Garlic Ingestion by Pregnant Women Alters the Odor of Amniotic Fluid

Amniotic fluid samples were obtained from 10 pregnant womenundergoing routine amniocentesis procedure. Approximately 45min prior to the procedure, five of the women ingested placebocapsules, whereas the remaining five ingested capsules containingthe essential oil of garlic. Randomly selected pairs of samples,one from a woman who ingested garlic and the other from a womanwho ingested placebo capsules, were then evaluated by a sensorypanel of adults. The odor of the amniotic fluid obtained fromfour of the five women who had ingested the garlic capsuleswas judged to be stronger or more like garlic than the pairedsamples collected from the women consuming placebo capsules.Thus, garlic ingestion by pregnant women significantly altersthe odor of their amniotic fluid.     

347例妊娠期肝内胆汁淤积症羊水性状与妊娠结局的分析

目的:探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy ICP)羊水性状与妊娠结局的关系。方法:对我院2005年1月～2009年12月住院分娩的患者资料进行回顾分析,统计羊水污染率、新生儿窒息发生率、围产儿死亡率及剖宫产率等。结果:347例ICP中轻度278例,重度69例。羊水污染89例(Ⅰ级19例,Ⅱ级14例,Ⅲ级56例),羊水污染率为25.6%。重度ICP中羊水污染46例,发生率为66.7%。89例ICP羊水Ⅱ级及Ⅲ级病例中出现3例新生儿窒息。结论:ICP的羊水性状与病情程度基本一致,羊水污染预示着不良的妊娠结局,适时终止妊娠可降低围生儿病率。     

347例妊娠期肝内胆汁淤积症羊水性状与妊娠结局的分析

目的:探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy ICP)羊水性状与妊娠结局的关系.方法:对我院2005年1月～2009年12月住院分娩的患者资料进行回顾分析,统计羊水污染率、新生儿窒息发生率、围产儿死亡率及剖宫产率等.结果:347例ICP中轻度278例,重度69例.羊水污染89例(Ⅰ级19例,Ⅱ级14例,Ⅲ级56例),羊水污染率为25.6％.重度ICP中羊水污染46例,发生率为66.7％.89例ICP羊水Ⅱ级及Ⅲ级病例中出现3例新生儿窒息.结论:ICP的羊水性状与病情程度基本一致,羊水污染预示着不良的妊娠结局,适时终止妊娠可降低围生儿病率.     

Fructose Levels Are Markedly Elevated in Cerebrospinal Fluid Compared to Plasma in Pregnant Women

Background

Fructose, unlike glucose, promotes feeding behavior in rodents and its ingestion exerts differential effects in the human brain. However, plasma fructose is typically 1/1000th of glucose levels and it is unclear to what extent fructose crosses the blood-brain barrier. We investigated whether local endogenous central nervous system (CNS) fructose production from glucose via the polyol pathway (glucose→sorbitol→fructose) contributes to brain exposure to fructose.

Methods

In this observational study, fasting glucose, sorbitol and fructose concentrations were measured using gas-chromatography-liquid mass spectroscopy in cerebrospinal fluid (CSF), maternal plasma, and venous cord blood collected from 25 pregnant women (6 lean, 10 overweight/obese, and 9 T2DM/gestational DM) undergoing spinal anesthesia and elective cesarean section.

Results

As expected, CSF glucose was ~60% of plasma glucose levels. In contrast, fructose was nearly 20-fold higher in CSF than in plasma (p < 0.001), and CSF sorbitol was ~9-times higher than plasma levels (p < 0.001). Moreover, CSF fructose correlated positively with CSF glucose (ρ 0.45, p = 0.02) and sorbitol levels (ρ 0.75, p < 0.001). Cord blood sorbitol was also ~7-fold higher than maternal plasma sorbitol levels (p = 0.001). There were no differences in plasma, CSF, and cord blood glucose, fructose, or sorbitol levels between groups.

Conclusions

These data raise the possibility that fructose may be produced endogenously in the human brain and that the effects of fructose in the human brain and placenta may extend beyond its dietary consumption.     

Performance of Polymerase Chain Reaction Analysis of the Amniotic Fluid of Pregnant Women for Diagnosis of Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis

IntroductionCongenital infection caused by Toxoplasma gondii can cause serious damage that can be diagnosed in utero or at birth, although most infants are asymptomatic at birth. Prenatal diagnosis of congenital toxoplasmosis considerably improves the prognosis and outcome for infected infants. For this reason, an assay for the quick, sensitive, and safe diagnosis of fetal toxoplasmosis is desirable.GoalTo systematically review the performance of polymerase chain reaction (PCR) analysis of the amniotic fluid of pregnant women with recent serological toxoplasmosis diagnoses for the diagnosis of fetal toxoplasmosis.MethodA systematic literature review was conducted via a search of electronic databases; the literature included primary studies of the diagnostic accuracy of PCR analysis of amniotic fluid from pregnant women who seroconverted during pregnancy. The PCR test was compared to a gold standard for diagnosis.ResultsA total of 1.269 summaries were obtained from the electronic database and reviewed, and 20 studies, comprising 4.171 samples, met the established inclusion criteria and were included in the review. The following results were obtained: studies about PCR assays for fetal toxoplasmosis are generally susceptible to bias; reports of the tests’ use lack critical information; the protocols varied among studies; the heterogeneity among studies was concentrated in the tests’ sensitivity; there was evidence that the sensitivity of the tests increases with time, as represented by the trimester; and there was more heterogeneity among studies in which there was more time between maternal diagnosis and fetal testing. The sensitivity of the method, if performed up to five weeks after maternal diagnosis, was 87% and specificity was 99%.ConclusionThe global sensitivity heterogeneity of the PCR test in this review was 66.5% (I²). The tests show low evidence of heterogeneity with a sensitivity of 87% and specificity of 99% when performed up to five weeks after maternal diagnosis. The test has a known performance and could be recommended for use up to five weeks after maternal diagnosis, when there is suspicion of fetal toxoplasmosis.     

Hypocalcemia in Pregnant Women

The objective of this study is to estimate the prevalence of hypocalcemia and its correlation with dietary intake of calcium (DICa) and urinary calcium excretion (UCaE) in pregnant women. Healthy pregnant women (n = 543) were enrolled consecutively. DICa was calculated form dietary history. Serum calcium (SCa) and 24-h UCaE was measured. Student t test and Chi-square tests were used to compare the continuous and categorical data in women with and without hypocalcemia (SCa ≤ 8.7 mg/dL). Linear regression was applied for determining the independent variables for hypocalcemia. The age and gestation (mean ± SD) were 21.9 ± 2.5 years and 18.0 ± 3.5 weeks, respectively. The body mass index (BMI; mean ± SD) was 23.3 ± 3.9 kg/m². Seventy-one percent women had an education of less than 10 years. The DICa and SCa were 325 ± 198 mg and 8.1 ± 1.5 mg/dL, respectively. The prevalence of hypocalcemia was 66.4% (362/545); all being asymptomatic. There was no significant difference in women with and without hypocalcemia in terms of weight, BMI, monthly family income, DICa, UCaE, and their obstetric outcome. Daily dietary calcium intake was less than the recommended dietary allowances. There was a high prevalence of asymptomatic hypocalcemia in pregnant women of low socio-economic status which was unrelated to their overall nutritional status and daily calcium intake. It did not have any adverse effect on the immediate pregnancy outcome.     

Evidence of Subclinical mtDNA Alterations in HIV-Infected Pregnant Women Receiving Combination Antiretroviral Therapy Compared to HIV-Negative Pregnant Women

Introduction

Combination antiretroviral therapy (cART) can effectively prevent vertical transmission of HIV but there is potential risk of adverse maternal, foetal or infant effects. Specifically, the effect of cART use during pregnancy on mitochondrial DNA (mtDNA) content in HIV-positive (HIV+) women is unclear. We sought to characterize subclinical alterations in peripheral blood mtDNA levels in cART-treated HIV+ women during pregnancy and the postpartum period.

Methods

This prospective longitudinal observational cohort study enrolled both HIV+ and HIV-negative (HIV-) pregnant women. Clinical data and blood samples were collected at three time points in pregnancy (13-<23 weeks, 23-<30 weeks, 30–40 weeks), and at delivery and six weeks post-partum in HIV+ women. Peripheral blood mtDNA to nuclear DNA (nDNA) ratio was measured by qPCR.

Results

Over a four year period, 63 HIV+ and 42 HIV- women were enrolled. HIV+ women showed significantly lower mtDNA/nDNA ratios compared to HIV- women during pregnancy (p = 0.003), after controlling for platelet count and repeated measurements using a multivariable mixed-effects model. Ethnicity, gestational age (GA) and substance use were also significantly associated with mtDNA/nDNA ratio (p≤0.02). Among HIV+ women, higher CD4 nadir was associated with higher mtDNA/nDNA ratios (p<0.0001), and these ratio were significantly lower during pregnancy compared to the postpartum period (p<0.0001).

Conclusions

In the context of this study, it was not possible to distinguish between mtDNA effects related to HIV infection versus cART therapy. Nevertheless, while mtDNA levels were relatively stable over time in both groups during pregnancy, they were significantly lower in HIV+ women compared to HIV- women. Although no immediate clinical impact was observed on maternal or infant health, lower maternal mtDNA levels may exert long-term effects on women and children and remain a concern. Improved knowledge of such subclinical alterations is another step toward optimizing the safety and efficacy of cART regimens during pregnancy.     

羊水栓塞妊娠大鼠血清中PLA2和PAF的水平变化研究

摘要 目的：探讨羊水栓塞妊娠大鼠血清中PLA2和PAF的水平变化。方法：30只健康妊娠大鼠均分为生理盐水组（A组）、羊水组（B组）及羊水胎粪混合组（C组）。将健康妊娠大鼠麻醉,麻醉效果生成后,全部切除大鼠子宫后关腹,分离出左颈总动脉,并将二通道生理记录仪与其连接,连续监测血液动力学指标,随后将生理盐水、羊水和羊水胎粪混合液腹腔静脉注射于大鼠,1小时后取大鼠肺组织,用HE、APK染色结合CK16免疫组织化学法来检测模型是否制作成功。实验前后1小时两个取血点时,在制备好的羊水栓塞模型大鼠左颈动脉插管处各取1 mL血。采取酶联免疫检测法,测定血清、羊水及羊水胎粪混合液中 PLA2、PAF 的含量。获得的数据用SPSS 20.0软件进行处理,采用配对 t 检验、协方差分析及相关回归分析对血清PLA2、PAF 的浓度进行分析。结果：B组和C组的3个血液动力学指标（动脉收缩压、舒张压及平均动脉压）均显著低于A组（P<0.05）,而B组与C组的4个血液动力学指标均无显著性差异（P>0.05）。同时,A组、B组与C组之间在心率改变方面无显著性差异（P>0.05）。HE染色中,B组与C组大鼠的肺间质显著变宽,且有充血、水肿及炎性细胞浸润,而A组无此现象。AMP染色中,B组和C组大鼠的肺小管中可见被染成蓝色的不定形物质和桃红色的角化鳞状上皮,而A组无此现象。CK16染色中,B组和C组大鼠的肺小管中,可以看到被染成黄色的颗粒和鳞状上皮,而A组无此现象。实验1小时后所取血液中,B组和C组的PLA2与PAF的含量显著高于A组（P<0.05）,且C组中升高程度更大。妊娠大鼠羊水与羊水胎粪混合液中均检测到PLA2和PAF,且羊水胎粪混合液中二者的含量均高。实验1小时前所取的血液中,PLA2和PAF浓度无相关性（P=0.762,R=0.012）,而实验1小时后所取血液中,PLA2和PAF浓度呈正相关关系（P=0.002,R=0.437）。结论：羊水栓塞妊娠模型大鼠羊水和胎粪中均有PLA2和PAF,且实验1小时后所取血液中,PLA2和PAF含量在B组和C组中显著高于A组,说明羊水和胎粪中含有使PLA2、PAF水平增高的刺激因子。     

Extrapolation of Rodent Studies on Amniotic Fluid Contaminatnts to Human Populations

If endocrine active chemicals (EACs) adversely affect human development, then there must be evidence of effects in animal models at properly scaled levels of exposure during pertinent sensitive periods as derived from quantified exposures of the human fetus. Our recent studies attempt to address both effects and exposures. First Study: Dams were gavaged from Gestation Day (GD) 14 through weaning on Post-Natal Day (PND) 21 with either corn oil alone (unexposed controls) or Low DES (0.5?mg/kg BW); High DES (5.0?mg/kg BW); GEN (15?mg/kg BW); GEN + DES (GEN at 15?mg/kg BW and DES at 0.5?mg/kg BW). No treatments affected duration of gestation, litter size or birth anogenital distance / birth body weights ((bAGD/bBW) or ratios of bAGD/cube root of bBW of pups of either sex. The ratio of weaning AGD to weaning body weight (wAGD/wBW) differed significantly between the control group and each of the estrogenic treatments in both sexes with larger wAGD/wBW values associated with each of the estrogenic treatments. Males exposed to High DES and GEN alone exhibited earlier onset of puberty. Only females in the low DES group showed an earlier onset of puberty. At 50 to 70 days of age, the ratios of male reproductive organ weights/body weight were unaffected by estrogen treatment in all groups except high DES which increased testicle weight and decreased epididymis, seminal vesicle, and prostate weights. Initial vaginal cycle lengths were affected only in the high DES group. Thus low doses of DES and GEN at levels comparable to the upper range of human exposure affect some but not all markers of sexual development. Second Study: Amniotic fluid samples obtained at routine amniocentesis between 15 and 23 weeks of gestation were assayed by gas chromatographic/mass spectrometric (GC/MS) analysis. The first group of amniotic fluid samples (n = 53) from 51 women were analysed for several xenobiotic EACs. Alpha-hexachlorocyclohexane, with a mean (± SD) concentration of 0.15 ± 0.06 (ng/ml), and p,p′-DDE, with a mean (± SD) concentration of 0.21 ± 0.18?ng/ ml, were detected in several specimens. Overall one in three amniotic fluid samples tested positive for at least one xenobiotic EAC. Another group of amniotic fluid samples (n = 62) from 56 women were analysed for phytoestrogenic EACs. The mean (± SD) concentration of daidzein and genistein in amniotic fluid were 1.14 ± 1.04 and 1.37 ± 1.00?ng/ml with maximum levels of 5.52 and 4.86?ng/ml, respectively. Overall, 26 and 34 of the samples had quantifiable levels of daidzein and genistein, respectively. Conclusions: One in three human fetuses were exposed to xenobiotic EACs and two of three human fetuses were exposed to phytoestrogenic EACs in utero. Our demonstrations that EACs have developmental effects in an animal model at levels of exposure that mimic those found in humans in North America during sensitive time-frames sustains concerns about potential adverse health effects of developmental exposures to EACs for the human fetus/neonate.     

早期妊娠妇女人工流产的因素调查

目的：了解早期妊娠行人工流产妇女的人群特征,探讨导致妇女人工流产的相关因素,为减少非意愿妊娠提供干预依据。方法：采用整群抽样方法,对丰台区四家二级医院计划生育门诊同期行人工流产的妇女进行问卷调查。结果：共回收调查问卷4381份。调查对象中,平均年龄26岁（16．54岁）,本市户籍占26．8％,外地户籍73．2％;已婚65．33％,未婚34．67％;文化程度初、高中占62．5％;职业列前三位的分别是服务员23．5％、公司职员18．2％、个体工商户10．5％;重复流产为37-3％。非意愿妊娠占83．24％,,非意愿妊娠的原因,39．53％是未避孕,43．71％为避孕失败,而避孕失败的原因中又以避孕套避孕失败居首;意愿妊娠占Ⅲ6．7鹞％,最终选择终止妊娠的原因分别为个人工作因素、情感因素及优生考虑。结论i为降低l妇女非意愿妊娠及重复流产率,对育龄妇女,尤其是流动、未婚人群,需广泛开展性健康教育及避孕方式知情选择,加强避孕知识以及人工流产危害的宣教,指导避孕方法的正确使用,同时,各级医院亟待开展流产后服务。