Isoenzymes of N-acetyl-beta-hexosaminidase in complicated pregnancy

The activity of N-acetyl-beta-hexosaminidase was found to be significantly higher in the placentas collected after delivery from women in puerperium with symptoms of prolonged pregnancy or complicated by EPH gestosis, than in placentas from normal pregnancy. Isoelectrofocusing of placenta homogenates showed the presence of isoenzymes A, P and B of N-acetyl-beta-hexosaminidase. Different isoenzyme A patterns in homogenates were observed in placentas obtained from normal and prolonged pregnancies and in those complicated by EPH gestosis.     

Clinical and immunologic evaluation of women with multiple sclerosis during and after pregnancy

Background: Multiple sclerosis (MS) is a disabling autoimmune disease of the central nervous system, typically affecting women of childbearing years. Although the disease course of MS is highly unpredictable, disease activity is almost invariably halted during pregnancy. After delivery, however, the relapse rate increases. Despite early recognition of this pattern of disease activity, its explanation remains a mystery.Objective: The aim of this study was to elucidate the underlying mechanisms responsible for the amelioration of MS during pregnancy and for its reactivation after delivery.Methods: This Finnish prospective study included clinical and immunologic follow-up of patients with MS during pregnancy and 6 months into the postpartum period. Groups of patients with MS who were not pregnant, along with pregnant and nonpregnant healthy women, served as controls. Laboratory investigations included subtype analysis of T, B, and natural killer (NK) cells during and after pregnancy, using immunofluorescence staining and fluorescence-activated cell sorting analysisResults: The clinical and immunologic follow-up data from 42 pregnant patients with MS indicated that the percentage of circulating NK cells decreases during the last trimester of pregnancy and increases again soon after the delivery. This correlates with disease activity as measured by annualized relapse rate. Early postpartum treatment with interferon-0 was effective in preventing relapses, and good response to postpartum treatment coincided with a reduction in the circulating NK cell levels.Conclusions: Our findings have implications for the treatment and follow-up of pregnant women with MS. To prevent postpartum relapses, disease-modifying treatment should be initiated as early as possible.     

Perinatal outcome of pregnancies in women aged 40 and over

Perinatal outcome of pregnancies at forty and over was analyzed starting from the diagnosis of pregnancy to seven days following delivery. Retrospectively, pre-gestational health and reproduction status were dealt with, as well as the course of pregnancy, deliveries, and newborn children (study group). The control group was composed of pregnant women aged 20 to 29, who were identical to study group in terms of parity. Statistical data processing was done by means of chi2-test, and contingency 2 x 2 tables. The difference was significant if p < 0.05. Out of 2,099 diagnosed wanted pregnancies at forty and over, 415 (19.8%) had a miscarriage, in 33 (1.6%) an artificial abortion was performed after determining the fetus karyotype and 1,651 (78.2%) of pregnant women delivered. In 66.2% of pregnancies the fetus karyotype was determined and in 33 (2.5%) fetuses chromosomal abnormalities were found Incidence of deliveries at 40 and over is 1.38%, which is a 35.6-percent increase in the last ten years. Nullipara and pluripara had an increase, and multipara had a decrease. Pre-gestational health and reproduction status in study group is lower than in control group. Complications during pregnancy: threatened abortion, EPH gestosis, placenta praevia, gestational diabetes, late fetal death are more frequent than in control group (p < 0.05). In intrapartal terms, more frequent were induction of delivery, meconium-stained amniotic fluid, fetal distress, operative vaginal deliveries, and Cesarean section (p < 0.05). In neonatal outcome there are more premature infant, there are more VLBW, LBW, SGA, newborn with low Apgar index values, and the total perinatal death is greater than in the control group (p < 0.05). In perinatal terms, (from the diagnosis to the seventh day following delivery) 1,617 children survived (77.0%), meaning that perinatal loss was 482 (23.0%). Authors conclude that pregnancy at 40 and over is a high-risk pregnancy. There is a high risk of pre-gestational and gestational complications, and perinatal loss is high. Therefore, those pregnancies are not desirable from the medical point of view.     

孕妇不良情绪、生活事件与妊娠结局以及分娩方式的关系研究

目的:探讨孕妇不良情绪、生活事件对妊娠结局以及分娩方式的影响。方法:选择2017年3月至2018年7月在海南省三亚市人民医院进行分娩的孕妇232例,搜集孕妇的基本资料,调查孕妇的生活事件及抑郁、焦虑状态,并记录孕妇的妊娠结局以及分娩方式,分析孕妇不良情绪、生活事件与妊娠结局以及分娩方式之间的关系。结果:在232例孕妇中,焦虑情绪孕妇有24例,占10.34%;抑郁孕妇有86例,占37.07%;发生生活事件的孕妇有69例,占29.74%。受到生活事件刺激、存在抑郁及焦虑的孕妇出现不良妊娠结局的概率均高于正常孕妇(P0.05)。剖宫产孕妇负性生活事件发生次数高于自然分娩的孕妇,而正性生活事件发生次数低于自然分娩的孕妇(P0.05)。剖宫产孕妇焦虑、抑郁的发生率均高于自然分娩的孕妇(P0.05)。结论:孕妇的不良情绪及生活事件普遍存在,可导致不良妊娠结局的发生并且对分娩方式产生一定的影响,应引起家庭及社会的重视。     

Production and reception of growth factors in placenta during physiological pregnancy and the pregnancy, complicated with gestosis

30 women with physiological pregnancy and 28 women with gestosis were examined. The content of epidermal growth factor (EGF), vascular-endothelial growth factor (VEGF) and their receptors were studied in the early chorion obtained after abortion and in the full-term placenta using the ELISA method. The process of normal gestation was characterized by the increase of the placental production both of the EGF and VEGF. During the pregnancy complicated with gestosis and miscarriage in the first trimester the content of EGF and its receptor was lower compared to the physiological values. For VEGF and its receptor opposite changes were found: the increase of quantity of the growth factor and the decrease of its receptor. In the case of gestosis and term of pregnancy the content of the both growth factors and their receptors was lower than in corresponding controls. The changes in production of the angiogenic growth factors and their receptors in the placenta may have the pathogenic importance in the development of gestosis.     

Dynamics of antibody nuclease activity in blood of women during pregnancy and lactation

In human milk we previously found catalytic antibodies (abzymes) catalyzing hydrolysis of DNA, RNA, NMP, NDP, and NTP and also phosphorylation of proteins and lipids. In the present study we have analyzed nuclease activities of antibodies in blood of women during pregnancy and lactation. Blood of healthy male and female volunteers lacked catalytically active antibodies, whereas antibodies from blood of pregnant women hydrolyzed DNA and RNA and their relative activity varied over a wide range. Relative blood abzyme activities significantly increased after delivery and at the beginning of lactation. The highest abzyme activity was observed in blood of parturient women. Although the dynamics of changes in antibody DNase activity during pregnancy was rather individual for each woman, there was a common trend in the increase in antibody activity in the first and/or third trimester of the pregnancy. The DNase activity of IgG and IgM from blood of healthy pregnant women was 4-5 times less than that from pregnant women with pronounced autoimmune thyroiditis.     

Blood glutathione redox status in gestational hypertension

Gestational hypertension during the third trimester reflects an exaggerated maternal inflammatory response to pregnancy. We hypothesized that oxidative stress present even in normal pregnancy becomes uncompensated in hypertensive patients. A glucose-6-phosphate dehydrogenase (G6PD) activity sufficient to meet the increased reductive equivalent need of the cells is indispensable for defense against oxidative stress. The erythrocyte glutathione redox system was studied, where G6PD is the only NADPH source. The glutathione (GSH) redox status was measured both in vivo and after an in vitro oxidative challenge in pregnant women with gestational hypertension (n = 19) vs. normotensive pregnant subjects (n = 18) and controls (n = 20). An erythrocyte GSH depletion with an increase in the oxidized form (GSSG) resulted in an elevated ratio GSSG/GSH (0.305 +/- 0.057; mean +/- SD) in hypertensive pregnant women vs. normotensive pregnant or control subjects (0.154 +/- 0.025; 0.168 +/- 0.073; p <.001). In hypertensive pregnant patients, a "GSH stability" decrease after an in vitro oxidative challenge suggested a reduced GSH recycling capacity resulting from an insufficient NADPH supply. The erythrocyte GSSG/GSH ratio may serve as an early and sensitive parameter of the oxidative imbalance and a relevant target for future clinical trials to control the effects of antioxidant treatment in women at increased risk of the pre-eclampsia syndrome.     

Selenium and malondialdehyde content and glutathione peroxidase activity in maternal and umbilical cord blood and amniotic fluid

Placenta tissue may be a major source of lipid peroxidation products in pregnancy. It was proven that placental peroxidation activity increases with gestation. Selenium (Se), as an essential constituent of glutathione peroxidase (GSH-Px), takes part in the reduction of hydrogen peroxides and lipid peroxides. Malondialdehyde (MDA) is a major breakdown product split off from lipid peroxides. In this study, Se and MDA content and GSH-Px activity were measured in blood and plasma taken from 20 apparently healthy nonpregnant women between 19 and 38 yr of age and from 115 unselected pregnant women between 17 and 45 yr of age (35 in the first trimester, 22 in the second trimester, 38 in the third trimester, and 20 within 2 d of delivery). Samples of umbilical cord blood and amniotic fluid were taken from women in the second and third trimesters and at delivery. The Se content was measured by atomic absorption spectrometry (AAS), plasma MDA concentration by thiobarbituric acid reaction, and Se-dependent GSH-Px spectrometrically. Blood and plasma Se contents of nonpregnant women were below those considered adequate, indicating low selenium intake. In comparison to nonpregnant women, pregnant women had significantly decreased whole-blood and plasma Se levels in the second and third trimesters and at delivery. The significant drop of whole-blood SeGSH-Px activity was observed in the first trimester of pregnancy and its lower activity was maintained until delivery. A significant drop in plasma SeGSH-Px activity occurred in the second trimester and attained the minimal level at delivery. The Se level and SeGSH-Px activity in maternal and umbilical cord blood were at similar levels. Amniotic-fluid SeGSH-Px activity was nondetectable or exceptionally low and its Se content remained unchanged during pregnancy. Plasma levels of MDA were significantly decreased in the second and third trimesters and at delivery. The fetal blood plasma at birth had a lower MDA level compared to the levels of MDA of their mothers at delivery. A low, but significant inverse correlation existed between blood SeGSH-Px activity and plasma MDA content and between plasma Se and plasma MDA contents during pregnancy. A significant decrease of Se and SeGSH-Px activities (antioxidant enzyme) in both blood and plasma suggests a possible drop in total antioxidant status during pregnancy. Elevated MDA plasma levels might be the result of increased lipid peroxidation in placental tissue during pregnancy.     

高龄瘢痕子宫再妊娠孕产妇剖宫产术终止妊娠直接病因及预后影响因素分析

摘要 目的：探讨高龄瘢痕子宫再妊娠孕产妇剖宫产术终止妊娠直接病因及预后影响因素分析。方法：回顾性分析2016年1月-2020年10月在我院收治的400例高龄瘢痕子宫再妊娠孕妇。按照是否终止妊娠将400例孕妇分为终止妊娠组（200例）和未终止妊娠组（200例）。并对200例终止妊娠孕妇进行2年随访,按照2年内再妊娠情况分为再妊娠成功组（150例）和再次终止妊娠组（50例）。采用Spearman检验进行相关性分析;采用logistics回归模型进行回归分析。结果：200例终止妊娠孕妇中瘢痕妊娠60（30.00 %）例,死胎13（6.50 %）例,胎儿畸形25（12.50 %）例,子痫前期81（40.50 %）例,胎膜早破11（5.50%）例,妊娠意外事件10（5.00 %）例。高龄瘢痕子宫孕妇终止妊娠后再妊娠与教育水平、是否有固定职业、家庭月收入无关（P＞0.05）;与年龄、孕次、产次、剖宫产手术史、终止妊娠病因有关（P<0.05）;200例终止妊娠孕妇预后再妊娠与年龄、孕次、产次、剖宫产手术史、终止妊娠病因密切相关（P<0.05）;多因素分析结果显示,年龄、孕次、产次、剖宫产手术史、终止妊娠病因是独立危险因素（P<0.05）。结论：高龄瘢痕子宫孕妇终止妊娠的主要病因为瘢痕妊娠,死胎,胎儿畸形例,子痫前期,胎膜早破,妊娠意外事件。年龄、孕次、产次、剖宫产手术史、终止妊娠病因是影响高龄瘢痕子宫孕妇预后再妊娠的独立危险因素。     

孕妇孕期营养指导及体质量控制对妊娠结局的影响

目的:对孕妇进行孕期营养指导及体质量控制,探究其对妊娠结局的影响。方法:将2011年2月-2014年2月期间我院收治的孕产妇150例纳入本次研究,所有研究对象随机均衡分为研究组和对照组,每组各75例。对照组孕产妇仅行常规妇科检查,研究组孕产妇在医护人员指导下行孕期营养指导和体质量控制,比较两组分娩方式,妊娠过程状况及围产儿情况。结果:研究组剖宫产率为17.33%低于对照组的57.33%,组间差异存在统计学意义(P0.05)。研究组贫血、羊水过少、产后出血率均低于对照组,差异有统计学意义(P0.05)。研究组胎龄及巨大儿及胎儿窘迫率均低于对照组,差异有统计学意义(P0.05)。结论:孕产妇在孕期进行营养膳食指导,控制体质量在合理范围内,可以改善孕妇妊娠结局,降低妊娠过程中并发症发病率,提高围产儿状况,保证孕妇和婴儿健康。     

The possibility of respiratory distress syndrome prevention of premature born children

Pregnant women and premature born children were classified into four groups. In each group there were thirty of them. The first group included the pregnant women with premature rupture of membranes and amniotic fluid effluxed for 72 hours before the delivery. The second group included the pregnant women with amniotic fluid effluxing less then 72 hours before the delivery. The third group included the pregnant women who were given corticosteroids. The forth group was a control group formed by those pregnant women (and their premature born children) whose amniotic fluid did not efflux long and those who weren't given corticosteroids during pregnancy. In all groups of pregnant women we observed: median age of pregnant women, the duration of pregnancy and mode of delivery (vaginal or cesarean section). In groups of premature born children we also observed: newborn birth weight, Apgar score in the first minute after delivery, Apgar score in the fifth minute after delivery, pH of the blood of umbilical cord, L/S ratio of amniotic fluid (lecithin-sphingomyelin ratio), RDS (neonatologist valuation in any degree of RDS developed et newborn child). Symptoms of RDS include tachypnoea, chest wall retraction and cyanosis and a zground glass' appearance of the chest on X-ray. Histopatological examinations of placentas compared the frequency of inflammatory or noninflammatory changes, also in all groups. No significant difference was found among groups of pregnant women for the following factors: the age of pregnant women, the duration of pregnancy and mode of delivery. No significant difference was found among the groups of children for the following factors: newborn birth weight, Apgar score in the fifth minute after delivery, blood pH of umbilical cord, L/S ratio of amniotic fluid. Significant difference was found among groups for the following factors: Apgar score in the first minute after delivery, the frequency of RDS and hystology of placentas. The prevention of premature delivery is the most important. All the pregnant women with symptoms of the premature delivery must be transported to the centers with the well developed unites of intensive neonatal care ("transport in utero").     

The evaluation of prevalence and the impact of pathological microflora of the lower genital tract among women at early pregnancy on the risk of preterm delivery

The main aim of this prospective study was to determine the prevalence and an association between pathological microflora of the lower genital tract diagnosed at early pregnancy and the risk of preterm delivery. The study group comprised 179 randomly selected pregnant women from Lodz region, between 8 and 16 week of pregnancy. For the qualitative and quantitative assessment of biocenosis of the lower genital tract vaginal and cervical swabs were collected from the pregnant women under study. The C. trachomatis antigen was detected by direct immunofluorescence assay. The vaginal swabs were tested for aerobic and anaerobic bacteria. Bacterial vaginosis was diagnosed by Gram stain according to Spiegel's criteria. To evaluate the risk factors odds ratios were calculated using EPI INFO software. 21 (11.7%) women delivered before 37th week of pregnancy. Bacterial vaginosis was diagnosed among 51 (28.5%) pregnant women while intermediate microflora was diagnosed by Gram stain in 62 (34.6%) women. The shortest mean gestational age at delivery was noted among women with BV. The rate of preterm delivery in BV group was 15.7% comparing to 9.1% among women with normal microflora. Among women with preterm delivery BV was diagnosed in 38.1% (OR = 1.86). Based on culture results only 84 (46.9%) women had normal microflora at early pregnancy. The pathological culture was associated with slightly increased preterm delivery rate (12.6%) as compare to 10.7% in control group. Positive culture for Bacteroides and Mobiluncus was connected with nonstatistical rise in the risk of preterm delivery. No association between C. trachomatis infection at early pregnancy and elevated risk of preterm delivery was found. Early pregnancy diagnosis of bacterial vaginosis and its treatment should lower the rate of prematurity in Poland.     

IL-12, IL-6 and IFN-gamma production by lymphocytes of pregnant women with rheumatoid arthritis remission during pregnancy

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease with progressive activity. The RA remission was observed in women during pregnancy, but the mechanism responsible for remission is hypothetical only and concerns mechanisms of immune regulation such as lymphocyte subpopulations and interleukin production. AIMS: The lymphocyte subpopulations and interleukin production in vitro in a group of healthy non-pregnant women, healthy pregnant women and pregnant women suffering from RA may help towards a better understanding of regulation of the immune processes. METHODS: The investigations were performed in trimester III--2 days after delivery and 6 weeks after delivery. Peripheral blood lymphocytes were isolated on Gradisol gradient and analysed immediately or after having been cultured for 72 hours in RPMI medium supplemented with 10% FCS. The cultures were terminated after 72 h, supernatants stored at -72 degrees C for interleukin evaluation. The concentrations of IFN-gamma, IL-2, IL-6, IL-12, TNF-alpha and its soluble receptors R-I, R-II were estimated in non-stimulated and PHA (Sigma, 5 microg/ml) stimulated culture supernatants using ELISA Endogen kits according to the manufacturer''s instructions. RESULTS: The general pattern of T cell subpopulation distribution was similar in all analysed groups. Decreased IFN-gamma, IL-12 and increased IL-6 production by lymphocytes after PHA stimulation was found in trimester III in pregnant women with RA as compared to healthy pregnant woman. CONCLUSION: The obtained results suggest that in pregnant women with RA the TH1 cell response predominates, contrary to healthy pregnant women with TH2 type functional response. These phenomena were not observed after delivery.     

Increase of serum somatomedin C in hyperthyroid patients with pregnancy.

In thyrotoxic women with pregnancy, serum somatomedin C (SmC) concentration was markedly elevated (mean +/- SD 13.57 +/- 4.66 U/ml) compared to thyrotoxic women without pregnancy (1.24 +/- 1.09 U/ml), non-pregnant euthyroid women previously treated for hyperthyroidism (0.87 +/- 0.30 U/ml), normal subjects with pregnancy (6.08 +/- 3.36 U/ml) and pregnant euthyroid women previously treated for hyperthyroidism (5.98 +/- 1.52 U/ml). Since SmC/growth hormone ratio was significantly more in thyrotoxic pregnant women than in normal pregnant women and euthyroid pregnant women previously treated for hyperthyroidism, and since human placental lactogen (HPL), human chorionic gonadotropin (HCG) and prolactin (PRL) do not crossreact with SmC antibody, it is suggested that excess thyroid hormone during pregnancy results in excessive hepatic somatomedin C production.     

Oxidative stress is closely related to clinical severity of pre-eclampsia

Pre-eclampsia is a hypertensive disorder of pregnancy in which enzymatic antioxidant defenses fail and tissues are injured. This prospective case-control study evaluated whether pre-eclamptic women and their newborns show higher degrees of oxidative stress than normal pregnancies and sought to determine if this stress is related to clinical severity. Forty-four pre-eclamptic and thirty healthy pregnant women attending two hospitals in Valparaíso, Chile, were studied. The following plasmatic variables of antioxidant capacity were evaluated: glutathione peroxidase activity (GPx), total antioxidant capacity measured by oxidation of ABTS substrate (2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid), and superoxide dismutase activity (SOD). malondialdehide (MDA) was measured to evaluate lipoperoxidation. The evaluation was performed at diagnosis of pre-eclampsia, delivery, 30 days and 120 days post delivery. Newborns were studied at delivery through umbilical cord blood samples. Our analysis shows that antioxidant enzyme activity (SOD, GPx, ABTS) was significantly decreased, while lipoperoxidation (MDA) was increased in both pre-eclamptic groups compared to normal pregnant women (p<0.01). Statistically significant difference was found between mild and severe pre-eclamptic groups (p<0.01), for all biochemical markers studied. Therefore, the clinical severity of this pathology is closely related to the degree of oxidative stress.     

Association of cytokines in hepatitis E with pregnancy outcome

AimsThe aim of this study was to evaluate tumour necrosis factor-alpha (TNF-α), interleukin (IL)-6, interferon gamma (IFN-γ) and transforming growth factor-beta1 (TGF-β1) in hepatitis E infection during pregnancy and its relation with pregnancy outcome.MethodsA total of 272 pregnant and 219 non-pregnant women with hepatitis and 262 age and gestational age matched healthy pregnant women and 208 age matched, healthy non-pregnant women were evaluated on the basis of history, clinical examination, liver function profile. Serological tests of hepatitis A, B, C and E and cytokines using commercially available (ELISA) kits. The patients with hepatitis E were further evaluated for viral load by Real Time PCR. All these were followed till delivery for pregnancy outcome.ResultsHEV viral load in acute viral hepatitis (AVH) and fulminant hepatic failure (FHF) of pregnant women were comparatively higher than non-pregnant women. Significantly higher levels of TNF-α, IL-6, IFN-γ and TGF-β1 were present in HEV infected pregnant women compared to non-pregnant women and controls. TNF-α, IL-6 and IFN-γ had significant positive correlation with viral load, serum bilirubin and prothrombin time in pregnant women. Higher levels of all four cytokines were found in pregnant women with HEV infection having adverse pregnancy outcome compared to that of pregnant women with non-HEV infection and controls.ConclusionIn conclusion, severity of HEV infection and associated adverse pregnancy outcome might be mediated by cytokine in pregnancy.     

Socio-demographic characteristics and lifestyle habits of pregnant women smokers

The aim of this study was to describe anthropometric, clinical, socio-demographic characteristics and lifestyle habits of pregnant smokers in comparison to pregnant nonsmokers. During years 1999-2003, 1,435 pregnant smokers and 4,772 pregnant nonsmokers were interviewed after delivery with a questionnaire. They were recorded clinical, anthropometric and socio-demographic data, smoking status, labor outcome, maternal and fetal hemoglobin concentrations for each patient. The two groups were comparable in anthropometric and clinical characteristics, duration of pregnancy and mode of delivery, except for birth weights, which were significantly lower in newborns of smokers. Maternal hemoglobin concentrations were significantly lower in smokers, but fetal hemoglobin concentrations were significantly higher in babies of smokers. The proportion of pregnant women who smoked during pregnancy was higher among urban women, among women with lower educational level and among unemployed subjects in comparison with nonsmokers. The pregnant women who smoked during pregnancy were more often caffeine and alcohol consumers. To further reduce smoking during pregnancy it is important to continue to promote smoking cessation among teenagers.     

妊娠期糖尿病患者妊娠中期体质指数水平对分娩结局的影响

目的:研究妊娠期糖尿病患者妊娠中期体质指数(BMI)水平对妊娠结局的影响。方法:选取2012年1月到2014年11月我院产检诊断为妊娠期糖尿病患者390例,根据患者的妊娠中期BMI水平由低到高依次将患者分为三组:I组119例,II组165例,III组106例,随访所有入选者至分娩,观察其分娩结局。结果:III组妊娠晚期出现巨大胎儿者24例,占22.64%,羊水过多者为26例,占24.53%,显著高于I组和II组,比较差异具有统计学意义(P0.05);III组出现妊娠期高血压者8例,占7.55%,新生儿窒息者4例,占3.77%,与I组和II组比较差异无统计学意义(P0.05)。结论:妊娠期糖尿病患者妊娠中期BMI较高者发生巨大儿和羊水过多的比率显著增加,应该适当控制妊娠期糖尿病患者的BMI水平。     

Depressive and anxiety symptoms in the early puerperium are related to increased degradation of tryptophan into kynurenine,a phenomenon which is related to immune activation

There is now some evidence that i) the availability of plasma tryptophan, the precursor of serotonin, is significantly lower in pregnant women at the end of term and the first few days after delivery than in nonpregnant women; and ii) both pregnancy and the early puerperium are accompanied by activation of the inflammatory response system. The aims of the present study were to examine the effects of pregnancy and delivery on plasma kynurenine, a major tryptophan catabolite synthesized after induction of indoleamine-2, 3 dioxygenase (IDO) by pro-inflammatory cytokines. We measured plasma kynurenine and tryptophan and immune markers, such as serum interleukin-6 (IL-6), IL-8 and the leukemia inhibitory factor-receptor (LIF-R) in healthy, nonpregnant and pregnant women at the end of term and one and three days after delivery. Plasma kynurenine was significantly lower in pregnant women at the end of term than in nonpregnant women, findings which may be attributed to lower plasma tryptophan at the end of term. The kynurenine/tryptophan (K/T) quotient was significantly higher in the pregnant women at the end of term and in the early puerperium than in nonpregnant women. In the early puerperium there was a significant increase in plasma kynurenine and the K/T quotient. The increases in plasma kynurenine and the K/T quotient were significantly more pronounced in women whose anxiety and depression scores significantly increased in the puerperium. The changes from the end of term to the early puerperium in plasma kynurenine and the K/T quotient were significantly related to those in the immune markers. It is concluded that 1) lower plasma kynurenine at the end of term is the consequence of lower plasma tryptophan; 2) the increased K/T quotient at the end of term and in the early puerperium indicates inflammation-induced degradation of tryptophan along the kynurenine pathway; and 3) that depressive and anxiety symptoms in the early puerperium are (causally) related to an increased catabolism of tryptophan into kynurenine, a phenomenon which probably results from immune activation.     

Low Rate of Pandemic A/H1N1 2009 Influenza Infection and Lack of Severe Complication of Vaccination in Pregnant Women: A Prospective Cohort Study

Background

In 2009, pregnant women were specifically targeted by a national vaccination campaign against pandemic A/H1N1 influenza virus. The objectives of the COFLUPREG study, initially set up to assess the incidence of serious forms of A/H1N1 influenza, were to assess the consequences of maternal vaccination on pregnancy outcomes and maternal seroprotection at delivery.

Methods

Pregnant women, between 12 and 35 weeks of gestation, non vaccinated against A/H1N1 2009 influenza were randomly selected to be included in a prospective cohort study conducted in three maternity centers in Paris (France) during pandemic period. Blood samples were planned to assess hemagglutination inhibition (HI) antibody against A/H1N1 2009 influenza at inclusion and at delivery.

Results

Among the 877 pregnant women included in the study, 678 (77.3%) had serum samples both at inclusion and delivery, and 320 (36.5%) received pandemic A/H1N1 2009 influenza vaccine with a median interval between vaccination and delivery of 92 days (95% CI 48–134). At delivery, the proportion of women with seroprotection (HI antibodies titers against A/H1N1 2009 influenza of 1∶40 or greater) was 69.9% in vaccinated women. Of the 422 non-vaccinated women with serological data, 11 (2.6%; 95%CI: 1.3–4.6) had laboratory documented A/H1N1 2009 influenza (1 with positive PCR and 10 with serological seroconversion). None of the 877 study’s women was hospitalized for flu. No difference on pregnancy outcomes was evidenced between vaccinated women, non-vaccinated women without seroconversion and non-vaccinated women with flu.

Conclusion

Despite low vaccine coverage, incidence of pandemic flu was low in this cohort of pregnant women.No effect on pregnancy and delivery outcomes was evidenced after vaccination.