV-DNA）病毒载量和妊娠结局的关系。方法：选取2021年1月～2022年1月南京医科大学第一附属医院收治的186例妊娠合并HBV感染患者为HBV感染组,根据HBV-DNA病毒载量分为阳性组56例和阴性组130例,根据妊娠结局分为结局不良组和结局良好组,另选取同期于南京医科大学第一附属医院进行孕检的150名健康孕妇为对照组。采用酶联免疫吸附法检测血清DNMT1、TIM-3水平。比较HBV感染组与对照组、阳性组与阴性组血清DNMT1、TIM-3水平。采用单因素及多因素Logistic回归分析妊娠合并HBV感染患者妊娠结局不良的影响因素,受试者工作特征（ROC）曲线分析血清DNMT1、TIM-3水平对妊娠合并HBV感染患者妊娠结局不良的预测价值。结果：与对照组比较,HBV感染组血清DNMT1、TIM-3水平升高（P＜0.05）。与阴性组比较,阳性组血清DNMT1、TIM-3水平升高（P＜0.05）。186例妊娠合并HBV感染患者妊娠结局不良发生率为55.38%（103/186）。单因素分析显示,妊娠结局不良与HBV感染孕周、HBV-DNA病毒载量、谷草转氨酶（AST）、谷丙转氨酶（ALT）、DNMT1、TIM-3有关（P＜0.05）。多因素Logistic回归分析显示,HBV-DNA病毒载量阳性和DNMT1＞34.94 ng/mL、TIM-3＞18.96 pg/mL为妊娠合并HBV感染患者妊娠结局不良的独立危险因素（P＜0.05）。ROC曲线分析显示,血清DNMT1、TIM-3水平单独和联合检测预测妊娠合并HBV感染患者妊娠结局不良的曲线下面积分别为0.798、0.791、0.870。结论：妊娠合并HBV感染患者血清DNMT1、TIM-3水平升高与HBV-DNA病毒载量阳性和妊娠结局不良密切相关,血清DNMT1、TIM-3水平联合对妊娠合并HBV感染患者妊娠结局预测价值良好。     

Free fatty acid profiles in preeclampsia

Preeclampsia has many characteristics similar to the metabolic syndrome. One of these is aberrant lipid metabolism. We studied free fatty acid (FFA) profiles at baseline and after oral glucose load in 21 preeclamptic and 11 normotensive pregnant women. Insulin sensitivity was measured by intravenous glucose tolerance test.We found that serum total FFA concentrations at baseline were 67% higher in preeclamptic than in normotensive pregnancies (P=0.0002). The difference between the two groups was largest in the concentrations of oleic (75%), linoleic (129%) and arachidonic (315%) acids. Oral intake of glucose suppressed total FFA in preeclamptic women by 40% (95% CI 32.1–46.1%, P<0.0001) but only 24% in control women (95% CI 0.01–42.0%, P=0.045). Insulin sensitivity, which in preeclamptic women was 37% lower (P=0.009), was unrelated to total or any individual FFA concentration.We concluded that preeclamptic women have higher circulating FFA concentrations, which despite insulin resistance are suppressed by oral glucose loading.     

Is there a dietary requirement for DHA in pregnancy?

The metabolic demand for docosahexaenoic acid (22:6 n-3, DHA) is increased during pregnancy because of the extra needs of the fetus, expanded maternal cell mass and placenta. In Western countries maternal dietary DHA intake in pregnancy is low and it is not clear whether adaptive metabolic mechanisms, such as increased DHA synthesis from precursor fatty acids, are capable of meeting the increased DHA need in pregnancy. Consequently randomized controlled trials are important to determine whether additional dietary DHA in pregnancy modifies maternal or infant health outcomes. The available randomized comparisons of DHA supplements vs placebo have assessed outcomes as diverse as maternal depression, infant visual acuity and development, and infant growth and allergy. The outcomes of these trials have not been conclusive because they have often been limited by small sample size. On the other hand, large-scale trials assessing marine oil supplementation with large doses indicate that DHA supplementation in pregnancy is safe.     

Endocrine changes during pregnancy, parturition and post-partum in guanacos (Lama guanicoe)

Plasma concentrations of progesterone (P4), estradiol-17β (E2), estrone (E1) and estrone sulfate (E1S) were measured during gestation in eight guanacos kept in captivity. Gestational length was 346.1 ± 9.8 days. P4 plasma concentrations increased after ovulation and remained elevated until parturition. However, during the last 4 weeks of gestation, a gradual decrease from 4.17 × 1.17^±1 nmol/L to 2.02 × 1.95^±1 nmol/L on day 5 before parturition was observed, followed by a more abrupt final decline to baseline concentrations which were reached on the day after parturition. Mean E2 plasma concentrations started to increase during the eighth month of gestation, and were significantly elevated up to maximum concentrations of 484.7 × 1.21^±1 pmol/L during the last 2 months of pregnancy. Concentrations returned to baseline during the last 2 days of gestation. An increase of E1S concentrations (p < 0.01) was observed in the eleventh month of gestation. Mean E1S concentrations remained rather constant during the last 3 weeks of gestation between 4 to 8 nmol/L until parturition, when a steep precipitous decline was observed. E1 concentrations were slightly elevated during the last 4 weeks of gestation, however, maximum concentrations did not exceed 1.5 nmol/L. The results show distinct species specific features of gestational steroid hormone profiles in the guanaco in comparison to domestic South American camelids, such as a more pronounced gradual prepartal decrease of P4 concentrations prior to the final decline to baseline, and clearly lesser E1S concentrations during the last 4 weeks of gestation, which lack a continuous prepartal increase.