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Horgan R, Sinkovskaya E, Saade G, Kalafat E, Rice MM, Heeze A, Abuhamad A. Longitudinal assessment of spiral and uterine arteries in normal pregnancy using novel ultrasound tool. Ultrasound Obstet Gynecol 2023; 62:860-866. [PMID: 37470712 PMCID: PMC10801897 DOI: 10.1002/uog.26312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES To use superb microvascular imaging (SMI) to evaluate longitudinally spiral artery (SA) and uterine artery (UtA) vascular adaptation in normal human pregnancy, and to develop reference ranges for use at various gestational ages throughout pregnancy. METHODS The data for this study were obtained from the National Institutes of Health (NIH)-funded Human Placenta Project. Women aged 18-35 years, with a body mass index < 30 kg/m2 , without comorbidities, with a singleton gestation conceived spontaneously, and gestational age at or less than 13 + 6 weeks were eligible for inclusion. The current analysis was restricted to uncomplicated pregnancies carried to term. Exclusion criteria included maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation or delivery < 37 weeks. Women who fulfilled the inclusion criteria formed the reference population of the Human Placenta Project study. Each participant underwent eight ultrasound examinations during pregnancy. The pulsatility index (PI) of both the left and right UtA were obtained twice for each artery and the presence or absence of a notch was noted. Using SMI technology, the total number of SA imaged was recorded in a sagittal placental section at the level of cord insertion. The PI and peak systolic velocity (PSV) were also measured in a total of six SA, including two in the central portion of the placenta, two peripherally towards the uterine fundal portion, and two peripherally towards the lower uterine segment. RESULTS A total of 90 women fulfilled the study criteria. Maternal UtA-PI decreased throughout the first half of pregnancy from a mean ± SD of 1.39 ± 0.50 at 12-13 weeks' gestation to 0.88 ± 0.24 at 20-21 weeks' gestation. The mean number of SA visualized in a sagittal plane of the placenta increased from 8.83 ± 2.37 in the first trimester to 16.99 ± 3.31 in the late-third trimester. The mean SA-PI was 0.57 ± 0.12 in the first trimester and decreased progressively during the second trimester, reaching a nadir of 0.40 ± 0.10 at 24-25 weeks, and remaining constant until the end of pregnancy. SA-PSV was highest in early pregnancy with a mean of 57.16 ± 14.84 cm/s at 12-13 weeks' gestation, declined to a mean of 49.38 ± 17.88 cm/s at 20-21 weeks' gestation and continued to trend downward for the remainder of pregnancy, reaching a nadir of 34.50 ± 15.08 cm/s at 36-37 weeks' gestation. A statistically significant correlation was noted between SA-PI and UtA-PI (r = 0.5633; P < 0.001). Multilevel regression models with natural cubic splines were used to create reference ranges of SA-PSV and SA-PI for given gestational ages. CONCLUSION From early gestation, we have demonstrated the ability to image and quantify SA blood flow in normal pregnancy, and have developed reference ranges for use at various gestational ages throughout pregnancy. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Horgan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - E Sinkovskaya
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - G Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - E Kalafat
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - M M Rice
- George Washington University Biostatistics Center, Milken Institute School of Public Health, Washington, DC, USA
| | - A Heeze
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - A Abuhamad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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Saade G, Macaeva E, Chiavassa S, Bongrand A, Koumeir C, Servagent N, Haddad F, Sterpin E, Bogaerts E, Delpon G, Supiot S, Potiron V. CALIBRATION OF THE ZEBRAFISH EMBRYO MODEL FOR RADIOTHERAPY WITH TESTING ON FLASH PROTONTHERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Venkatesh KK, Chiang CW, Castillo WC, Battarbee AN, Donneyong M, Harper LM, Costantine M, Saade G, Werner EF, Boggess KA, Landon MB. Changing patterns in medication prescription for gestational diabetes during a time of guideline change in the USA: a cross-sectional study. BJOG 2022; 129:473-483. [PMID: 34605130 PMCID: PMC8752504 DOI: 10.1111/1471-0528.16960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To define patterns of prescription and factors associated with choice of pharmacotherapy for gestational diabetes mellitus (GDM), namely metformin, glyburide and insulin, during a period of evolving professional guidelines. DESING Cross-sectional study. SETTING US commercial insurance beneficiaries from Market-Scan (late 2015 to 2018). STUDY DESIGN We included women with GDM, singleton gestations, 15-51 years of age on pharmacotherapy. The exposure was pharmacy claims for metformin, glyburide and insulin. MAIN OUTCOMES Pharmacotherapy for GDM with either oral agent, metformin or glyburide, compared with insulin as the reference, and secondarily, consequent treatment modification (addition and/or change) to metformin, glyburide or insulin. RESULTS Among 37 762 women with GDM, we analysed data from 10 407 (28%) with pharmacotherapy, 21% with metformin (n = 2147), 48% with glyburide (n = 4984) and 31% with insulin (n = 3276). From late 2015 to 2018, metformin use increased from 17 to 29%, as did insulin use from 26 to 44%, whereas glyburide use decreased from 58 to 27%. By 2018, insulin was the most common pharmacotherapy for GDM; metformin was more likely to be prescribed by 9% compared with late 2015/16, but glyburide was less likely by 45%. Treatment modification occurred in 20% of women prescribed metformin compared with 2% with insulin and 8% with glyburide. CONCLUSIONS Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for GDM among a privately insured US population during a time of evolving professional guidelines. Further evaluation of the relative effectiveness and safety of metformin compared with insulin is needed. TWEETABLE ABSTRACT Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for gestational diabetes mellitus in the USA.
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Affiliation(s)
- K K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - C W Chiang
- Department of Bioinformatics, The Ohio State University, Columbus, OH, USA
| | - W C Castillo
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - A N Battarbee
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AB, USA
| | - M Donneyong
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - L M Harper
- Department of Women's Health, University of Texas, Dell Medical School, Austin, TX, USA
| | - M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - E F Werner
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - K A Boggess
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - M B Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
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Lindsay KL, Milone GF, Grobman WA, Haas DM, Mercer BM, Simhan HN, Saade G, Silver RM, Chung JH. Periconceptional diet quality is associated with gestational diabetes risk and glucose concentrations among nulliparous gravidas. Front Endocrinol (Lausanne) 2022; 13:940870. [PMID: 36133312 PMCID: PMC9483841 DOI: 10.3389/fendo.2022.940870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) and elevated glucose concentrations below the threshold for GDM diagnosis have been associated with adverse pregnancy and offspring outcomes. Dietary interventions initiated during pregnancy have demonstrated inconsistent beneficial effects. Limited data exist regarding the effects of periconceptional diet on gestational glycemia. OBJECTIVE To evaluate independent associations between periconceptional diet quality with GDM frequency and glucose concentrations from GDM screening and diagnostic tests among nulliparous gravidas. DESIGN This is a secondary analysis of N=7997 participants from the NuMoM2b multicenter, prospective, observational cohort study of first pregnancies. The Alternative Healthy Eating Index (AHEI)-2010 was computed from food frequency questionnaires completed in early pregnancy (6-13 weeks), reporting usual dietary intake over the preceding 3 months. GDM screening was performed either by non-fasting 1-hour 50g glucose load (N=6845), followed by 3-hour 100g glucose tolerance test (GTT) for those with raised glucose concentrations (N=1116; at risk for GDM), or by a single 2-hour 75g GTT (N=569; all GDM risk levels). Logistic and linear regression were used to estimate the associations between the AHEI-2010 score with odds of GDM, having raised blood glucose on the 1-hour screening test, and continuous glucose concentrations on screening and diagnostic tests. All models were adjusted for a priori covariates: maternal age, race/ethnicity, early-pregnancy body mass index, smoking habits, rate of gestational weight gain, energy intake, nausea and vomiting in early pregnancy, study site. RESULTS Poorer periconceptional diet quality was observed among participants who were younger, with higher BMI, lower income levels, and of non-Hispanic Black or Hispanic ethnicity. The GDM rate was 4%. Each 1-point increase in AHEI-2010 score was associated with a 1% decrease in the odds of being diagnosed with GDM (beta=-0.015, p=0.022, OR=0.986, 95% CI 0.973 to 0.998). Diet quality was inversely associated with each post glucose load concentration on the non-fasting screening test and the 2-hour and 3-hour GTT. CONCLUSION Poor periconceptional diet quality is independently associated with an increased risk of GDM and with minor elevations in serum glucose concentrations on GDM screening and diagnostic tests, in a diverse cohort of nulliparas. Periconception intervention studies targeting diet quality are warranted.
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Affiliation(s)
- Karen L. Lindsay
- Susan Samueli Integrative Health Institute, Susan & Henry Samueli College of Health Sciences, University of California, Irvine, CA, United States
- Division of Endocrinology, Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, United States
- *Correspondence: Karen L. Lindsay,
| | - Gina F. Milone
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Orange, CA, United States
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brian M. Mercer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, United States
| | - Hyagriv N. Simhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - George R. Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
| | - Robert M. Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, United States
| | - Judith H. Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Orange, CA, United States
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Museau L, Hervet C, Saade G, Menard D, Belloc C, Meurens F, Bertho N. Prospecting potential links between PRRSV infection susceptibility of alveolar macrophages and other respiratory infectious agents present in conventionally reared pigs. Vet Immunol Immunopathol 2020; 229:110114. [PMID: 32905850 DOI: 10.1016/j.vetimm.2020.110114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/01/2022]
Abstract
Porcine Reproductive and Respiratory Syndrome virus (PRRSV) is one of the main component of the porcine respiratory disease complex (PRDC), which strongly impact the pig production. Although PRRSV is often considered as a primary infection that eases subsequent respiratory coinfections, the possibility that other PRDC components may facilitate PRRSV infection has been largely overlooked. The main cellular targets of PRRSV are respiratory macrophages among them alveolar macrophages (AM) and pulmonary intravascular macrophages (PIM). AM, contrarily to PIM, are directly exposed to the external respiratory environment, among them co-infectious agents. In order to explore the possibility of a co-infections impact on the capacity of respiratory macrophages to replicate PRRSV, we proceed to in vitro infection of AM and PIM sampled from animals presenting different sanitary status, and tested the presence in the respiratory tract of these animals of the most common porcine respiratory pathogens (PCV2, Actinobacillus pleuropneumoniae, Mycoplasma hyopneumoniae, Mycoplasma hyorhinis, Mycoplasma floculare, Pasteurella multocida, Bordetella bronchiseptica, Streptoccocus suis). In this exploratory study with a limited number of animals, no statistic differences were observed between AM and PIM susceptibility to in vitro PRRSV infection, nor between AM coming from animals presenting very contrasting respiratory coinfection loads.
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Affiliation(s)
- L Museau
- BIOEPAR, INRAE, ONIRIS, Nantes, France
| | - C Hervet
- BIOEPAR, INRAE, ONIRIS, Nantes, France
| | - G Saade
- BIOEPAR, INRAE, ONIRIS, Nantes, France
| | - D Menard
- BIOEPAR, INRAE, ONIRIS, Nantes, France
| | - C Belloc
- BIOEPAR, INRAE, ONIRIS, Nantes, France
| | - F Meurens
- BIOEPAR, INRAE, ONIRIS, Nantes, France
| | - N Bertho
- BIOEPAR, INRAE, ONIRIS, Nantes, France.
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Monahan R, Caballero A, Reddy U, Stoll B, Silver B, Saade G, Dudley D. 198: Inadequate prenatal care increases the risk for stillbirth. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Manuck TA, Watkins WS, Esplin MS, Biggio J, Bukowski R, Parry S, Zhan H, Huang H, Andrews W, Saade G, Sadovsky Y, Reddy UM, Ilekis J, Yandell M, Varner MW, Jorde LB. Pharmacogenomics of 17-alpha hydroxyprogesterone caproate for recurrent preterm birth: a case-control study. BJOG 2017; 125:343-350. [DOI: 10.1111/1471-0528.14485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- TA Manuck
- Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine; University of Utah School of Medicine; Salt Lake City UT USA
- Intermountain Healthcare Department of Maternal Fetal Medicine; Salt Lake City UT USA
- Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine; University of North Carolina-Chapel Hill; Chapel Hill NC USA
| | - WS Watkins
- Department of Human Genetics; University of Utah; Salt Lake City UT USA
| | - MS Esplin
- Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine; University of Utah School of Medicine; Salt Lake City UT USA
- Intermountain Healthcare Department of Maternal Fetal Medicine; Salt Lake City UT USA
| | - J Biggio
- Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine and Center for Women's Reproductive Health; University of Alabama at Birmingham; Birmingham AL USA
| | - R Bukowski
- Department of Obstetrics and Gynecology; Division of Maternal-Fetal Medicine; University of Texas Medical Branch; Galveston TX USA
| | - S Parry
- Department of Obstetrics and Gynecology; University of Pennsylvania School of Medicine; Philadelphia PA USA
| | - H Zhan
- Collaborative Center for Statistics in Science; Yale University School of Public Health; New Haven CT USA
| | - H Huang
- Collaborative Center for Statistics in Science; Yale University School of Public Health; New Haven CT USA
| | - W Andrews
- Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine and Center for Women's Reproductive Health; University of Alabama at Birmingham; Birmingham AL USA
| | - G Saade
- Department of Obstetrics and Gynecology; Division of Maternal-Fetal Medicine; University of Texas Medical Branch; Galveston TX USA
| | - Y Sadovsky
- Magee-Womens Research Institute; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - UM Reddy
- Pregnancy and Perinatology Branch; Center for Developmental Biology and Perinatal Medicine; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Bethesda MD USA
| | - J Ilekis
- Pregnancy and Perinatology Branch; Center for Developmental Biology and Perinatal Medicine; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Bethesda MD USA
| | - M Yandell
- Department of Human Genetics; University of Utah; Salt Lake City UT USA
| | - MW Varner
- Department of Obstetrics and Gynecology; Division of Maternal Fetal Medicine; University of Utah School of Medicine; Salt Lake City UT USA
- Intermountain Healthcare Department of Maternal Fetal Medicine; Salt Lake City UT USA
| | - LB Jorde
- Department of Human Genetics; University of Utah; Salt Lake City UT USA
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Gyamfi-Bannerman C, Saade G, Blackwell SC. Concerns regarding the use of antenatal betamethasone in late preterm gestation: is the evidence of potential harm being overstated? BJOG 2016; 125:923-924. [PMID: 27592849 DOI: 10.1111/1471-0528.14271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- C Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - G Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - S C Blackwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School-University of Texas at Houston, Houston, TX, USA
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Mourtakos SP, Tambalis KD, Panagiotakos DB, Antonogeorgos G, Alexi CD, Georgoulis M, Saade G, Sidossis LS. Association between gestational weight gain and risk of obesity in preadolescence: a longitudinal study (1997-2007) of 5125 children in Greece. J Hum Nutr Diet 2016; 30:51-58. [PMID: 27412890 DOI: 10.1111/jhn.12398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The present study aimed to investigate the association between gestational weight gain (GWG) and birth weight, as well as the body mass index (BMI) status, of children at the ages of 2 and 8 years. METHODS Population-based data were obtained from a database of all 7-9-year-old Greek children who attended primary school during 1997-2007. The study sample consisted of 5125 children matched with their mothers, randomly selected according to region and place of residence, and equally distributed (approximately 500 per year) throughout the study period (1997-2007). A standardised questionnaire was applied; telephone interviews were carried out to collect maternal age, BMI status at the beginning and the end of pregnancy and GWG, birth weight of offspring and BMI status at the ages of 2 and 8 years, as well as several other pregnancy characteristics (e.g. pregnancy duration, gestational medical problems, maternal smoking and alcohol consumption habits, and lactation of offspring after pregnancy). RESULTS Gestational weight gain was positively associated with the weight status of offspring at all three life stages studied: newborn (birth weight), infant (BMI) and child (BMI) [b = 0.008 (0.001), b = 0.053 (0.009) and b = 0.034 (0.007), respectively, all P < 0.001], after adjusting for maternal age at pregnancy (significant inverse predictor only at age 2 years). The same applied to excessive GWG, as defined by the Institute of Medicine guidelines. CONCLUSIONS Excessive GWG was associated with a higher risk of greater infant size at birth and a higher BMI status at the ages of 2 and 8 years. Healthcare providers should encourage women to limit their GWG to the range indicated by the current guidelines.
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Affiliation(s)
- S P Mourtakos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - K D Tambalis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.,Department of Physical Education and Sport Science, University of Athens, Athens, Greece
| | - D B Panagiotakos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - G Antonogeorgos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - C D Alexi
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - M Georgoulis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - L S Sidossis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.,Department of Internal Medicine, Sealy Center on Aging, Institute for Translational Sciences and Shriners Hospital for Children, University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Miller R, Smiley R, Thom EA, Grobman WA, Iams JD, Mercer BM, Saade G, Tita AT, Reddy UM, Rouse DJ, Sorokin Y, Blackwell SC, Esplin MS, Tolosa JE, Caritis SN. The association of beta-2 adrenoceptor genotype with short-cervix mediated preterm birth: a case-control study. BJOG 2015; 122:1387-94. [PMID: 25600430 DOI: 10.1111/1471-0528.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether β2 -adrenoceptor (β2 AR) genotype is associated with shortening of the cervix or with preterm birth (PTB) risk among women with a short cervix in the second trimester. DESIGN A case-control ancillary study to a multicentre randomised controlled trial. SETTING Fourteen participating centres of the Maternal-Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. POPULATION Four hundred thirty-nine women, including 315 with short cervix and 124 with normal cervical length. METHODS Nulliparous women with cervical length <30 mm upon a 16-22-week transvaginal sonogram and controls frequency-matched for race/ethnicity with cervical lengths ≥40 mm were studied. β2 AR genotype was determined at positions encoding for amino acid residues 16 and 27. MAIN OUTCOME MEASURES Genotype distributions were compared between case and control groups. Within the short cervix group, pregnancy outcomes were compared by genotype, with a primary outcome of PTB <37 weeks. RESULTS Genotype data were available at position 16 for 433 women and at position 27 for 437. Using a recessive model testing for association between short cervix and genotype, and adjusted for ethnicity, there was no statistical difference between cases and controls for Arg16 homozygosity (OR 0.7, 95% CI 0.4-1.3) or Gln27 homozygosity (OR 0.9, 95% CI 0.3-2.7). Among cases, Arg16 homozygosity was not associated with protection from PTB or spontaneous PTB. Gln27 homozygosity was not associated with PTB risk, although sample size was limited. CONCLUSIONS β2 AR genotype does not seem to be associated with short cervical length or with PTB following the second-trimester identification of a short cervix. Influences on PTB associated with β2 AR genotype do not appear to involve a short cervix pathway.
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Affiliation(s)
- R Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - R Smiley
- Division of Obstetrical Anesthesiology, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E A Thom
- The George Washington University Biostatistics Center, Washington, DC, USA
| | - W A Grobman
- Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - J D Iams
- The Ohio State University, Columbus, OH, USA
| | - B M Mercer
- Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - G Saade
- University of Texas Medical Branch, Galveston, TX, USA
| | - A T Tita
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - U M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - D J Rouse
- Brown University, Providence, RI, USA
| | - Y Sorokin
- Wayne State University, Detroit, MI, USA
| | - S C Blackwell
- The University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX, USA
| | - M S Esplin
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - J E Tolosa
- Oregon Health and Science University, Portland, OR, USA
| | - S N Caritis
- University of Pittsburgh, Pittsburgh, PA, USA
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Abramovici A, Gandley RE, Clifton RG, Leveno KJ, Myatt L, Wapner RJ, Thorp JM, Mercer BM, Peaceman AM, Samuels P, Sciscione A, Harper M, Saade G, Sorokin Y. Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG 2014. [PMID: 25516497 DOI: 10.1111/1471‐0528.13201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Smoking and pre-eclampsia (PE) are associated with increases in preterm birth, placental abruption and low birthweight. We evaluated the relationship between prenatal vitamin C and E (C/E) supplementation and perinatal outcomes by maternal self-reported smoking status focusing on outcomes known to be impacted by maternal smoking. DESIGN/SETTING/POPULATION A secondary analysis of a multi-centre trial of vitamin C/E supplementation starting at 9-16 weeks in low-risk nulliparous women with singleton gestations. METHODS We examined the effect of vitamin C/E by smoking status at randomisation using the Breslow-Day test for interaction. MAIN OUTCOME MEASURES The trial's primary outcomes were PE and a composite outcome of pregnancy-associated hypertension (PAH) with serious adverse outcomes. Perinatal outcomes included preterm birth and abruption. RESULTS There were no differences in baseline characteristics within subgroups (smokers versus nonsmokers) by vitamin supplementation status. The effect of prenatal vitamin C/E on the risk of PE (P = 0.66) or PAH composite outcome (P = 0.86) did not differ by smoking status. Vitamin C/E was protective for placental abruption in smokers (relative risk [RR] 0.09; 95% CI 0.00-0.87], but not in nonsmokers (RR 0.92; 95% CI 0.52-1.62) (P = 0.01), and for preterm birth in smokers (RR 0.76; 95% CI 0.58-0.99) but not in nonsmokers (RR 1.03; 95% CI 0.90-1.17) (P = 0.046). CONCLUSION In this cohort of women, smoking was not associated with a reduction in PE or the composite outcome of PAH. Vitamin C/E supplementation appears to be associated with a reduction in placental abruption and preterm birth among smokers.
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Affiliation(s)
- A Abramovici
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R E Gandley
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - R G Clifton
- Department of Obstetrics and Gynecology, The George Washington University Biostatistics Center, Washington, DC, USA
| | - K J Leveno
- Department of Obstetrics and Gynecology, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - L Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - R J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - J M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - P Samuels
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - A Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA, USA
| | - M Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Y Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Abramovici A, Gandley RE, Clifton RG, Leveno KJ, Myatt L, Wapner RJ, Thorp JM, Mercer BM, Peaceman AM, Samuels P, Sciscione A, Harper M, Saade G, Sorokin Y. Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG 2014; 122:1740-7. [PMID: 25516497 DOI: 10.1111/1471-0528.13201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Smoking and pre-eclampsia (PE) are associated with increases in preterm birth, placental abruption and low birthweight. We evaluated the relationship between prenatal vitamin C and E (C/E) supplementation and perinatal outcomes by maternal self-reported smoking status focusing on outcomes known to be impacted by maternal smoking. DESIGN/SETTING/POPULATION A secondary analysis of a multi-centre trial of vitamin C/E supplementation starting at 9-16 weeks in low-risk nulliparous women with singleton gestations. METHODS We examined the effect of vitamin C/E by smoking status at randomisation using the Breslow-Day test for interaction. MAIN OUTCOME MEASURES The trial's primary outcomes were PE and a composite outcome of pregnancy-associated hypertension (PAH) with serious adverse outcomes. Perinatal outcomes included preterm birth and abruption. RESULTS There were no differences in baseline characteristics within subgroups (smokers versus nonsmokers) by vitamin supplementation status. The effect of prenatal vitamin C/E on the risk of PE (P = 0.66) or PAH composite outcome (P = 0.86) did not differ by smoking status. Vitamin C/E was protective for placental abruption in smokers (relative risk [RR] 0.09; 95% CI 0.00-0.87], but not in nonsmokers (RR 0.92; 95% CI 0.52-1.62) (P = 0.01), and for preterm birth in smokers (RR 0.76; 95% CI 0.58-0.99) but not in nonsmokers (RR 1.03; 95% CI 0.90-1.17) (P = 0.046). CONCLUSION In this cohort of women, smoking was not associated with a reduction in PE or the composite outcome of PAH. Vitamin C/E supplementation appears to be associated with a reduction in placental abruption and preterm birth among smokers.
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Affiliation(s)
- A Abramovici
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R E Gandley
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - R G Clifton
- Department of Obstetrics and Gynecology, The George Washington University Biostatistics Center, Washington, DC, USA
| | - K J Leveno
- Department of Obstetrics and Gynecology, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - L Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - R J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - J M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - P Samuels
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - A Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA, USA
| | - M Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Y Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Polettini J, Silva MG, Kacerovsky M, Syed TA, Saade G, Menon R. Expression profiles of fetal membrane nicotinamide adenine dinucleotide phosphate oxidases (NOX) 2 and 3 differentiates spontaneous preterm birth and pPROM pathophysiologies. Placenta 2014; 35:188-94. [PMID: 24439294 DOI: 10.1016/j.placenta.2013.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/27/2013] [Accepted: 12/23/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Nicotinamide adenine dinucleotide phosphate oxidases (NOX 1-5) are enzymes that generate cellular reactive oxygen species (ROS) besides mitochondria and might be important ROS sources associated with pregnancy complications, particularly preterm premature rupture of membranes (pPROM), that has been related to ROS. OBJECTIVE To characterize NOX enzymes expression in human fetal membranes. METHODS Differential expression and localization of NOX isoforms in human fetal membranes collected from women with uncomplicated pregnancies at term, preterm birth (PTB) or pPROM and in vitro in normal term membranes maintained in an organ explant system stimulated with water-soluble cigarette smoke extract (wsCSE) were documented by real time PCR and immunohistochemistry. RESULTS Fetal membranes from term deliveries, PTB and pPROM expressed NOX 2, 3 and 4 mRNAs whereas NOX 1 and 5 were not detected. NOX 2 expression was 2.3-fold higher in PTB than pPROM (p = 0.005) whereas NOX 3 was 2.2-fold higher in pPROM compared to PTB (p = 0.04). NOX 2 and 3 expressions at term mimicked pPROM and PTB, respectively. No difference in NOX 4 expression was observed among the studied groups. NOX 2, 3 and 4 were localized to both amniotic and chorionic cells. Expression of NOX 2, 3 and 4 were not significant in wsCSE-stimulated membranes compared to untreated controls. DISCUSSION/CONCLUSIONS NOX enzymes are present in the fetal membranes and are differentially expressed in PTB and pPROM. Absence of any changes in NOXs expression after wsCSE stimulation suggests ROS generation in the membranes does not always correlate with NOX expression.
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Affiliation(s)
- J Polettini
- Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA; Department of Pathology, Botucatu Medical School, UNESP - Univ. Estadual Paulista, Botucatu, Sao Paulo, Brazil
| | - M G Silva
- Department of Pathology, Botucatu Medical School, UNESP - Univ. Estadual Paulista, Botucatu, Sao Paulo, Brazil
| | - M Kacerovsky
- Biomedical Research Center, University Hospital Hradec Kralove, Czech Republic; Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - T A Syed
- Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - G Saade
- Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - R Menon
- Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
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Maul H, Saade G, Gebauer G, Rolf N, Rezniczek G, Schmid B. Erfahrungen mit dem Einsatz einer mit Chitosan beschichteten Uterustamponade (Celox®) bei mittleren und schweren postpartalen Blutungen. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Myatt L, Clifton RG, Roberts JM, Spong CY, Wapner RJ, Thorp JM, Mercer BM, Peaceman AM, Ramin SM, Carpenter MW, Sciscione A, Tolosa JE, Saade G, Sorokin Y, Anderson GD. Can changes in angiogenic biomarkers between the first and second trimesters of pregnancy predict development of pre-eclampsia in a low-risk nulliparous patient population? BJOG 2013; 120:1183-91. [PMID: 23331974 DOI: 10.1111/1471-0528.12128] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine if change in maternal angiogenic biomarkers between the first and second trimesters predicts pre-eclampsia in low-risk nulliparous women. DESIGN A nested case-control study of change in maternal plasma soluble Flt-1 (sFlt-1), soluble endoglin (sEng) and placenta growth factor (PlGF). We studied 158 pregnancies complicated by pre-eclampsia and 468 normotensive nonproteinuric controls. SETTING A multicentre study in 16 academic medical centres in the USA. POPULATION Low-risk nulliparous women. METHODS Luminex assays for PlGF, sFlt-1 and sEng performed on maternal EDTA plasma collected at 9-12, 15-18 and 23-26 weeks of gestation. Rate of change of analyte between first and either early or late second trimester was calculated with and without adjustment for baseline clinical characteristics. MAIN OUTCOME MEASURES Change in PlGF, sFlt-1 and sEng. RESULTS Rates of change of PlGF, sEng and sFlt-1 between first and either early or late second trimesters were significantly different in women who developed pre-eclampsia, severe pre-eclampsia or early-onset pre-eclampsia compared with women who remained normotensive. Inclusion of clinical characteristics (race, body mass index and blood pressure at entry) increased sensitivity for detecting severe and particularly early-onset pre-eclampsia but not pre-eclampsia overall. Receiver operating characteristics curves for change from first to early second trimester in sEng, PlGF and sFlt-1 with clinical characteristics had areas under the curve of 0.88, 0.84 and 0.86, respectively, and for early-onset pre-eclampsia with sensitivities of 88% (95% CI 64-99), 77% (95% CI 50-93) and 77% (95% CI 50-93) for 80% specificity, respectively. Similar results were seen in the change from first to late second trimester. CONCLUSION Change in angiogenic biomarkers between first and early second trimester combined with clinical characteristics has strong utility for predicting early-onset pre-eclampsia.
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Affiliation(s)
- L Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
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Oto A, Ernst R, Ghulmiyyah L, Hughes D, Saade G, Chaljub G. The role of MR cholangiopancreatography in the evaluation of pregnant patients with acute pancreaticobiliary disease. Br J Radiol 2008; 82:279-85. [PMID: 19029218 DOI: 10.1259/bjr/88591536] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study aimed to determine the usefulness of MR cholangiopancreatography (MRCP) in the evaluation of pregnant patients with acute pancreaticobiliary disease and its additional value over ultrasound. MRI studies of pregnant patients who were referred because of acute pancreaticobiliary disease were included. MR images and patient charts were reviewed retrospectively to determine clinical outcome and the results of other imaging studies. 18 pregnant patients underwent MRCP because of right upper quadrant pain (n = 6), pancreatitis (n = 9), cholangitis (n = 1) or jaundice (n = 2). 15 patients were also evaluated with ultrasound. Biliary dilatation was detected in eight patients by ultrasound, but the cause of biliary dilatation could not be determined by ultrasound in seven patients. MRCP demonstrated the aetiology in four of these patients (choledocholithiasis (n = 1), Mirizzi syndrome (n = 1), choledochal cyst (n = 1) and intrahepatic biliary stones (n = 1)) and excluded obstructive pathology in the other four patients. MRCP was unremarkable in the seven patients who had no biliary dilatation on ultrasound. Three patients underwent only MRCP; two had choledocholithiasis and one cholelithiasis and pancreatitis. Choledocholithiasis diagnosed with MRCP (n = 3) was confirmed by endoscopic retrograde cholangiopancreatography. Mirizzi syndrome (n = 1) and a choledochal cyst (n = 1) were confirmed by surgery. The patients with normal MRCP (n = 12) and one patient with intrahepatic stones improved with medical treatment. MRCP appears to be a valuable and safe technique for the evaluation of pregnant patients with acute pancreaticobiliary disease. Especially when ultrasound shows biliary dilatation, MRCP can determine the aetiology and save the patient from unnecessary endoscopic retrograde cholangiopancreatography by excluding a biliary pathology.
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Affiliation(s)
- A Oto
- Department of Radiology, University Texas Medical Branch at Galveston, Galveston, Texas 77555, USA.
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Saade G, Abou Jaoude S, Afifi R, Warren CW, Jones NR. Patterns of tobacco use: results from the 2005 Global Youth Tobacco Survey in Lebanon. East Mediterr Health J 2008; 14:1280-1289. [PMID: 19161103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report the results of the 2005 Global Youth Tobacco Survey in Lebanon which investigated the self-reported attitudes and behaviours related to tobacco among 3314 Lebanese schoolchildren aged 13-15 years. Current use of any tobacco product was 60.1%; the use of cigarettes was 10% and other tobacco products 59% with male predominance in all areas. About 80% of students lived in homes where others smoked. About 60% of current smokers wanted to quit smoking and 51% of all students had learned about the effects of tobacco in class. Over a quarter (27%) thought that boys who smoke have more friends and 17% believed that smoking makes boys more attractive. The majority of students had been exposed to both anti-smoking media messages and pro-smoking advertisements.
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Affiliation(s)
- G Saade
- Noncommunicable Disease Programme, World Health Organization, Beirut, Lebanon
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Freerksen N, Maul H, Vedernikov Y, Saade G, Garfield RE, Günter HH, Sohn C. Einfluss von PAR-2-AP auf induzierte Myometrium-Kontraktionen bei schwangeren und nichtschwangeren Ratten. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lambert-Messerlian G, Dugoff L, Vidaver J, Canick JA, Malone FD, Ball RH, Comstock CH, Nyberg DA, Saade G, Eddleman K, Klugman S, Craigo SD, Timor-Tritsch IE, Carr SR, Wolfe HM, D'Alton ME. First- and second-trimester Down syndrome screening markers in pregnancies achieved through assisted reproductive technologies (ART): a FASTER trial study. Prenat Diagn 2006; 26:672-8. [PMID: 16764012 DOI: 10.1002/pd.1469] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether first- and second-trimester Down syndrome screening markers and screen-positive rates are altered in pregnancies conceived using assisted reproductive technologies (ARTs). METHODS ART pregnancies in the multicenter FASTER trial were identified. Marker levels were evaluated for five types of ART: in vitro fertilization with ovulation induction (IVF-OI), IVF with OI and egg donation (IVF-OI-ED), IVF with ED (IVF-ED), and intrauterine insemination with OI (IUI-OI) or without OI (IUI). Each group was compared to non-ART controls using Mann-Whitney U analysis. RESULTS First-trimester marker levels were not significantly different between ART and control pregnancies, with the exception of reduced PAPP-A levels in the IUI-OI group. In contrast, second-trimester inhibin A levels were increased in all ART pregnancies, estriol was reduced and human chorionic gonadotropin (hCG) was increased in IVF and IUI pregnancies without ED, and alpha-fetoprotein (AFP) was increased in ED pregnancies. Second-trimester screen-positive rates were significantly higher than expected for ART pregnancies, except when ED was used. CONCLUSIONS These data show that ART significantly impacts second-, but not first-, trimester markers and screen-positive rates. The type of adjustment needed in second-trimester screening depends on the particular type of ART used.
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Maul H, Weichert J, Günter HH, Shi L, Garfield RE, Saade G. Der Platelet-Activating Factor Antagonist WEB-2170 hemmt die Lipopolysaccharid-induzierte vorzeitige Reifung der uterinen Zervix. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maul H, Maner WL, Weichert J, Günter HH, Saade G, Garfield RE. Die Bestimmung des Energiegehalts nicht-invasiv gemessener uteriner elektrischer Aktivität ist prädikativ für eine Frühgeburt innerhalb von 48 Stunden. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maul H, Weichert J, Sohn C, Garfield RE, Saade G. Platelet-activating Factor Antagonist Web-2170 und sein Einfluss auf die Infektions-assoziierte vorzeitige Zervixreifung. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rosen M, Brauer KI, Alperin JB, Hankins GDV, Saade G. Postpartum hemorrhagic shock resulting in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. J Matern Fetal Neonatal Med 2003. [DOI: 10.1080/713605824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rosen M, Brauer KI, Alperin JB, Hankins GDV, Saade G. Postpartum hemorrhagic shock resulting in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. J Matern Fetal Neonatal Med 2003; 13:208-10. [PMID: 12820844 DOI: 10.1080/jmf.13.3.208.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thrombotic microangiopathies may be initiated by a number of antecedent events. When presented with postpartum hemorrhage and unexplained thrombocytopenia, it is prudent to consider microangiopathic hemolytic anemia in the differential diagnosis. A 25-year-old woman, gravida 2, para 1, had an uncomplicated repeat Cesarean delivery at 38 weeks' gestation. She subsequently had an exploratory laparotomy for hemoperitoneum resulting from a left uterine artery laceration. On postoperative day 3, she developed thrombotic chrombocytopenic purpura-hemolytic uremic syndrome and was treated with plasma exchange therapy and dialysis. It is critical that clinicians consider this potentially fatal disease in the differential diagnosis when hemorrhagic shock is associated with unexplained thrombocytopenia, so that appropriate and early treatment may lead to a favorable outcome.
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Affiliation(s)
- M Rosen
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas 77555-0587, USA
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Abstract
OBJECTIVE The objective of this study was to test the hypothesis that fetuses destined to deliver preterm do not reach their individual growth potential. STUDY DESIGN In a case control design, data on 44 preterm deliveries at < or =34 weeks were compared with data on a control group of next consecutive term deliveries. Criteria for inclusion were dating by ultrasonography at <20 weeks and no medical or obstetric complications. For each fetus, GROW v.2 software was used to generate an individual optimal growth curve and to calculate the percentile of achieved growth potential for birth weight based on 6 independent factors (maternal weight, height, parity, ethnicity, fetal sex, and gestational age) identified as determining fetal weight from multivariate logistic regression analysis of 40,000 uncomplicated term pregnancies. Birth weight percentiles based on standard norms were also calculated for each fetus. RESULTS The number of fetuses with birth weight below the 5th, 10th, and 25th percentile of their growth potential was significantly higher in the preterm group (10, 13, and 18) compared with that in the control group (2, 2, and 6; P <.008, P <.001, and P <.008, respectively). There were no significant differences in variables defining growth potential between the case and control groups. The number of fetuses below the 5th and 10th percentile based on standard birth weight norms was not significantly different between preterm and term pregnancies (3 vs 1 and 5 vs 2; P =.37 and P =.27). Among preterm deliveries, those preceded by preterm premature rupture of the membranes had significantly fewer fetuses >75th percentile of their growth potential (2 vs 8; P =.025). Fetuses with lower gestational ages at preterm delivery achieved lower median percentiles of their growth potential. CONCLUSION A significant proportion of fetuses destined to deliver preterm do not reach their individual growth potential compared with those delivered at term. This finding challenges our concept of preterm delivery and management strategy aimed at tocolysis.
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Affiliation(s)
- R Bukowski
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, 77555-0587, USA
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Belfort MA, Tooke-Miller C, Varner M, Saade G, Grunewald C, Nisell H, Herd JA. Evaluation of a noninvasive transcranial Doppler and blood pressure-based method for the assessment of cerebral perfusion pressure in pregnant women. Hypertens Pregnancy 2001; 19:331-40. [PMID: 11118407 DOI: 10.1081/prg-100101995] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We have developed a Doppler method for the estimation of cerebral perfusion pressure (CPP) using noninvasive techniques. Our objective was to evaluate our new method in pregnant women. METHODS AND MATERIALS Laboring women with a lumbar epidural in situ had transcranial Doppler interrogation of the maternal middle cerebral artery (MCA) to measure systolic, diastolic, and mean velocities. A pressure transducer was connected to the epidural catheter and pressure was recorded. Systolic (SBP), diastolic (DBP), and mean (MAP) blood pressure were taken with a Dinamap monitor. Doppler estimated CPP (mm Hg) = [V(mean)/(V(mean) - V(diastolic)](MAP - DBP) and directly measured CPP = MAP - Epidural pressure data were plotted on a Bland-Altman graph with limits of agreement. The mean difference (the mean of the sum of both positive and negative differences) and absolute difference (the mean of the sum of the absolute differences) were calculated. In addition, linear and polynomial regression analyses were performed. RESULTS Twenty laboring women were studied. All had normal pregnancies. The mean maternal age was 28 +/- 7 years and the mean gestational age was 39 +/- 2 weeks. The mean maternal MAP was 77 +/- 12 mm Hg. The Bland-Altman plot showed a mean difference of 2.2 mm Hg at a mean CPP of 65 +/- 12 mm Hg; with a standard deviation of 4.8 mm Hg, the absolute difference was 3.9 +/- 3.0 mm Hg at a mean CPP of 65 +/- 12 mm Hg. The regression analysis showed an r = 0.92, r(2) = 0.86, and p < 0.0001. CONCLUSIONS Our formula allows the estimation of CPP using a simple calculation and noninvasively acquired data. This method may be of use for frequent, easy, and accurate CPP and intracranial pressure estimation and may, as such, have significant research and clinical applications.
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Affiliation(s)
- M A Belfort
- Departments of Obstetrics and Gynecology, University of Utah Medical School, Salt Lake City, Utah, USA
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Okawa T, Suzuki H, Yaanagida K, Sato A, Vedernikov Y, Saade G, Garfield R. Effect of lipopolysaccharide on uterine contractions and prostaglandin production in pregnant rats. Am J Obstet Gynecol 2001; 184:84-9. [PMID: 11174485 DOI: 10.1067/mob.2001.108083] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Our aim was to evaluate the effect of lipopolysaccharide on prostaglandin production and on contraction of isolated myometrial strips from preterm pregnant rats. STUDY DESIGN Pregnant Wistar rats on day 17 of gestation were killed 3 hours after intraperitoneal injection of lipopolysaccharide (1.5 mg/kg) or vehicle, with or without pretreatment with indomethacin (5 mg/kg administered intraperitoneally) 1 hour beforehand. Concentrations of endotoxin in maternal serum and amniotic fluid, prostaglandin F2alpha and prostaglandin E2 in amniotic fluid, and progesterone in maternal serum were determined. Longitudinal uterine strips were prepared, placed in organ chambers with Krebs-Ringer solution, aerated with 95% oxygen and 5% carbon dioxide (37 degrees C, pH approximately 7.4), and equilibrated at 1g passive tension. Concentration-contraction relationships to oxytocin were determined. Samples of bathing solution were collected 10 minutes after the concentration of oxytocin was maximal. Prostaglandins and progesterone were measured by radioimmunoassay and endotoxin was measured by the Endospecy (Seikagaku Kogyo, Tokyo, Japan) kit. RESULTS Lipopolysaccharide treatment significantly increased the levels of prostaglandin F2alpha and prostaglandin E2 in amniotic fluid. Treatment with lipopolysaccharide inhibited the production and release of prostaglandin F2alpha and prostaglandin E2 that were activated by oxytocin in uterine strips and increased the sensitivity of strips to the contractile effect of oxytocin. Indomethacin did not affect the basal or the lipopolysaccharide-activated levels of endotoxin in serum and amniotic fluid and exerted a counteraction on lipopolysaccharide-induced increases in concentrations of prostaglandin F2alpha and prostaglandin E2 in amniotic fluid. Indomethacin counteracted oxytocin-activated production and release of prostaglandin F2alpha and prostaglandin E2 in uterine tissues after lipopolysaccharide administration without changing the sensitivity of uterine strips to oxytocin. Concentrations of progesterone were not changed after lipopolysaccharide, indomethacin, or their combined application, which suggests that the changes described were not associated with alterations in the levels of the hormone. CONCLUSIONS The activation of the uterine contractile system by prostaglandin and oxytocin during intra-amniotic infection may be one of the causes of preterm delivery. A combination of an oxytocin receptor antagonist and an inhibitor of cyclooxygenase may be beneficial in prevention or treatment of preterm labor.
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Affiliation(s)
- T Okawa
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Japan
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Andres RL, Saade G, Gilstrap LC, Wilkins I, Witlin A, Zlatnik F, Hankins GV. Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia. Am J Obstet Gynecol 1999; 181:867-71. [PMID: 10521744 DOI: 10.1016/s0002-9378(99)70316-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our purpose was to correlate umbilical artery blood gas parameters with neonatal death and indicators of morbidity in neonates with pathologic fetal acidemia (pH <7.0). STUDY DESIGN We reviewed maternal and neonatal charts of 93 neonates with an umbilical artery pH <7.0 who were delivered at 2 university-based centers. The relationships between umbilical artery pH, PO (2), PCO (2), bicarbonate, base deficit, and neonatal variables-death, need for intubation, cardiopulmonary resuscitation, seizures, hypoxic-ischemic encephalopathy, respiratory distress syndrome, intraventricular hemorrhage, meconium, sepsis, and intrauterine growth restriction-were determined with the Student t test, Mann-Whitney U test, and multiple logistic regression analysis. Data are presented as either median with 25th-75th percentiles or mean +/- SD. RESULTS The mean gestational age at delivery was 37.9 +/- 3. 6 weeks, and the mean birth weight was 3003 +/- 866 g. There was no relationship between neonatal death, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, meconium, sepsis, and any umbilical artery blood gas parameter. The PO (2) was not related to any of the variables studied. A lower umbilical artery pH was associated with hypoxic-ischemic encephalopathy (6.69 vs 6.93, P =.03), cardiopulmonary resuscitation (6.83 vs 6.93, P =.03), seizure (6.75 vs 6.93, P =.02), intubation (6.83 vs 6.94, P <.001), and intrauterine growth restriction (6.72 vs 6.93, P =.01). Greater mean base deficit was associated with seizure (20.6 vs 15, P =.01), intubation (18.0 vs 13.7, P <.001), cardiopulmonary resuscitation (18.5 vs 15.0, P =.03), intrauterine growth restriction (22.0 vs 14. 0, P =.02), and hypoxic-ischemic encephalopathy (24.0 vs 14.5, P =. 03). Arterial PCO (2) was higher only in infants with hypoxic-ischemic encephalopathy (138 vs 95.5, P =.048), intubation (106.0 vs 90.5, P =.003), and cardiopulmonary resuscitation (106.5 vs 93.0, P =.04). After control for birth weight and gestational age in the multivariate analysis, base deficit and bicarbonate were independently related to death or morbidity. CONCLUSION Our data suggest that "pathologic" fetal acidemia is indicated by an umbilical artery pH <7.00 with a metabolic component. The metabolic component of fetal acidemia (ie, base deficit and bicarbonate) is the most important variable in subsequent neonatal morbidity. As expected, the umbilical artery PO (2) has no apparent clinical utility. The ability to predict more accurately which newborn infants with fetal acidemia are at risk of having complications may lead to a more efficient implementation of preventive measures.
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Affiliation(s)
- R L Andres
- Department of Obstetrics, The University of Texas-Houston Medical School, Houston, USA
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Moise KJ, Rodkey LS, Yared M, Hudon L, Saade G, Dorman K, Graham A. An animal model for hemolytic disease of the fetus or newborn in New Zealand white and New Zealand red rabbits: newborn effects. Am J Obstet Gynecol 1998; 179:1353-8. [PMID: 9822528 DOI: 10.1016/s0002-9378(98)70159-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Our purpose was to study the neonatal effects of red blood cell alloimmunization in a rabbit model. STUDY DESIGN Eighteen does were alloimmunized to incompatible red blood cells. Does were bred twice, once with a homozygous buck of incompatible blood type and once with a homozygous buck of compatible blood type. Fetal blood sampling was undertaken on day 27 of gestation (term 28 to 31 days). Does were delivered on day 30 and the neonatal pups were anesthetized. Direct cardiac samplings were performed for hemoglobin, reticulocyte count, and direct Coombs' test. Hepatic, splenic, and renal wet weights were measured. RESULTS Twenty-two pregnancies (12 compatible and 10 incompatible) were studied. Neonatal hemoglobin was higher in the compatible litters (11.1 gm/dL [7.7 to 12.6 gm/dL] vs 4.9 gm/dL [2.1 to 9.1 gm/dL], P <.001), whereas no difference could be detected between the respective reticulocyte counts (34.0/100 red blood cells [27.3 to 36.1/100 red blood cells] vs 32.6/100 red blood cells [26.8 to 43.5/100 red blood cells], P =.55). The direct Coombs' assay was negative in 23 pups from 8 compatible litters and false positive (weakly positive result) in 2 pups of a ninth compatible litter. The Coombs' assay was positive in all 22 incompatible pups tested. Hepatosplenomegaly was noted in affected pups but not in controls. CONCLUSIONS A disease analogous to human hemolytic disease of the newborn can be induced in the rabbit neonate.
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Affiliation(s)
- K J Moise
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Vedernikov Y, Saade G, Belfort M, Garfield RE. Effect of glycosylated hemoglobin on endothelium-dependent relaxation of omental arteries from pregnant women. Am J Obstet Gynecol 1998; 179:1047-50. [PMID: 9790396 DOI: 10.1016/s0002-9378(98)70213-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study was intended to test the hypothesis that glycosylated hemoglobin adversely affects endothelium-dependent vascular relaxation during pregnancy. STUDY DESIGN Omental artery rings (3 mm) obtained from patients undergoing cesarean delivery at term were suspended in organ chambers for isometric tension recording in Krebs bicarbonate solution. They were bubbled with 5% carbon dioxide in air (37 degrees C, pH 7.4). After equilibration at 1-g passive tension and contraction with endothelin 1, concentration-relaxation curves in response to bradykinin were determined in the presence or absence of oxyhemoglobin, glycosylated hemoglobin, or nitric oxide synthase inhibitors (N(omega)-nitro-L-arginine methyl ester or N(omega)-nitro-L-arginine). RESULTS Oxyhemoglobin and glycosylated hemoglobin attenuated the endothelium-dependent relaxation induced by bradykinin. The inhibition did not differ significantly between the 2 nitric oxide scavengers and was of the same magnitude as that noted with the nitric oxide synthase inhibitors. CONCLUSION Glycosylation of hemoglobin does not change its effect on endothelium-dependent relaxation in human omental vessels during pregnancy. These data do not support the hypothesis that glycosylated hemoglobin may be the reason for abnormal endothelial function in diabetes.
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Affiliation(s)
- Y Vedernikov
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston 77555-1062, USA
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Garfield RE, Saade G, Buhimschi C, Buhimschi I, Shi L, Shi SQ, Chwalisz K. Control and assessment of the uterus and cervix during pregnancy and labour. Hum Reprod Update 1998; 4:673-95. [PMID: 10027621 DOI: 10.1093/humupd/4.5.673] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Preterm labour and resultant preterm birth are the most important problems in perinatology. Countless efforts have failed to establish a single effective treatment of preterm labour, partly because the mechanisms regulating the uterus and cervix during pregnancy are not well understood. New knowledge is needed to inhibit early progression of labour (uterine contractility and cervical ripening), and adequate quantitative tools to evaluate the uterus and cervix during pregnancy are lacking. In this review, we outline studies showing that the uterus (myometrium) and cervix pass through a conditioning step in preparation for labour. This step is not easily identifiable with present methods to assess the uterus or cervix. In the uterus, this seemingly irreversible step consists of changes in the electrical properties to make muscle more excitable and responsive to produce forceful contractions. In the cervix, the step consists of softening of the connective tissue components. Progesterone appears to have a dominant role in controlling both the uterus and cervix, as antiprogestins induce early, preterm conditioning leading to preterm labour. Apparently, nitric oxide (NO) also controls conditioning of the uterus and cervix. In the uterus, NO, in concert with progesterone, inhibits uterine contractility. At term, NO production by the uterus and placenta are decreased and allow labour to progress. In contrast, NO in the cervix increases at the end of pregnancy and it may be the final pathway for stimulating cervical ripening by activation of metalloenzymes. The progress of labour can be assessed non-invasively using electromyographic (EMG) signals from the uterus (the driving force for contractility) recorded from the abdominal surface. Uterine EMG bursts detected in this manner characterize uterine contractile events during human and animal pregnancy. A low uterine EMG activity, measured transabdominally throughout most of pregnancy, rises dramatically during labour. EMG activity also increases substantially during preterm labour in humans and rats. This method may be used one day to predict impending preterm labour and identify control steps and treatments. A quantitative method also assesses the cervix, using an optical device which measures collagen fluorescence in the cervix. The collascope estimates cervical collagen content from a fluorescent signal generated when collagen cross-links are illuminated with excitation light of about 340 nm. The system has proved useful in rats and humans at various stages of pregnancy, and indicates that cervical softening occurs progressively in the last one-third of pregnancy. In rats, collascope readings correlate with resistance measurements made in the isolated cervix, which may help to assess cervical function during pregnancy, and indicate control and treatments.
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Affiliation(s)
- R E Garfield
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston 77555-1062, USA
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Abstract
BACKGROUND To report the technique and results of simultaneous surgery for cataract and retinal detachment. METHODS This retrospective study covered 452 cases of phakic detachment. Dense cataract was present in 15 cases that did not need intravitreal surgery. For these, a triple procedure involving phacoemulsification, posterior chamber lens insertion, and scleral buckling surgery was performed. Combined cataract and scleral buckling surgery was carried out after the failure of initial detachment surgery in four cases, including scleral buckling in three and vitrectomy in one. RESULTS A clear intraoperative view of the fundus was obtained in all cases and retinal breaks were identified in 13. The retina was reattached by combined surgery in 13 cases (87%) and a final acuity of 20/40 or better was attained in 7 of these 13 reattached cases (54%). There was no instance of visual imbalance due to gross miscalculation of intraocular lens power. CONCLUSION Combined cataract and scleral buckling surgery spares the patient repeat surgery and may improve the outcome by avoiding delay for detachment repair. To perform this procedure, however, vitreoretinal surgeons must be familiar with phacoemulsification techniques.
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Affiliation(s)
- P Girard
- Fondation Ophtalmologique Rothschild, Paris, France
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Vedernikov YP, Kravtsov GM, Postnov YV, Saade G, Garfield RE. Effect of red blood cells and hemoglobin on spontaneously hypertensive and normotensive rat aortas. Am J Hypertens 1998; 11:105-12. [PMID: 9504457 DOI: 10.1016/s0895-7061(97)00362-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Experiments were designed to compare the contractile effect of red blood cells (RBC) on aortic rings with and without endothelium from normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Red blood cells of 4 week old WKY and SHR rats induced a negligible increase in tension of aortic rings, either with or without endothelium, being slightly more effective in SHR rats. However, red blood cells of 16 week old rats increased tension of WKY and SHR aortic rings, with endothelium at this age being more pronounced then red blood cells in 4 week old animals. The contractions induced by WKY and SHR red blood cells both in WKY and SHR aortic rings without endothelium at this age are significantly greater compared to the effect on aortic rings with endothelium. Red blood cell ghosts of rats of both strains increased the tension of the rings without endothelium of SHR aorta to near 50% of those induced by red blood cells, whereas they were ineffective in aortic rings without endothelium of WKY rats. Oxyhemoglobin increased the tension of 16 week SHR aortic rings both with and without endothelium, whereas the effect on the rings of WKY rats was negligible. This increase in tension was inhibited by BM 13505, nordihydroguaiaretic acid, and indomethacin in SHR rings both with and without endothelium, demonstrating an eicosanoid involvement in oxyhemoglobin-induced contractions. Hemoglobin or its metabolites may be involved in development or in maintenance of spontaneous hypertension.
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Affiliation(s)
- Y P Vedernikov
- University of Texas Medical Branch, Department of Obstetrics and Gynecology, Galveston 77555-1062, USA.
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Abstract
OBJECTIVE To test the usefulness of ultrasound-derived measurements of intracardiac filling pressures and cardiac performance in the noninvasive management of obstetric patients with an indication for hemodynamic monitoring. METHODS We included patients with oliguria unresponsive to crystalloid boluses, with hypertension unresponsive to hydralazine, and at high risk for pulmonary edema who were determined to be candidates for invasive monitoring. They were first studied with two-dimensional echocardiography and Doppler ultrasound using a technique previously validated at our institution. Cardiac dimensions, filling pressures, and function were assessed at the bedside. Subsequently, management decisions were made based on these findings. RESULTS Fourteen patients were studied. Two received a pulmonary artery catheter after noninvasive evaluation indicated a need for continuous monitoring. The 12 patients managed without the need for a pulmonary artery catheter included women with intractable hypertension (one patient), pulmonary edema (two patients), complex cardiac lesions (two patients), oliguria (five patients), intractable hypertension and oliguria (one patient), and unexplained dyspnea with peripheral arterial oxygen desaturation (one patient). Although some patients received as much as 8 L of crystalloid, none developed pulmonary edema or left ventricular failure. In all 12 cases, the ultrasound monitoring allowed successful noninvasive management of the patient. CONCLUSION This pilot study suggests that two-dimensional echocardiography and Doppler examination may be an effective alternative to invasive monitoring in the management of selected pregnant patients.
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Affiliation(s)
- M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
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Buhimschi C, Buhimschi I, Saade G, Chwalisz K, Garfield R. Electrical uterine activity recorded from the rat abdominal surface during tocolysis. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brandt ML, Moise KJ, Eckert JW, Johnson L, Waltrip T, Saade G, Wu Y, Finegold MJ. Transuterine puncture of the fetal stomach provides access to the small bowel in the rabbit. J INVEST SURG 1997; 10:41-6. [PMID: 9100174 DOI: 10.3109/08941939709032124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prevention of perinatal complications of congenital gastrointestinal (GI) diseases such as cystic fibrosis may require prenatal treatment. New Zealand White rabbits were evaluated as a potential animal model to study gastrointestinal anatomy and transit in the fetus. The lengths of the GI tract of fetuses at 21/31 and 28/31 days gestation were established, and gastric volume was measured. Gastric volume at 28 days gestation averaged 2.6 mL, adequate to permit instillation of a solution into the fetal stomach. A study was then carried out to establish gastric emptying and delivery of the solution into the small bowel. Using ultrasound guidance, the stomachs of 26 fetuses from 7 litters were punctured and 0.5 mL of dilute barium was injected. A cesarean section was performed 4 h later and the progression of barium though the GI tract was measured. In 18/26 (69.2%) of the fetuses barium was successfully delivered to the lumen of the stomach. In these 18 fetuses, barium progressed to the duodenum in 15 (58%), the jejunum in 13 (50%), and the ileum in 8 (31%). The stomach of the 3.5- to 4-week-old fetus is large enough to allow transuterine delivery of a solution of dilute barium. Gastric and intestinal motility in the 25-day-old rabbit fetus is coordinated and results in delivery of barium to the small bowel in 50% of animals successfully injected. The results suggest that the rabbit is an acceptable model for the study of gastrointestinal delivery of therapeutic drugs or genes to the fetus.
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Affiliation(s)
- M L Brandt
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Shi S, Chwalisz K, Shi L, Liao QP, Saade G, Garfield R. Interaction of nitric oxide (NO) and progesterone on preterm delivery in rats. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vedernikov Y, Saade G, Belfort M. Effect of glycosylated hemoglobin on endothelium dependent relaxation of omental arteries from pregnant women. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80697-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shi SO, Saade G, Liao P, Shi L, Chwalisz K, Garfield R, Hankins G. Uteroplacental ischemia does not produce a preeclampsia-like condition in the pregnant rat. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goodrum J, Olson G, Glassman W, Buhimschi I, Martin E, Chwalisz K, Saade G, Garfield R. Changes in collagen content of the human cervix as measured with light-induced fluorescence. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Buhimschi C, Buhimschi I, Saade G, Chwalisz K, Garfield R. The effect of oxytocin on uterine contractility and electromyographic activity recorded from the rat abdominal surface. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Okawa T, Syal A, Vedernikov Y, Saade G, Chwalisz K, Garfield R. Effects of a nitric oxide donor and a scavenger on isolated uterine and aortic rings from pregnant rats. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Glassman W, Goodrum L, Olson G, Liao P, Shi SQ, Buhimschi I, Saade G, Chwalisz K, Garfield R. Changes in collagen content of the rat cervix during term and preterm labor as measured with light-induced fluorescence. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shi L, Shi S, Classman W, Buhimschi I, Saade G, Chwalisz K, Garfield R. Changes in cervical ripening in the rat during pregnancy effect of a nitric oxide synthase inhibitor. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80073-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buhimschi I, Chwalisz K, Liao O, Saade G, Garfield R. The effect of an endothelin antagonist on blood pressure in a rat model of preeclampsia. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liao QP, Buhimschi IA, Saade G, Chwalisz K, Garfield RE. Regulation of vascular adaptation during pregnancy and post-partum: effects of nitric oxide inhibition and steroid hormones. Hum Reprod 1996; 11:2777-84. [PMID: 9021390 DOI: 10.1093/oxfordjournals.humrep.a019209] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Treatment of pregnant rats with the nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME), has been shown to produce symptoms similar to pre-eclampsia (i.e. elevated blood pressure, proteinuria and fetal growth retardation). After L-NAME infusion is initiated on day 17 or 18 of gestation, the blood pressure proceeds in a biphasic pattern (immediate rise, followed by a decline, then increasing again in the post-partum period). The blood pressure actually begins to rise prior to delivery on days 21-22, i.e. after progesterone withdrawal occurs, suggesting that these responses may be regulated by changes in steroid hormone concentrations during pregnancy. Therefore, we evaluated the effects of the different steroid hormones: progestins (progesterone, promegestone, levonorgestrel), antiprogestins (mifepristone), 17 beta-oestradiol or androgens (testosterone, dihydrotestosterone) on systolic blood pressure in pregnant, non-pregnant female and normal male rats with and without L-NAME treatment and spontaneously hypertensive male rats. The animals received continuous infusions of L-NAME (150 mg/kg/day) or vehicle through osmotic mini-pumps and daily s.c. injections of steroid hormones. In pregnant rats the pump was inserted on day 17 or 18 of gestation and steroid hormone injections were started on the first day following delivery at term and continued daily until post-partum day 10. In non-pregnant female or male rats steroid hormone injections were initiated 5 days after the L-NAME pump was inserted. Systolic blood pressure was measured daily from the tail with a pneumatic tail-cuff device. R5020 (1.5 mg/kg/day) significantly attenuated the blood pressure elevation induced by L-NAME during the post-partum period. Similarly, it lowered blood pressure in L-NAME treated non-pregnant female rats or male rats. R5020 also lowered blood pressure in spontaneously hypertensive male rats. Progesterone (6 mg/kg/day) had similar effects on blood pressure in the post-partum period, although it also lowered the blood pressure in control animals. Interestingly, administration of two different doses of levonorgestrel (0.3 and 1.5 mg/kg/day) did not decrease the blood pressure in either L-NAME-infused rats or controls. Mifepristone (RU486, 30 mg/kg/day) further increased blood pressure in L-NAME-treated rats post-partum. 17 beta-oestradiol (30 micrograms/kg/day) had no effect on blood pressure in either L-NAME infused rats in the post-partum period or controls, whereas both testosterone (0.3 mg/kg/day) and dihydrotestosterone (0.3 mg/kg/day) significantly attenuated the blood pressure increase after L-NAME, while raising the blood pressure in vehicle-infused animals. These results suggest that the control of systemic blood pressure during pregnancy may be modulated by steroid hormones. Progesterone may be the steroid hormone with the major action on vascular tension during pregnancy.
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Affiliation(s)
- Q P Liao
- University of Texas Medical Branch, Department of Obstetrics and Gynecology, Galveston 77555-1062, USA
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Moise KJ, Rodkey LS, Saade G, Gei A, Duré M, Graham A, Creech C. An animal model for hemolytic disease of the fetus and newborn. I. Alloimmunization techniques. Am J Obstet Gynecol 1995; 173:51-5. [PMID: 7631726 DOI: 10.1016/0002-9378(95)90168-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Our purpose was to establish an animal model for hemolytic disease of the fetus and newborn by developing red blood cell alloimmunization techniques in the rabbit. STUDY DESIGN Twenty-six nonpregnant New Zealand White or Red does underwent blood typing to identify them as homozygous at the HgA or HgF red blood cell antigen locus. Alloimmunization to incompatible red blood cells was attempted through a series of subcutaneous injections using complete then incomplete Freund's adjuvant. RESULTS Successful induction of an antibody response occurred in 96% of cases. The median response in FF rabbits was 2560 (range 40 to 10,240), whereas the response in AA does was 2560 (range 320 to 20,480). These responses were not statistically different (p = 0.77). Responses were categorized as poor, moderate, or good. No difference was noted between FF and AA does in distribution of the categories of response (p = 0.53). CONCLUSION Red blood cell alloantibodies of high titer can be induced successfully in the rabbit.
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Affiliation(s)
- K J Moise
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Moise KJ, Perkins JT, Sosler SD, Brown SJ, Saade G, Carpenter RJ, Thorp JA, Ludomirski A, Wilkins IA, Grannum PA. The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization. Am J Obstet Gynecol 1995; 172:1003-9. [PMID: 7892839 DOI: 10.1016/0002-9378(95)90034-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection of fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and monocyte monolayer assay. STUDY DESIGN Forty-seven serum samples from pregnant women with red blood cell antibodies associated with fetal anemia were analyzed at cordocentesis. Fetal blood was analyzed for hematocrit (corrected for gestational age) and antigen status. Fetal anemia was defined as a hematocrit value of < 2 SD from the mean value for gestational age. Fetuses were classified into three groups: Antigen positive with anemia (n = 19), antigen positive without anemia (n = 17), antigen negative (n = 11). Statistical methods included Kruskal-Wallis test, Newman-Keuls test, Spearman's rank correlation, and receiver-operator characteristic curves; p < 0.05 was considered significant. RESULTS The median monocyte monolayer assay (phagocytosis, adherence, and association) did not differ among the three groups. Both maternal titers and Marsh scores were significantly higher in fetuses with anemia compared with the other two groups of fetuses (256 vs 64 vs 64, p < 0.001, and 86 vs 69 vs 64, p = 0.02, respectively). Both titer and Marsh score exhibited significant correlations with corrected fetal hematocrit (r = -0.70, p < 0.001; r = -0.63, p < 0.001, respectively). Comparison of the overall receiver-operator characteristic curves for titer and Marsh score revealed no statistical difference; however, a Marsh score of 57 was noted to have a superior specificity than a titer of 16 (p = 0.02). CONCLUSION The maternal Marsh score can be performed in conjunction with standard indirect Coombs' titers to enhance the predictability of fetal anemia.
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Affiliation(s)
- K J Moise
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030
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Kramer WB, Saade G, Ou CN, Rognerud C, Dorman K, Mayes M, Moise KJ. Placental transfer of sulindac and its active sulfide metabolite in humans. Am J Obstet Gynecol 1995; 172:886-90. [PMID: 7892880 DOI: 10.1016/0002-9378(95)90016-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Our aim was to investigate whether the human placenta is permeable to sulindac or its active sulfide metabolite. STUDY DESIGN Nine pregnant patients (median gestational age [range]: 31.8 [24.3 to 36.4] weeks) were given a 200 mg oral dose of sulindac 5.5 (4.4 to 6.7) hours before 18 intravascular transfusions for rhesus or Kell alloimmunization. At each procedure maternal and fetal serum levels of sulindac and the active sulfide metabolite were measured by high-performance liquid chromatography. RESULTS The maternal sulfide level was significantly higher than the fetal sulfide levels, but no significant difference was noted between maternal and fetal sulindac levels. The sulfide fetal/maternal ratio was significantly lower than the sulindac fetal/maternal ratio. The sulfide/sulindac ratio was significantly higher in maternal serum versus fetal serum. The sulfide/sulindac ratio correlated with time from drug ingestion to sampling on the maternal side only. In patients studied on more than one occasion no consistent relationship between fetal sulindac, fetal sulfide, or fetal sulfide/sulindac ratio, and gestational age could be demonstrated. CONCLUSION The placenta is permeable to sulindac but less so to its active sulfide metabolite. The reduction of sulindac to its active sulfide metabolite is decreased in the human fetus.
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Affiliation(s)
- W B Kramer
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030
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