Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II.

OBJECTIVES--To define relation between mood and concentrations of progesterone and cortisol during perinatal period to test hypothesis that rapid physiological withdrawal of steroid hormones after delivery is associated with depression. DESIGN--Prospective study of primiparous women from two weeks before expected date of delivery to 35 days postpartum. SETTING--Antenatal clinic in university hospital, obstetric inpatient unit, patients'' homes. SUBJECTS--120 of 156 primiparous women interviewed. Remainder excluded because of major marital, socioeconomic, or medical problems or because caesarean section required. MAIN OUTCOME MEASURES--Concentrations of progesterone and cortisol in saliva samples; women''s moods assessed by various scores for depression. RESULTS--Changes in salivary progesterone and cortisol concentrations were similar to those already characterised for plasma. Peak mean score for maternity blues (5.3 on Stein scale) was on day five postpartum (P < 0.02 compared with mean scores on other postpartum days). High postpartum scores for maternity blues were associated with high antenatal progesterone concentrations on day before delivery (P < 0.05), with high rate of rise of antenatal progesterone concentrations (P < 0.05), with decreasing progesterone concentrations from day of delivery to day of peak blues score (P > or = 0.01), and with low progesterone concentrations on day of peak blues score (P < 0.01). Seventy eight women were designated as having maternity blues (peak score > or = 8 on Stein scale) while 39 had no blues. Women with blues had significantly higher antenatal progesterone concentrations and lower postnatal concentrations than women without blues (geometric mean progesterone concentrations: one day before delivery 3860 pmol/l v 3210 pmol/l respectively, P = 0.03; ten days postpartum 88 pmol/l v 114 pmol/l, P = 0.048). Cortisol concentrations were not significantly associated with mood. CONCLUSION--Maternal mood in the days immediately after delivery is related to withdrawal of naturally occurring progesterone.     

The Bristol third stage trial: active versus physiological management of third stage of labour.

OBJECTIVE--To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant (physiological) management, in particular to determine whether active management reduced incidence of postpartum haemorrhage. DESIGN--Randomised trial of active versus physiological management. Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery. Five months into trial high rate of postpartum haemorrhage in physiological group (16.5% v 3.8%) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management. Sample size of 3900 was planned, but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped. SETTING--Maternity hospital. PARTICIPANTS--Of 4709 women delivered from 1 January 1986 to 31 January 1987, 1695 were admitted to trial and allocated randomly to physiological (849) or active (846) management. Reasons for exclusion were: refusal, antepartum haemorrhage, cardiac disease, breech presentation, multiple pregnancy, intrauterine death, and, after May 1986, ritodrine given two hours before delivery, anticoagulant treatment, and any condition needing a particular management of third stage. INTERVENTIONS--All but six women allocated to active management actually received it, having prophylactic oxytocic, cord clamping before placental delivery, and cord traction; whereas just under half those allocated to physiological management achieved it. A fifth of physiological group received prophylactic oxytocic, two fifths underwent cord traction and just over half clamping of the cord before placental delivery. ENDPOINT--Reduction in incidence of postpartum haemorrhage from 7.5% under physiological management to 5.0% under active management. MEASUREMENTS AND MAIN RESULTS--Incidence of postpartum haemorrhage was 5.9% in active management group and 17.9% in physiological group (odds ratio 3.13; 95% confidence interval 2.3 to 4.2), a contrast reflected in other indices of blood loss. In physiological group third stage was longer (median 15 min v 5 min) and more women needed therapeutic oxytocics (29.7% v 6.4%). Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups. Babies in physiological group weighed mean of 85 g more than those in active group. When women allocated to and receiving active management (840) were compared with those who actually received physiological management (403) active management still produced lower rate of postpartum haemorrhage (odds ratio 2.4;95% CI1.6 to 3.7). CONCLUSIONS--Policy of active management practised in this trial reduces incidence of postpartum haemorrhage, shortens third stage, and results in reduced neonatal packed cell volume.     

The origin of circulating 13,14-dihydro-15-keto-prostaglandin F2α during delivery

All uterine tissues as well as the fetal membranes and the placenta can form prostaglandins from endogenous precursors but it is not clear which of the tissues is the main site for the increase in PGF_2α production during human parturition. To examine this question, we measured plasma prostaglandin levels before and at intervals after expulsion of the fetus, placenta, and membranes. The concentration of PGFM at the beginning of the second stage of labor was significantly higher than before the onset of labor. Five minutes after the birth of the infant, the concentration had doubled. Thirty minutes after the expulsion of placenta and membranes, plasma PGFM had fallen to the levels at full dilatation; two hours postpartum it was still significantly raised over levels before labor. Since the halflife of PGFM in the circulation is about 7 minutes, these findings indicate that the uterine tissues are important sources of PGFM during labor. In contrast, endogenous oxytocin levels, which were significantly raised over control levels at the second stage of labor, did not change during the third stage, and decline postpartum to control levels. Oxytocin infusion did not influence PGFM levels at 5 and at 30 minutes postpartum, but raised them at 2 hours.     

Plasma kisspeptin is raised in patients with gestational trophoblastic neoplasia and falls during treatment

Kisspeptin is a 54-amino acid peptide, encoded by the anti-metastasis gene KiSS-1, that activates G protein-coupled receptor 54 (GPR54). The kisspeptin-GPR54 system is critical to normal reproductive development. KiSS-1 gene expression is increased in the human placenta in normal and molar pregnancies. Circulating kisspeptin is dramatically increased in normal pregnancy, but levels in GTN have not previously been reported. The present study was designed to determine whether plasma kisspeptin levels are altered in patients with malignant GTN. Thirty-nine blood samples were taken from 11 patients with malignant GTN at presentation during and after chemotherapy. Blood was also sampled from nonpregnant and pregnant volunteers. Plasma kisspeptin IR and hCG concentrations were measured. Plasma kisspeptin IR concentration in nonpregnant (n = 16) females was <2 pmol/l. Plasma kisspeptin IR in females was 803 +/- 125 pmol/l in the first trimester of pregnancy (n = 13), 2,483 +/- 302 pmol/l in the third trimester of pregnancy (n = 7), and <2 pmol/l on day 15 postpartum (n = 7). Plasma kisspeptin IR and hCG concentrations in patients with malignant GTN were elevated at presentation and fell during and after treatment with chemotherapy in each patient (mean plasma kisspeptin IR: prechemotherapy 1,363 +/- 1,076 pmol/l vs. post-chemotherapy <2 pmol/l, P < 0.0001; mean plasma hCG: prechemotherapy 227,191 +/- 152,354 U/l vs. postchemotherapy 2 U/l, P < 0.0001). Plasma kisspeptin IR strongly positively correlated with plasma hCG levels (r(2) = 0.99, P < 0.0001). Our results suggest that measurement of plasma kisspeptin IR may be a novel tumor marker in patients with malignant GTN.     

Plasma atrial natriuretic peptide and cyclic nucleotide levels before and after a marathon

Plasma alpha-atrial natriuretic peptide (alpha-ANP) concentration and levels of cyclic nucleotides [guanosine 3',5'-cyclic monophosphate (cGMP) and adenosine 3',5'-cyclic monophosphate (cAMP)] were studied in 23 runners before and after a marathon race. Blood samples were drawn from an antecubital vein the morning before the race (base line), at 3 P.M. (i.e., 2 h before the start), on arrival, and 12 and 36 h and 7 days later. Compared with the base-line values of plasma alpha-ANP (5 pmol/l), cGMP (3.8 nmol/l), and cAMP (15.8 nmol/l), the plasma levels of alpha-ANP, cGMP, and cAMP were increased immediately after the marathon, respectively, to 12.0 pmol/l, 12.7 nmol/l, and 50.5 nmol/l. The increase in the plasma alpha-ANP concentration was related (r = 0.85; P less than 0.001) to the changes in plasma cGMP, plasma lactate, hematocrit, and body weight. The plasma cGMP and cAMP concentrations had returned to the prerace levels 12 h after the marathon, whereas the plasma alpha-ANP concentration was significantly lower (3.1 pmol/l) than the base-line values and increased above the prerace values 36 h (7.5 pmol/l) and 7 days (6.8 pmol/l) after the marathon. The plasma cGMP level was also higher 36 h (5.4 nmol/l) and 7 days (5.0 nmol/l) after the marathon race.     

Randomised controlled trial of oxytocin alone versus oxytocin and ergometrine in active management of third stage of labour.

OBJECTIVE--To compare intramuscular oxytocin alone and intramuscular oxytocin with ergometrine (Syntometrine) for their effect in reducing the risk of postpartum haemorrhage when both are used as part of the active management of the third stage of labour. DESIGN--Double blind, randomised controlled trial. SETTING--Two metropolitan teaching hospitals in Perth, Western Australia. SUBJECTS--All women who expected a vaginal birth during the period of the trial. Informed consent was obtained. MAIN OUTCOME MEASURES--Postpartum haemorrhage, nausea, vomiting, and increased blood pressure. RESULTS--3497 women were randomly allocated to receive oxytocin-ergometrine (n = 1730) or oxytocin (n = 1753). Rates of postpartum haemorrhage (> or = 500 ml or > or = 1000 ml) were similar in both arms (odds ratio 0.90 (0.82); 95% confidence interval 0.75 to 1.07 (0.59 to 1.14) at 500 ml (1000 ml) threshold). The use of oxytocin-ergometrine was associated with nausea, vomiting, and increased blood pressure. CONCLUSIONS--There are few advantages but several disadvantages for the routine use of oxytoxinergometrine when prophylactic active management of the third stage of labour is practised. Further investigation of dose-response for oxytocin may be warranted.     

Consequences of fetomaternal haemorrhage after intrauterine transfusion.

Fetomaternal haemorrhage was studied after 68 consecutive fetal intravascular transfusions performed in 20 patients with Rh isoimmunisation. alpha Fetoprotein concentration was assayed in maternal blood taken before, and immediately after each transfusion and three and 24 hours later. An increase of 50% or more in the concentration in any of the samples after transfusion was considered to indicate fetomaternal haemorrhage. Fetal alpha fetoprotein concentration in blood sampled before transfusion was also assayed and the amount of fetomaternal haemorrhage calculated. Fetomaternal haemorrhage occurred in 21 of 32 patients with an anterior placenta and in six of 36 with a posterior or fundal placenta. The mean estimated volume of haemorrhage was 2.4 ml, which was on average equal to 3.1% of the total fetoplacental blood volume. When the volume of fetomaternal haemorrhage at the first transfusion was greater than 1 ml there was a greater increase in maternal Rh (D) antibody titres and a greater fall in fetal packed cell volume. Sampling of fetal blood should not be routinely done early in patients with Rh isoimmunisation, and intrauterine transfusion should be delayed as long as possible. Sampling sites other than the placental cord insertion reduces the risk of fetomaternal haemorrhage.     

Oxytocin levels during breast-feeding in established lactation

Serial blood samples were taken from eight lactating women while they were nursing their babies 1–4 months postpartum, and from four lactating controls while they were not nursing. The plasma was assayed for oxytocin by radioimmunoassay after extraction with activated Vycor glass powder. In the suckling mothers mean plasma oxytocin rose from 5.4 pg/ml before nursing to 13.0 pg/ml during nursing. Oxytocin levels changed rapidly from minute to minute, with individual peaks as high as 54 pg/ml. Oxytocin levels in the control mothers averaged 4.4 pg/ml.     

Plasma oxytocin concentrations during late pregnancy and parturition in the dog

While oxytocin is widely used in the treatment of dystocia in dogs, there is little information about its secretion before and during normal unassisted whelping. We therefore measured plasma oxytocin concentrations during late pregnancy and the expulsive stage of parturition. Blood samples were collected from eight dogs at 3-min intervals during a 42-min period between the 2nd and 14th day before whelping and during parturition after the birth of 1-3 pups. The litters consisted of 5-15 pups and the progression of the expulsive stage was linear and nearly parallel in the eight bitches. The overall mean (+/-S.D.) plasma oxytocin concentration during late pregnancy was 3.6+/-2.1pg/ml. Mean values in individual dogs ranged from 1.2 to 7.4 pg/ml, but the intra-animal variation was rather small. During the expulsive stage the overall mean (+/-S.D.) plasma oxytocin concentration was 12.9+/-13.9 pg/ml, with mean values in individual dogs ranging from 3.5 to 46 pg/ml. The mean area under the oxytocin curve for parturient dogs was significantly higher (P<0.05) than for pregnant dogs. During the expulsive stage, the peak plasma oxytocin level in individual dogs ranged between 10 and 117 pg/ml. In six of the eight dogs a pup was born during blood collection and in five of these animals the plasma oxytocin concentration increased temporarily during periods of abdominal straining and expulsion. However, straining efforts and expulsion were not consistently associated with a rise in the circulating oxytocin level. It is concluded that in the dog plasma oxytocin levels are higher and more variable during the expulsive stage of parturition than during late pregnancy. Interrelationships between the secretion pattern of oxytocin, the level of uterine contractility, and the progress of fetal expulsion in dogs need further exploration.     

Temporary peripartal impairment in memory and attention and its possible relation to oxytocin concentration

The aim of the present study was to investigate peripartal performance on cognitive tests and its possible relationship with plasma oxytocin concentrations. Twenty women (cases) were tested on five experimental occasions, the first toward the end of pregnancy and the last 12 months postpartum. On each experimental occasion performance on cognitive tests of memory and attention was recorded and oxytocin concentrations were simultaneously assayed in plasma-samples. Twenty non-pregnant women (controls) were investigated at similar intervals. Cases were found to have improved their performance on some cognitive tests significantly more than controls when results at 6 and 12 months after delivery were compared with those from the end of pregnancy and up to three months after partus. This observation strongly suggests impairment in cognitive performance during the peripartal period. Cases had significantly higher oxytocin concentrations than controls in plasma samples up to three months post partum. No correlation was, however, found between cognitive test results and levels of oxytocin concentration.     

Radioimmunoassay of atrial natriuretic peptide in human plasma: application to studies of volume and blood pressure homeostasis

Sensitive radioimmunoassay for determination of immunoreactive atrial natriuretic peptide (ANP) in human plasma was developed and employed for the study of plasma ANP concentrations in healthy controls under basal conditions (2.4 +/- 0.1 pmol/l) and during volume expansion by saline infusion (9.6 +/- 2.0 pmol/l and 14.2 +/- 1.8 pmol/l, respectively). Plasma renin activity and plasma aldosterone concentration exhibited opposite changes during saline infusion. In pathological states associated with extracellular fluid volume (ECFV) expansion, ANP concentration were significantly higher than in the controls (liver cirrhosis 8.6 +/- 0.9; congestive heart failure 33.1 +/- 4.8; chronic renal failure before haemodialysis 72.2 +/- 6.4 pmol/l). Further volume expansion in liver cirrhosis by saline infusion led to the further increase in ANP (13.3 +/- 1.3 and 16.1 +/- 1.5 pmol/l, respectively) and ECFV reduction by ultrafiltration during haemodialysis in chronic renal failure diminished but did not normalize plasma ANP (22.5 +/- 2.9 pmol/l). In patients with arterial hypertension the concentration of ANP exceeded the normal range by 62.5% and reached 8.0 +/- 0.5 pmol/l on the average. Our results support the suggestion that ANP is an important regulatory humoral mechanism participating in the regulation of sodium, volume and blood pressure homeostasis.     

Concentrations and origin of oxytocin in breast milk

Samples of human milk obtained from lactating women in the early postpartum period were assayed for oxytocin concentrations by specific RIA, following extraction procedures with Florisil. Mean oxytocin concentrations in human milk at postpartum day 1 to 5 were 4.5 +/- 1.1, 4.7 +/- 1.1, 4.0 +/- 1.3, 3.2 +/- 0.4, 3.3 +/- 0.6 microunits/ml (+/- SE), respectively. Oxytocin levels in milk were significantly increased by nursing (3.1 +/- 0.6, 5.3 +/- 1.0 microunits/ml, respectively). 3H-oxytocin in human milk was stable even after incubation at 37 degrees C for 2 hours. The dilution curve for milk was parallel to the curve for the standard oxytocin. The chromatographic fraction of immunoreactive oxytocin was identical to that of 3H-oxytocin. 3H-oxytocin was administered to lactating rats. Radioactivity in the neonatal gastric contents and plasma were 12.8% and 4.4% of the counts in the maternal plasma. It was made clear that oxytocin is stable in milk and that oxytocin in maternal blood can be transferred to mik and then to neonates.     

The effects of chronic environmental stress on parturition and on oxytocin and vasopressin secretion in the pig

Previous work has suggested that an acute behavioural confinement in mid-partum can inhibit oxytocin secretion and prolong delivery in the pig, an effect that is opioid mediated. The present experiment investigated the effect of longer-term (chronic) behavioural confinement, that has previously been shown to elevate total plasma cortisol, on speed of delivery and on plasma oxytocin and lysine vasopressin concentrations during the peri-parturient period in primiparous pigs (gilts). Five days before their expected parturition (farrowing) date, gilts with preplaced jugular catheters were either confined to farrowing crates that severely restricted maternal behaviour, or housed in pens that permitted free movement and maternal behaviour (e.g. nest building). Blood samples were taken continuously from 24 h before the birth of the first piglet (BFP) to 6 h post-BFP, and for oxytocin on Days 1, 2, and 7 following parturition (Days P1, P2, P7). Both oxytocin and vasopressin were strongly influenced by parturition (P<0.001). There was no overall effect of chronic crating on either hormone, but crated and penned gilts did show significant differences with respect to the pattern of both oxytocin and vasopressin concentrations over time (P<0.05 in both cases). Oxytocin and vasopressin first increased in crated and penned gilts from 3 h pre-BFP (P<0.05). Crated gilts subsequently showed greater increases in both oxytocin and vasopressin over the first hour of delivery than penned gilts (mean oxytocin (pmol 1⁻¹): 53.3±8.5 vs. 39.7±5.0 for crated vs. penned gilts; mean vasopressin (pmol l⁻¹):4.4±0.7 vs. 2.0±04 for crated vs. penned gilts; both P<0.05). For oxytocin, crated gilts then showed subsequent declining concentrations relative to penned gilts (P<0.05). For vasopressin, penned gilts reached similar concentrations as crated gilts in the third hour post-BFP before vasopressin concentrations in both groups declined. Crated gilts also gave birth to piglets faster in the early stages of delivery (e.g. mean interval between Piglets 2 and 3 (min): 9.6±2.5 vs. 25.6±8.54 for crated and penned gilts, respectively: P<0.02). We conclude that confinement of gilts to a farrowing crate for 5 days neither adversely affects the progress of delivery in the primiparous pig nor the secretion of posterior pituitary hormones involved in parturition.     

The renal actions of oxytocin in the conscious rat

The renal actions of oxytocin were studied in the conscious unrestrained rat infused with 0.077 M saline at a rate of 150 microliters/min. During the control period volume and sodium excretion reached stable equilibria, the rates being equal to those infused. Administration of oxytocin at 200 pmol/min produced plasma oxytocin levels of 26.0 +/- 2.1 pmol/l and caused a significant diuresis and natriuresis. Renal responses could also be seen with a lower dose of 30 pmol/min which produced plasma levels of 5.1 +/- 0.5 pmol/l while a dose of 15 pmol/min which produced no significant increase in the plasma oxytocin had no renal effect. It appears that oxytocin has a natriuretic action in concentrations within the physiological range.     

Hormonal Interrelationships in Postpartum Suckled Dairy Cows

Three cross-bred cows calved in March and April and were followed until day 62 after parturition. Each animal was suckled by 2 calves ad libitum. All calves were removed from the cows on day 55 after parturition. Blood was collected 3 times per day from the jugular vein by venipuncture. On 4 occasions after parturition - i.e. days 7–8, 21–22, 35–36 and 49–50, the cows were bled through a jugular venous catheter every 30 min during the 24 h. The plasma samples were analyzed for the content of 15-keto-13,14-dihydro-PGF2α (main PGF2α metabolite), LH, prolactin, Cortisol and progesterone by radioimmunoassay methods. The concentration of PGF2α increased from 280 to 730 pmol/1 within the last 4 days before parturition. The highest geometric mean was 3106 pmol/1 on the day of parturition. Thereafter a steady decrease of PGF2α metabolite concentration was seen until day 21 when it reached plateau at 148 pmo/1. In all cows plasma LH concentrations increased significantly (P<0.05) from about 1.6 µg/l on days 7–8 to 2.4 µg/1 on days 21–22 post partum. The frequency of LH pulses showed no tendency to increase as the postpartum period progressed and averaged 6.5 pulses/24 h. Mean plasma LH concentrations increased from 2.1 µg/l 2 days before weaning to 3.2 µg/l 2 days after weaning (P<0.05). LH peaks occurred less frequently in association with prolactin and Cortisol peaks than in their absence. A partial positive correlation between PGF2α metabolite and Cortisol (r = 0.30) was found on days 7–8 post partum. Correlation between prolactin and Cortisol on days 7–8 and 21–22 post partum was also positive (r = 0.20 and r = 0.27, respectively). There was a negative correlation between LH and Cortisol on days 7–8 (r = −0.27) and days 49–50 (r = −0.21) post partum. The first and short progesterone increase observed after weaning was terminated in conjuction with PGF2α metabolite peaks.     

Pre-Eclampsia Increases the Risk of Postpartum Haemorrhage: A Nationwide Cohort Study in The Netherlands

Background

Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Identifying risk indicators for postpartum haemorrhage is crucial to predict this life threatening condition. Another major contributor to maternal morbidity and mortality is pre-eclampsia. Previous studies show conflicting results in the association between pre-eclampsia and postpartum haemorrhage. The primary objective of this study was to investigate the association between pre-eclampsia and postpartum haemorrhage. Our secondary objective was to identify other risk indicators for postpartum haemorrhage in the Netherlands.

Methods

A nationwide cohort was used, containing prospectively collected data of women giving birth after 19 completed weeks of gestation from January 2000 until January 2008 (n =  1 457 576). Data were extracted from the Netherlands Perinatal Registry, covering 96% of all deliveries in the Netherlands. The main outcome measure, postpartum haemorrhage, was defined as blood loss of ≥1000 ml in the 24 hours following delivery. The association between pre-eclampsia and postpartum haemorrhage was investigated with uni- and multivariable logistic regression analyses.

Results

Overall prevalence of postpartum haemorrhage was 4.3% and of pre-eclampsia 2.2%. From the 31 560 women with pre-eclampsia 2 347 (7.4%) developed postpartum haemorrhage, compared to 60 517 (4.2%) from the 1 426 016 women without pre-eclampsia (odds ratio 1.81; 95% CI 1.74 to 1.89). Risk of postpartum haemorrhage in women with pre-eclampsia remained increased after adjusting for confounders (adjusted odds ratio 1.53; 95% CI 1.46 to 1.60).

Conclusion

Women with pre-eclampsia have a 1.53 fold increased risk for postpartum haemorrhage. Clinicians should be aware of this and use this knowledge in the management of pre-eclampsia and the third stage of labour in order to reach the fifth Millenium Developmental Goal of reducing maternal mortality ratios with 75% by 2015.     

Plasma C-peptide concentration in women with Type 1 diabetes during early and late pregnancy

Diabet. Med. 29, e361-e364 (2012) ABSTRACT: Aims There are previous suggestions of increased C-peptide concentration in women with Type?1 diabetes during pregnancy. Our aim was to re-evaluate the hypothesis of a pregnancy-induced increase by measuring plasma C-peptide concentration in women with stable blood glucose control under standardized fasting and meal-stimulated conditions. Methods Ten women with Type 1 diabetes; median age 31.1?years, median diabetes duration 19?years, median HbA(1c) 52?mmol/mol (6.9%) were admitted to a clinical research facility for two 24-h visits in early (12-16?weeks) and late (28-32?weeks) pregnancy. Women They ate standardized study meals - 80-g carbohydrate dinner, 60-g carbohydrate breakfast, and fasted between meals and overnight. Closed-loop insulin delivery maintained stable and comparable glycaemic conditions. Paired samples for plasma glucose and C-peptide were obtained. Results Plasma glucose levels were comparable in early (median 6.5?mmol/l; interquartile range 5.6-8.6) and late pregnancy (median 7.0?mmol/l; interquartile range 6.1-7.8; P?=?0.72). There was no change in fasting or meal-stimulated plasma C-peptide concentration from early to late pregnancy; mean difference 4.0?pmol/l (95%?CI -6.0 to 7.0; P?=?0.9). Four women had detectable C-peptide; peak (range) early vs. late pregnancy 48.5 (10-115) vs. 40.0?pmol/l (80-105); P?=?0.5, which was weakly associated with plasma glucose; R(2) =?0.15, P?相似文献   

Blood levels of 15-keto-13, 14-dihydroprostaglandin F(2alpha) during the postpartum period in primiparous cows

Plasma levels of the PGF(2alpha) metabolite 15-keto-13, 14-dihydroprostaglandin F(2alpha) were determined postpartum in 51 primiparous Black and White Lowland cows. The highest geometric mean was 1702 pmol/l on day 3 and lowest 190 pmol/l on day 21. It should be noted that variation between animals in the concentration of the metabolite is high. For instance, on days 4, 10, 16 and 22, concentration of metabolite ranged from 775-2500, 209-2450, 45-851 and 30-398 pmol/l, respectively. The duration of the massive postpartum release of PGF(2alpha) could be determined in only 29 cows. Significant correlations were found between the duration of elevated PGF(2alpha) metabolite levels and the time required for completion of uterine involution (r = -0.41, P < 0.05) and between the duration of increased PGF(2alpha) metabolite levels and the interval from parturition to occurrence of the first ovulation followed by a normal luteal phase length (r = -0.37, P < 0.05). The occurrence of the first ovulation followed by a normal luteal phase length in the 29 cows was positively correlated with the time needed for completion of uterine involution (r = 0.54, P < 0.01).     

Beta-endorphin and insulin/glucose responses to different meals in obesity.

The responses of plasma beta-endorphin, insulin and glucose to two different isocaloric mixed meals--high carbohydrate (CHO meal) and high fat (fat meal)--were assessed in women with android obesity before (n = 11) as well as after (n = 5) weight reduction, and in normal-weight controls (n = 8). Basal plasma beta-endorphin concentrations in the obese subjects (7.7 +/- 1.2 pmol/l) were significantly (p less than 0.005) higher than in the controls (3.8 +/- 0.5 pmol/l) and were not influenced by weight loss. Fasting plasma levels and the integrated releases of insulin and glucose, both after the CHO meal and after the fat meal were significantly higher in the obese subjects than in the controls. The fat meal induced no changes in beta-endorphin levels in either group. After the CHO meal a significant decrease in plasma beta-endorphin concentration was observed only in the obese group before weight reduction. An influence on beta-endorphin release by macronutrients is hypothesized.     

Plasma gastrin and somatostatin levels in infants during the first four postnatal days

This study was designed to measure plasma gastrin and somatostatin levels in infants and to simultaneously investigate the infants' metabolic status as reflected by the body weight as well as by the blood levels of FFA, D-beta-hydroxybutyrate and glucose. Healthy infants (n = 94) who were born at term were studied cross-sectionally during their first four days of life. We found that the gastrin concentration (mean +/- SD) on the first day of life was 118 +/- 37 pmol/l. Subsequently the concentration decreased and reached its lowest value on the third day; 94 +/- 27 pmol/l (P less than 0.05). On the fourth day the mean concentration increased to the same level as on the first day. There was a significant (P less than 0.01) increase in somatostatin concentrations from 18 +/- 6 pmol/l on the first day to 26 +/- 7 pmol/l on the fourth day and the concentrations were highly related (P less than 0.0001) to postnatal age. We conclude that the decrease in gastrin concentration is probably related to the low volume of breast milk ingested during the first days after delivery, and therefore to the low secretory activity of the gastrin-producing cells. The infants' catabolic condition during that time was evidenced by the reduction in body weight, the decrease in plasma glucose level and the increase in FFA and D-beta-hydroxybutyrate levels. The gastrin increase found on the fourth day reflects most likely, the change in breast milk availability which occurs with the establishment of lactation. The mechanisms controlling the release of somatostatin remains to be established.