Age-related changes in the metoclopramide-induced prolactin release in nulliparous women

Long-term plasma lipid changes associated with a first birth: the Coronary Artery Risk Development in Young Adults study

Previous studies have reported declines in high density lipoprotein (HDL) cholesterol 1-2 years after pregnancy. In 1986-1996, the authors prospectively examined the association between childbearing and changes in fasting plasma lipids (low density lipoprotein, HDL, and total cholesterol; triglycerides) among 1,952 US women (980 Black, 972 White) in the Coronary Artery Risk Development in Young Adults study. Repeated-measures multiple linear regression was used to examine lipid changes over three time intervals (baseline to years 5, 7, and 10) in time-dependent follow-up groups: P0 (0 pregnancies), P1 (>/=1 miscarriages/abortions), B1 (1 birth), and B2 (>/=2 births). Means stratified by race and baseline parity (nulliparous or parous) were fully adjusted for study center, time, height, baseline diet, and other baseline and time-dependent covariates (age, smoking, education, weight, waist circumference, alcohol intake, oral contraceptive use, physical activity, short pregnancies). For both races, fully adjusted HDL cholesterol declines of -3 to -4 mg/dl were associated with a first birth versus no pregnancies during follow-up (p < 0.001). Higher-order births were not associated with greater declines in HDL cholesterol (B2 similar to B1, no association among women parous at baseline). In Whites, total and low density lipoprotein cholesterol declines were associated with follow-up births. HDL cholesterol declines of -3 to -4 mg/dl after a first birth persisted during the 10 years of follow-up independent of weight, central adiposity, and selected behavior changes.

Response of Diamond-Blackfan anemia to metoclopramide: evidence for a role for prolactin in erythropoiesis

A 47-year-old woman with severe macrocytic anemia markedly improved during the second and third trimesters of 3 pregnancies and when breast-feeding her 2 children. Because the serum prolactin level is elevated at these times, we later treated her with metoclopramide (10 mg orally 3 times daily), a medication known to induce prolactin release. Her serum prolactin levels increased from 7 to 133 ng/mL (normal < 20 ng/mL) and hematocrit from 17% to 22% to 35%. With continued therapy (now 10 mg orally daily), her hematocrit has ranged from 30% to 40% for 6 years, although the macrocytosis persists (mean corpuscular volume, 100-112 fL). On the basis of this observation, a pilot study was undertaken of metoclopramide therapy in patients with Diamond-Blackfan anemia who were refractory to low doses of corticosteroids. Fifteen patients were enrolled and 9 completed the planned 16 weeks of therapy. Three individuals responded, suggesting that this therapeutic approach may benefit others. As with the index case, the anemia did not improve until 12 to 15 weeks of therapy had been completed.

The relative importance of gestational gain and maternal characteristics associated with the risk of becoming overweight after pregnancy

OBJECTIVES

To assess the relationships between gestational gain, race/ethnicity, reproductive history, age, education and the risk of becoming overweight after pregnancy.

STUDY DESIGN

Prospective cohort study of adult women from four race/ethnicity groups who had two consecutive births between 1980 and 1990 at the University of California, San Francisco (UCSF).

MEASUREMENTS

Height and pregravid weights for each pregnancy were self-reported. Women were classified as overweight or not overweight according to the Institute of Medicine (IOM) criteria for pregnancy. Gestational gain was defined as the difference between the pregravid weight and the last weight before delivery of the first study pregnancy.

SUBJECTS

1300 healthy women aged 18-41 y who had a singleton, full-term, live birth (index or first study pregnancy) followed by a second birth. Self-reported pregravid weights and heights were used to calculate body mass index (BMI). Women with a pregravid BMI below 26.0 kg/m2 before the index pregnancy were classified as not overweight (n = 1128). Overweight status following the index pregnancy was based on pregravid BMI for the second pregnancy.

RESULTS

Seventy-two women (6.4%) became overweight following the index pregnancy. Statistically significant independent predictors of the risk of becoming overweight included: maternal age 24-30 vs above 30 y, high gestational gain, short interval from menarche to first ever birth ( < 8 y), and young age at menarche ( < 12 y). The risk of becoming overweight was increased 2.5-3 times for each of these risk factors. Whites were 4.5 times more likely to become overweight than Asians, but blacks and Hispanics did not appear to differ from whites. Parity, time interval, smoking habit, education, marital status and other factors were not associated with the risk of becoming overweight.

CONCLUSIONS

These findings suggest that young age at menarche, maternal age and short time from menarche to first ever birth may be as important as high gestational weight gain in determining the risk of becoming overweight after pregnancy.

Acute dopaminergic blockade augments the naloxone-induced LH rise in estrogen-treated postmenopausal women

OBJECTIVES

To assess the effect of estrogen replacement on the simultaneous blockade of the dopaminergic (DA) and opioidergic neural control of hypothalamic-gonadotropic function in postmenopausal women.

METHODS

Twenty healthy postmenopausal women, 48-55 years old were randomly assigned to receive either a 4-h naloxone infusion at 2 mg/h (group 1, n = 7) or a 10 mg i.v. bolus of metoclopramide (group 2, n = 7) or both drugs, simultaneously (group 3, n = 6) before and after 3 weeks of transdermal estradiol (100 microg/day). Blood samples were obtained at 30-min intervals during 4 h and duplicate determinations of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) were performed in all samples.

RESULTS

In group 1 only a mild but significant LH rise after but not before estrogen replacement was seen. In group 2 PRL had a greater rise after than before estrogen therapy, without other hormonal changes. In group 3 a greater rise in PRL occurred after than before estrogen administration and serum LH had a sustained rise throughout the test only after estrogen replacement (greater than in group 1). No FSH changes were observed. The after-estradiol PRL response was nearly similar in groups 2 and 3.

CONCLUSIONS

Our results indicate that in the untreated postmenopausal women, the dopaminergic system has little and the opioidergic system has no significant input in the control of gonadotropin or prolactin release. However, following estrogen replacement, opioids are involved in the inhibition of LH release and stimulating PRL release, while the dopaminergic system acts to inhibit PRL release and modulates LH release or inhibition, depending on the levels of circulating estrogens.

Subhypnotic doses of propofol do not possess antidopaminergic properties

In order to investigate the possible interactions of propofol with the dopaminergic system, a prospective, randomized, double-blind, placebo-controlled study was performed on the profile of prolactin secretion, since prolactin blood levels are known to increase when dopaminergic receptors are blocked. Ten fasting female patients scheduled to receive cancer chemotherapy were allocated to receive either propofol at a rate of 1 mg.kg-1.h-1 or Intralipid 0.1 ml.kg-1.h-1. The study included two consecutive chemotherapy cycles; each patient received in a random order propofol or Intralipid. The infusions were started 4 h prior to induction of chemotherapy; prolactin blood levels were determined at time 0, 30, 60, 120, and 240 min (end of the study period). The basal prolactin blood levels were 14.2 +/- 4.3 vs 12.8 +/- 2.7 and 10.7 +/- 1.7 vs 14.0 +/- 3.6 ng/mL at the end of the study for propofol and Intralipid, respectively. These results suggest that the antiemetic properties of propofol are not mediated via interactions with the dopaminergic system.