Association between maternal symptoms of sleep disordered breathing and fetal telomere length

STUDY OBJECTIVES

Our investigation aims to assess the impact of symptoms of maternal sleep-disordered breathing, specifically sleep apnea risk and daytime sleepiness, on fetal leukocyte telomere length.

PARTICIPANTS AND SETTING

Pregnant women were recruited upon hospital delivery admission.

INTERVENTIONS

Sleep exposure outcomes were measured using the Berlin Questionnaire to quantify sleep apnea and the Epworth Sleepiness Scale to measure daytime sleepiness. Participants were classified as "High Risk" or "Low Risk" for sleep apnea based on responses to the Berlin, while "Normal" or "Abnormal" daytime sleepiness was determined based on responses to the Epworth.

DESIGN

Neonatal umbilical cord blood samples (N = 67) were collected and genomic DNA was isolated from cord blood leukocytes using Quantitative PCR. A ratio of relative telomere length was derived by telomere repeat copy number and single copy gene copy number (T/S ratio) and used to compare telomere lengths. Bootstrap and ANOVA statistical procedures were employed.

MEASUREMENTS AND RESULTS

On the Berlin, 68.7% of participants were classified as Low Risk while 31.3% were classified as High Risk for sleep apnea. According to the Epworth scale, 80.6% were determined to have Normal daytime sleepiness, and 19.4% were found to have Abnormal daytime sleepiness. The T/S ratio among pregnant women at High Risk for sleep apnea was significantly shorter than for those at Low Risk (P value < 0.05), and the T/S ratio among habitual snorers was significantly shorter than among non-habitual snorers (P value < 0.05). Although those with Normal Sleepiness had a longer T/S ratio than those with Abnormal Sleepiness, the difference was not statistically significant.

CONCLUSION

Our results provide the first evidence demonstrating shortened telomere length among fetuses exposed to maternal symptoms of sleep disordered breathing during pregnancy, and suggest sleep disordered breathing as a possible mechanism of accelerated chromosomal aging.

Impact of intrauterine tobacco exposure on fetal telomere length

OBJECTIVE

We sought to investigate whether maternal smoking during pregnancy affects telomere length of the fetus.

STUDY DESIGN

Pregnant women were recruited on hospital admission at delivery. A self-report questionnaire and salivary cotinine test were used to confirm tobacco exposure. Neonatal umbilical cord blood samples were collected, and genomic DNA was isolated from cord blood leukocytes and was analyzed for fetal telomere length based on quantitative polymerase chain reaction. A ratio of relative telomere length was determined by telomere repeat copy number and single copy gene copy number (T/S ratio) and used to compare the telomere length of active, passive, and nonsmokers. Bootstrap and analysis of variance statistical methods were used to evaluate the relationship between prenatal smoking status and fetal telomere length.

RESULTS

Of the 86 women who were included in this study, approximately 69.8% of the participants were covered by Medicaid, and 55.8% of the participants were black or Hispanic. The overall mean T/S ratio was 0.8608 ± 1.0442. We noted an inverse relationship between smoking and fetal telomere length in a dose-response pattern (T/S ratio of nonsmokers that was more than passive smokers that was more than active smokers). Telomere length was significantly different for each pairwise comparison, and the greatest difference was between active and nonsmokers.

CONCLUSION

Our results provide the first evidence to demonstrate a positive association between shortened fetal telomere length and smoking during pregnancy. Our findings suggest the possibility of early intrauterine programming for accelerated aging that is the result of tobacco exposure.

Circulating Anti-PLAC1 Antibodies during Pregnancy and in Women with Reproductive Failure: A Preliminary Analysis

The aims of this study were to determine the prevalence of anti-PLAC1 antibodies in normal pregnant women and in women with infertility or recurrent pregnancy loss (RPL). Secondary outcomes were the development of complications associated with anti-PLAC1 seropositivity and the rate of seroconversion during pregnancy. Sera from 103 healthy pregnant women and 45 women with unexplained infertility or RPL were analyzed by ELISA. The prevalence of anti-PLAC1 antibodies was 2% in healthy pregnant women and 4.5% in women with unexplained infertility or RPL (P=0.355). There was no detectable association of seropositivity with increased risk of pregnancy complications. Finally, 2% of women seroconverted during pregnancy. The prevalence of anti-PLAC1 antibodies in women with unexplained infertility or RPL is not significantly higher than the prevalence in normal pregnant women. However, the sample size in this study was too small. The exposure to the PLAC1 antigen during pregnancy can lead to the spontaneous development of antibodies.

Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus

BACKGROUND

Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus (GDM) over the Internet.

METHODS

Women with GDM were randomized to either the Internet group (n = 32) or the control group (n = 25). Patients in the Internet group were provided with computers and/or Internet access if needed. A website was established for documentation of glucose values and communication between the patient and the health care team. Women in the control group maintained paper logbooks, which were reviewed at each prenatal visit. Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery.

RESULTS

Women in the Internet group accessed the system and sent on average 21.8 (+/- 16.9) sets of data. There was no difference between the two groups in regards either fasting or post-prandial blood glucose values, although more women in the Internet group received insulin therapy (31% vs. 4%; P <0.05). There were also no significant differences in pregnancy and neonatal outcomes between the two groups. Women in the Internet group demonstrated significantly higher feelings of self-efficacy at the study's end.

CONCLUSIONS

The benefit of monitoring blood glucose in indigent women with GDM via the Internet was limited by their infrequent use of the telemedicine system. Although system use was not associated with improved pregnancy outcomes, women in the telemedicine group did experience enhanced feelings of diabetes psychosocial self-efficacy.

Urinary tract infections in pregnant women with bacterial vaginosis

OBJECTIVE

Our purpose was to investigate the risk of urinary tract infections in pregnant women with bacterial vaginosis.

STUDY DESIGN

In a cross-sectional study, 503 pregnant women were examined for bacterial vaginosis and urinary tract infections from July 1999 through April 2000.

RESULTS

Nineteen (13.6%) of 140 women who had bacterial vaginosis had urinary tract infections compared with 24 (6.6%) of 363 women without it. Bacterial vaginosis in pregnancy was associated with an increased risk for urinary tract infections (odds ratio 2.21, 95% CI 1.16-4.18).

CONCLUSION

Pregnant women with bacterial vaginosis are more likely to have urinary tract infections.

Intensive interventional maternity care reduces infant morbidity and hospital costs

OBJECTIVE

The purpose of this study was to introduce an intensive interventional maternity care program, called the Temple Infant and Parent Support Services (TIPSS) program, and to determine whether comprehensive maternal and infant care would reduce the high rate of infant morbidity and mortality.

METHODS

The TIPSS program was comprehensive, offering multidisciplinary services that were family focused and community based. Program services included community outreach, health education, as well as clinical care for the entire family. The effect of this program was evaluated among a very high-risk group of women who were recruited into care versus a control group of high-risk patients from the same neighborhood who voluntarily sought care at the Temple University School of Medicine. Outcome parameters evaluated included gestational age at delivery, birth weight, neonatal intensive care admission, infant death and cost of infant care.

RESULTS

Among the TIPSS study group, 5.2% of infants were below 2500 g versus 11% in the control group (p < 0.05). Similarly, preterm deliveries occurred in 4.2% and 12% of the study and control groups, respectively (p < 0.005). Other significant differences observed included the number of prenatal visits (p < 0.001), maternal weight gain (p < 0.05) and admission to the neonatal intensive care unit (2% vs. 6.6%; p < 0.05). The reduced admission rate among neonates from the TIPSS program resulted in significant cost savings: $2849 for neonates in the study group versus $8499 for those in the control group. This corresponds to a $5560 savings per infant born to mothers cared for in the TIPSS study group.

CONCLUSIONS

The Temple Infant and Parent Support Services program demonstrated that infant morbidity could be reduced when a comprehensive prenatal program was made available to indigent patients, even if there were multiple factors that placed the mother and her infant at high risk for complications.