Maternal poly I:C exposure during pregnancy regulates TNF alpha, BDNF, and NGF expression in neonatal brain and the maternal-fetal unit of the rat

Maternal infection during pregnancy is associated with increased risk for neurodevelopmental disorders. Polyriboinosinic-polyribocytidilic acid (poly I:C) or saline was administered to rats to model maternal infection; levels of TNFalpha, brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) were determined by ELISA. TNFalpha was significantly increased in maternal plasma, placenta, and amniotic fluid, while it was significantly decreased in fetal liver/spleen and neonatal brain. NGF and BDNF were significantly decreased in the placenta and fetal liver/spleen. There was no change in BDNF or NGF in the fetal or neonatal brain. Changes in TNFalpha, BDNF, and NGF after maternal exposure to poly I:C represent a potential mechanism through which maternal infection increases risk for neurodevelopmental disorders.

The Anti-thyroid Drug Methimazole Induces Neovascularization in the Neonatal Rat Analogous to ROP

PURPOSE

To determine the effect of methimazole (MMI), an anti-thyroid drug known to reduce serum l-thyroxine (T4), and insulin-like growth factor (IGF)-1 concentrations, on retinal vascular development in neonatal rats.

METHODS

Sprague-Dawley rats (n=175) were raised in expanded litters of 25 in room air and were exposed to MMI from birth (given as a 0.1% solution to nursing mothers for either 4 or 10 days). Experiments ended on day 4 (n=25) or 10 (n=50) of life. A third group was exposed to MMI for the initial 4 days of life and then allowed to recover for the next 6 days (n=50). Fifty control rats were analyzed on day 4 (n=25) or 10 (n=25) of life. Left eyes were fixed, and retinas were dissected and stained with adenosine diphosphatase (ADPase). Retinas were graded for presence and severity of neovascularization (NV) in a masked manner, and retinal vascular areas were quantified. In a subsequent study, serum IGF-1 and T4 levels were measured by radioimmunoassay in an additional 200 rats exposed to treatments identical to those described.

RESULTS

Retinal NV occurred in 31% of rats exposed to 10 days of MMI and 4% (P=0.02) of rats exposed to 4 days of MMI, followed by 6 days of recovery. None of the rats exposed to 4 days of MMI alone and none of the control animals was graded positive for NV. Retinal vascular areas were significantly reduced in rats exposed to 4 days of MMI compared with 4-day control animals (36% +/- 6% vs. 50% +/- 6%, P=0.0001). Serum IGF-1 levels were markedly reduced in 4-day MMI rats compared with age-matched control animals (42 ng/mL vs. 133 ng/mL, P=0.0001) and in 10-day MMI rats compared with 10-day control animals (133 ng/mL vs. 206.5 ng/mL, P=0.005). Serum T4 levels were similarly suppressed in the MMI-exposed litters compared with control animals at day 10 (P=0.008). In contrast, rats exposed to 4 days of MMI followed by 6 days of recovery had normal serum IGF-1 and T4 levels by day 10.

CONCLUSIONS

The anti-thyroid drug, MMI, induces NV in neonatal rats. This may be mediated by the initial suppression of serum IGF-1. Nevertheless, the lower incidence of NV when serum IGF-1 levels are initially suppressed followed by complete recovery, is contrary to a purely permissive role for serum IGF-1, as reported previously. The relationship between the temporal course of serum IGF-1 and NV in immature retinas needs further investigation.

Cardiovascular pharmacotherapeutic considerations during pregnancy and lactation

Cardiovascular drugs are often used in pregnancy for the treatment of maternal and fetal conditions. Mothers could also require continued postpartum drug therapy. Most cardiovascular drugs taken by pregnant women can cross the placenta and therefore expose the developing embryo and fetus to their pharmacologic and teratogenic effects. These effects are influenced by the intrinsic pharmacokinetic properties of a given drug as well as by the complex physiological changes occurring during pregnancy. Many drugs are also transferred into human milk and therefore can potentially have adverse effects on the nursing infant. This 2-part article summarizes some of the available literature concerning the risks and benefits of using various cardiovascular drugs and drug classes during pregnancy and lactation. Included in the discussion are cardiac glycosides, antiarrhythmic drugs, drugs used to treat both acute and chronic hypertension, cholesterol-lowering agents, anticoagulants, thrombolytics, and antiplatelet drugs.

Influence of maternal tobacco smoking during pregnancy on uterine, umbilical and fetal cerebral artery blood flows

BACKGROUND

Cigarette smoking during pregnancy is a major cause of adverse perinatal outcome but effects on critical fetal and maternal circulations remain unclear.

AIMS

To determine (1) the influence of habitual maternal cigarette smoking on blood flow velocities in uterine, umbilical and fetal middle cerebral arteries, and (2) the time-course of changes in these flows after smoking a cigarette.

SUBJECTS AND METHODS

In 74 women who smoked and 69 non-smoking controls we measured Doppler blood flow velocity waveforms in the uterine, umbilical and fetal middle cerebral (MCA) arteries; smokers were divided into light (<10 cigarettes/day, n=28) and heavy smokers (>10 cigarettes/day, n=45).

RESULTS

In the uterine artery there was no significant difference between the systolic/diastolic (S/D) ratio in smoking and non-smoking women; however, in smokers, a diastolic notch was more frequently observed in the uterine artery waveform than in controls (p<0.05), suggestive of a greater resistance in the uterine vasculature. In the umbilical artery, the S/D ratio was significantly greater in smokers than in non-smokers. In the fetal MCA, the S/D ratio was higher in heavy smokers than in light smokers (p<0.05) indicative of greater cerebrovascular resistance. There were no significant correlations between the interval between smoking the last cigarette and making the Doppler measurements and the S/D ratios in any of the vessels.

CONCLUSION

Maternal cigarette smoking is associated with evidence of chronically increased resistances in the uterine, umbilical and fetal middle cerebral arteries.

Fetal phenotypes and neonatal and early childhood outcomes in twins

OBJECTIVES

The purpose of this study was to evaluate factors associated with, and postnatal consequences of, altered patterns of fetal growth in twins.

STUDY DESIGN

Fetal growth was measured at 28 weeks' gestation on 218 twins, including head circumference, abdominal circumference, and femur length, and characterized as > or < or =10th %ile; children were followed up until the age of three years. Logistic regression was used to generate odds ratios of perinatal factors associated with reduced fetal growth.

RESULTS

Maternal height <62 inches was associated with reductions in femur length (adjusted odds ratio [AOR] 3.88, 95% CI 1.42-10.57) and abdominal circumference (AOR 8.63, 95% CI 2.41-30.94), while primiparity had a protective effect on both of these fetal measurements (AOR 0.28, 95% CI 0.13-0.64, and AOR 0.18, 95% CI 0.06-0.60, respectively), as well as head circumference (AOR 0.32, 95% CI 0.15-0.69). Smoking adversely affected femur and head growth (AOR 24.10, 95% CI 3.69-157.57, and AOR 10.82, 95% CI 1.73-67.79, respectively). Fetal reduction adversely affected femur and abdomen growth (AOR 5.85, 95% CI 1.52-22.51 and AOR 4.90, 95% CI 1.01-23.86, respectively), and monochorionicity and maternal weight gain <0.65 lb/wk before 20 weeks adversely affected femur growth (AOR 5.47, 95% CI 1.65-18.10, and AOR 3.39, 95% CI 1.34-8.59, respectively). At age 3 years, all categories of twins with reduced growth by 28 weeks' gestation were significantly shorter in height, and those with reduced abdominal circumference or head circumference at 28 weeks were also significantly lighter in weight compared with twins with adequate fetal growth by 28 weeks' gestation.

CONCLUSION

These data identify short maternal height, smoking, monochorionicity, fetal reduction, and inadequate weight gain before 20 weeks as risk factors associated with reduced twin fetal growth by 28 weeks' gestation and significant residual reductions in height and weight through 3 years of age.

Effects of maternally administered dexamethasone and acute hypoxemia at 0.7 gestation on blood pressure and placental perfusion in sheep

Glucocorticoid administration to women in premature labor significantly decreases preterm infant morbidity and mortality. Fetal exposure to maternally administered glucocorticoids in late gestation causes fetal hypertension. We determined the effects of a single course (4 injections at 12-hr intervals) of dexamethasone (DM; 2 mg, a weight-adjusted dose equivalent to one-third the dose administered to pregnant women) or saline (S) in sheep at 103-104 days of gestation (dGA; term 149 dGA) on maternal and fetal blood pressure (BP). We also determined the BP and placental perfusion effects of acute maternal hypoxemia. Venous and arterial catheters were placed in 10 ewes and fetuses (DM = 6, S = 4) at 96 +/- 1 dGA. Maternal and fetal placental perfusion was determined with fluorescent microspheres. Dexamethasone increased fetal but not maternal BP; maternal and fetal placental blood flow and vascular resistance (VR) were unchanged. At 105 dGA, hypoxemia was induced for 1 hr by maternal nitrogen gas inhalation to decrease fetal PaO2 by 40%. Hypoxemia increased BP in DM but not S fetuses or mothers in either group. Hypoxemia decreased maternal placental blood flow by 39 +/- 7% and 51 +/- 9% and increased maternal placental VR by 65 +/- 7% and 69 +/- 6% in S and DM mothers, respectively. Hypoxemia did not alter fetal placental blood flow or VR in either treatment group. In summary, at 0.7 gestation, DM induces a hypertensive response to fetal hypoxemia that is characteristic of older fetuses but does not alter hypoxemia-induced reductions in maternal placental blood flow.

Transplacental exposure to the DNA demethylating agent, 5-AZA-CdR, affects the sexual behavior of CD-1 male mice

Intrauterine exposure to 5-AZA-2'-deoxycytidine (5-AZA-CdR) alters gene expression causing malformations, abnormal post-natal growth and altered reproductive capacity. To elucidate whether the phenomenon observed in 5-AZA-CdR in utero exposed male mice was a behavioral alteration, at gestation day (GD) 10, CD-1 pregnant mice were administered 1mg/kg i.p. of 5-AZA-CdR or saline solution. After parturition, the number and sex of pups were recorded. While litter size was not affected, the ratio of male to female offspring was altered in treated mice. To determine whether the phenotypic observation of male gender corresponded to the appropriate genotype, presence of Sry gene in 5-AZA-CdR F1 males was determined. At 3 months of age, the male sexual behavior test outlined by Chubb was conducted. Presence of vaginal plug and pregnancy were determined in the natural breeding phase. Mount latency and number of mounts per mouse were assessed in the behavioral test phase. In utero exposed male mice resulted in diminished mating behavior (as measured by vaginal plug presence, mount latency and number of mounts) and reduced sexual interest while exposed to a receptive female. While normal presence of Sry gene was observed, mating behavior was altered in exposed males suggesting that the reproductive alteration could be attributed to a behavioral phenomenon.

In utero exposure to tobacco and alcohol modifies neurobehavioral development in mice offspring: consideration a role of oxidative stress

OBJECTIVE

To determine whether in utero tobacco and alcohol exposure induces long-term neurobehavioral alterations and whether oxidative stress/damage is a possible causal factor.

METHODS

Gravid mice were subjected to tobacco smoking and alcohol consumption. Their offspring were subsequently evaluated in developmental and behavioral tests. Antioxidative enzymes and erythrocyte membrane fluidity of adult offspring were measured.

RESULTS

The intrauterine tobacco and alcohol exposure has resulted in significant reduced postnatal body and organ weights accompanied by reduced gestational body weight gain in their mothers. Such exposure also induced remarkable developmental delay in neonatal reflexes and notable behavioral deficit in adulthood, namely reduced motive coordination and locomotor activity as well as impaired learning and memory abilities. Furthermore, the formation of malondialdehyde (MDA) increased significantly whereas the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), catalase (Cat) and glutathione S-transferases (GST) decreased in the cerebral cortex and liver of prenatal intoxicated offspring. The embryonic intoxication also markedly reduced erythrocyte membrane fluidity in offspring.

CONCLUSION

Our study shows the long-term neurotoxicity associated with prenatal tobacco and alcohol exposure, and suggests that the deleterious outcome may be in relation to increased free radicals formation and oxidative stress.

Effect of dietary protein, zinc, and carbon monoxide on fetal zinc concentration in mice

Dietary protein and zinc deficiencies known to be detrimental to the developing fetus are common in pregnant women in developing countries. Everyone in modern society is at risk of exposure to carbon monoxide (CO). This study was conducted to observe the effect of dietary protein, zinc, and exposure to CO on the fetal zinc concentrations by factorial experimentation. Pregnant mice of CD-1 strain were maintained on 17% (control) or 9% (deficient) protein diets mixed with deficient, normal (control), or supplemental zinc throughout gestation. The dams in each dietary group were exposed to air (control) or 500 ppm CO in air in environmental chambers from gestation day 8 to gestational day 18. The dams were sacrificed on d 18 and fetal zinc levels were measured by atomic absorption spectrophotometry. Carbon monoxide levels used in this study had no significant effect on fetal zinc concentration in any treatment group. When both dietary protein and zinc levels were normal, the mean fetal zinc concentrations were higher than all other dietary protein/zinc combinations (15.2 +/-6.0 and 14.2 +/- 4.1 microg Zn/g of tissue for 0 and 500 ppm CO levels). However, when dietary protein levels were deficient, supplemental zinc increased the fetal zinc concentrations significantly (12.7+/-3.8 and 13.1+/-0.3.6 microg Zn/g of tissue, in 0 and 500 ppm CO groups) as compared to zinc-deficient groups (8.7 +/- 3.0 and 10.0 +/- 3.3 microg Zn/g of tissue in 0 and 500 ppm CO groups). The results of this study may be relevant to populations that experience both marginal zinc and protein diets during gestation.

Expression and function of PPARgamma in rat placental development

Peroxisome proliferator-activated receptor (PPAR) gamma is a nuclear receptor known to regulate adipogenesis. Deletion of the PPARgamma gene in the mouse results in death by embryonic day 10.0 (E10.0) due to the failure of establishment of a labyrinth layer in the placenta, which suggests that PPARgamma is involved in trophoblast differentiation. To define PPARgamma function further in placental development, the expression and localization of the PPARgamma gene in the rat placenta was investigated. RT-PCR analysis shows the presence of PPARgamma mRNA in the placenta of day 11 of pregnancy (d11). The expression level is higher at d13 and then later decreased. Immunohistochemistry detects both PPARgamma and its putative intrinsic ligand, 15-deoxy-Delta(12,14)-prostaglandin J(2), in the trophoblast of layer I which lined the maternal sinus. Oral administration of troglitazone, an agonist of PPARgamma, to pregnant rats between d9 and d11 increases the expression level of PPARgamma in the placenta and reduces the mortality of the fetuses by half. These results suggest that PPARgamma is required not only for trophoblast differentiation but also trophoblast maturation to establish maternal-fetal transport.

[New antidepressive agents during pregnancy and lactation. Drug concentration should be monitored and the lowest possible dose administered]

This article presents a literature review on the treatment with new antidepressants during pregnancy and lactation, focusing on possible unwanted effects to the fetus and infant. Most data is available for the selective serotonin reuptake inhibitors, and particularly for fluoxetine. Some information exists for venlafaxine, whereas no published data was found for other new antidepressants such as reboxetine and mirtazapine. In general, treatment with new antidepressants during the first trimester in pregnancy has not been associated with an increased risk for congenital malformations. In contrast, symptoms such as irritability, respiratory distress and muscular hypotonia have been reported in newborns after third trimester exposure. The excretion of new antidepressants in breast milk seems in most cases to be negligible. However, suspected adverse effects have been reported in a few infants. In conclusion, existing data seems to indicate that the positive effects of maternal drug treatment and of lactation to the infant generally outweigh the risks of possible pharmacological effects. Nevertheless, before a new antidepressant is prescribed to a pregnant or lactating woman, an individual risk/benefit-assessment should always be carried out.

Effects of obstetric analgesics and anesthetics on the neonate : a review

Most anesthetic and analgesic agents in current use traverse the placental barrier in varying degrees, but are well tolerated by the fetus if judiciously administered. For labor analgesia, many options are available. Systemic administration of opioids and sedatives is one such option. Repeated maternal administration of opioids such as pethidine (meperidine) results in significant fetal exposure and neonatal respiratory depression. Patient-controlled analgesia with synthetic opioids such as fentanyl, alfentanil, and the new ultra-short-acting remifentanil may be used for labor analgesia in selected patients. Other options for labor analgesia include epidural and combined spinal-epidural techniques. With such techniques, neonatal exposure to opioids and sedatives can be minimized or totally avoided. While limiting the fetal exposure to the harmful effects of depressant drugs, epidural anesthesia and/or analgesia improves placental perfusion and oxygenation of the fetus, which is beneficial, especially in conditions such as pregnancy-induced hypertension. Regional blocks are also administered for the majority of cesarean deliveries because of the overwhelming and unequivocal evidence of maternal and fetal safety compared with general anesthesia for this indication. However, in some instances, administration of general anesthesia is unavoidable. Neonatal respiratory depression with low Apgar scores, and umbilical arterial and venous pH associated with general anesthesia, is often transient. A properly administered anesthetic, whether regional or general, has no significant adverse fetal or neonatal effects.

Influence of a maternal cholesterol-enriched diet on [1-14C]-linoleic acid and L-[4, 5-3H]-leucine entry in plasma of rabbit offspring

Fetal development requires an important entry of essential free fatty acids (EFFA) and essential amino acids (EAA) into the fetal circulation. We have reported that a 0.2% enriched-cholesterol diet (ECD) during rabbit gestation significantly reduces fetus weight compared to control diet. It is known that dietary linoleic acid deficiency, an EFFA, during the fetal development induces an important impair to the somatic development. Moreover, intrauterine growth retardation induced a reduction of the flux of leucine, an EAA, from maternal to fetal circulation. Therefore, we hypothesized that the administration of an ECD induces modifications of placental lipid composition concomitant alterations of the transfer of linoleic acid and leucine in fetal circulation. Quantification of placental lipids revealed that in the ECD group a reduction of total-cholesterol (TC) and free-cholesterol (FC) is observed, however an increased in FFA and phospholipids is noticed when compared to the control group. In placenta from the ECD group, the FC/ TC ratio is significantly reduced compared to the control group. In the ECD group, the liver shows an increase of TC, FC and FFA compared to the control group. However, the quantity of triacylglycerol present in the liver from the ECD is significantly reduced compared to the control group. To evaluate the placental transfer of some essential nutrients, intravenous injection of [1-14C]-linoleic acid or L-[4, 5-3H]-leucine to term rabbit (control and ECD group) were done. Two hours later, rabbits were euthanized and we collected placenta, livers and blood from dams and offspring. The concentrations of both radiolabeled molecules (linoleic acid and its esterified form or leucine) were higher in the plasma of ECD offspring than those found in offspring from control diet. Despite such alteration of placental lipid composition, linoleic acid and leucine transfer by the placenta was not compromised but rather increased.

[Effect of anti-epileptic drugs on human placenta and the fetus]

The pregnancy in women with epilepsy is associated with an increased risk of complications and especially with an increased incidence of congenital malformations in offspring. Currently, anti-epileptic drugs (AEDs) are concerned to be a major etiologic factor of abnormal fetal development. The most of AEDs may cross the placenta and reach pharmacologically concentrations in the fetus. Although the pathomechanism of teratogenicity of AEDs is complex and not well understood, a AEDs--dependent folate deficiency is thought as crucial. The reasons may also theoretically include a primary effect of AEDs on placental function and morphology. In the own study on perfused human placental cotyledon, only toxic concentrations of valproic acid caused morphological changes in placental tissue, including microvascular degeneration of cytoplasm, atrophy of syncytiotrophoblast, colliquative necrosis of some mesenchymal cells. The toxic but not therapeutic dose of valproic acid influenced also hormonal function of placenta by lowering of chorionic gonadotrophin concentration in perfusate. Although a knowledge about an influence of AEDs on the placenta and fetus is not complete, the use of these drugs during pregnancy may be more safe. If a dosage of AEDs in pregnant women with epilepsy is reduced to a reasonable minimum and the monotherapy is preferred, the risk of congenital malformations in their offspring can be minimized.

The effect of methadone treatment on the quantity and quality of human fetal movement

OBJECTIVE

To evaluate the effect of daily maternal methadone maintenance treatment on the quality and quantity of fetal movement.

METHODS

At 34-37 weeks gestation, real-time ultrasound recordings were obtained from 17 methadone treated and 17 non-opioid-dependent mothers at two time points relative to the methadone mothers' daily dose of methadone. The first observation was just prior to the mother taking her daily dose (Time A) and the second was 1-h postdose (Time B). The incidence and pattern of fetal breathing movements (FBMs), fetal trunk movements (FTMs) and total fetal activity (TFA) were obtained from these ultrasounds.

RESULTS

A time by group effect was found for measures of FBM and TFA, Fs(1,32)=6.06 and 4.94, P<0.05. At Time A and Time B for these measures t-tests showed no difference in the incidence of FBM (47.9% vs. 55.4%) and TFA (56% vs. 64%) at Time A between the methadone and comparison groups; however, at Time B the incidence of FBM (16.6% vs. 53.5%) and TFA (27% vs. 65%) was decreased for the methadone group. In addition, there was a between-group difference for two qualitative measures of fetal breathing. A slower rate of fetal breathing (40.3 vs. 47.2 breaths/min) and fewer FBMs per breathing episode (51.7 vs. 92.4) were found for the methadone group regardless of time since the mothers' daily dose.

CONCLUSION

Taken together these results suggest that daily maternal methadone maintenance treatment altered both quantitative and qualitative measures of fetal activity that have been found to be related to normal fetal development.

Human maternal and fetal plasma glyceryl trinitrate concentrations

OBJECTIVE

This study was undertaken to determine the maternal and fetal steady-state concentrations of glyceryl trinitrate (GTN) and its dinitrate metabolites during transdermal administration, at the time of fetal blood sampling for obstetric indications.

STUDY DESIGN

Transdermal GTN (0.4 mg/h) was applied approximately 2 hours before investigative fetal blood sampling to maintain uterine quiescence. Serial maternal venous (MV) and a single fetal venous (FV) plasma samples were collected and assayed for GTN and its metabolites, 1,2- and 1,3-glyceryl dinitrate.

RESULTS

The steady-state MV plasma concentration was 4.3+/-0.84 nmol/L (mean+/-SEM, n=7), and the dinitrate metabolites were detectable in the MV but not quantifiable. GTN was detectable in the FV (n=7) but was not quantifiable as the levels were less than the lower limit of sensitivity of the assay (<1 nmol/L).

CONCLUSION

During transdermal GTN administration, the steady-state FV/MV concentration ratio is less than 0.23 at the time of fetal blood sampling.

Stereoselectivity in the placental transfer and kinetic disposition of racemic bupivacaine administered to parturients with or without a vasoconstrictor

The aim of the present study was to investigate the stereoselectivity in the kinetic disposition and the transplacental distribution of bupivacaine in term parturients during labor. Maternal age ranged from 18-37 years and fetal gestational age from 37.6-41.5 weeks. Healthy parturients (n = 23) received epidural 0.5% racemic bupivacaine alone (group A) or combined with epinephrine (group B). Maternal venous blood was sampled at regular intervals until 8 h after drug administration and umbilical venous blood was obtained at delivery. Bupivacaine enantiomers were determined in plasma samples by HPLC using a Chiralcel(R) OD-R column and a UV detector. One- or two-compartment models were fitted to data and differences between the (+)-(R) and (-)-(S) enantiomers were compared with the paired Wilcoxon test (P< 0.05). The influence of epinephrine was evaluated using the unpaired Mann-Whitney test (P< 0.05). The disposition of bupivacaine in maternal plasma was stereoselective, with higher V(d/f) (140.60 vs. 132.81 L for group A and 197.86 vs. 169.46 L for group B) and C(l/f) (29.00 vs. 25.43 L/h for group A and 33.15 vs. 26.39 L/h for group B) and lower t(1/2)beta (3.24 vs. 3.30 h for group A and 4.36 vs. 4.45 h for group B) being observed for (+)-(R)-bupivacaine. The combined administration of epinephrine resulted in higher V(d/f) (197.86 vs. 140.60 L for (+)-(R) and 169.46 vs. 132.81 L for (-)-(S)) and t(1/2)beta values (4.36 vs. 3.24 h for (+)-(R) and 4.45 vs. 3.30 h for (-)-(S)). The transplacental distribution of bupivacaine was stereoselective only when bupivacaine was administered without epinephrine (group B), with a higher cord blood/maternal blood ratio being observed for (-)-(S)-bupivacaine (0.40 vs. 0.35). Chirality 16:65-71, 2004.

[Teratogenic effect of rubber components]

This study was performed to evaluate the effects of prenatal development of rats were exposed to Polnoks R and its monomer 2,2,4-trimethyl-1,2-dihydroquinoline (TMDHQ) by gavage every day on days 6-15 of gestation at doses equivalent 6%, 13% and 25% of LD50. Polnoks R and TMDHQ administered per os associated with significant maternal toxicity, embryonal lethality, retarded fetal development and congenital defects. Polnoks R induced skeletal malformations, internal hydrocephalus, and hydronephrosis. 2,2,4-trimethyl-1,2-dihydroquinoline produced internal malformations (exencephale, hydrocephalus, anophthalmia, hydronephrosis and renal hypoplasia) and skeletal malformations of ribs and vertebrae. Polnoks R monomer--2,2,4-trimethyl-1,2-dihydroquinoline is used as an antioxidant in elastomer and rubber productions. Polnoks R and its monomer 2,2,4-trimethyl-1,2-dihydroquinoline are teratogenic to rats and induces CNS, kidneys and skeletal defects.

Pharmacokinetics of betamethasone after maternal or fetal intramuscular administration

OBJECTIVE

The purpose of this study was to determine the pharmacokinetics of betamethasone in maternal and fetal circulations after maternal or fetal intramuscular administration.

STUDY DESIGN

Ewes that bore single fetuses underwent surgery at approximately 96 days of pregnancy for the implantation of fetal and maternal vascular catheters. At approximately 103 days, five ewes were injected intramuscularly with betamethasone (0.5 mg/kg body weight) or five fetuses received ultrasound-guided intramuscular injections of betamethasone (0.5 mg/kg estimated fetal weight). Maternal and fetal blood samples were collected serially for the measurement of plasma betamethasone concentrations.

RESULTS

Fetal injection caused higher peak fetal betamethasone concentrations (341.2+/-23.7 nmol/L) than maternal injection (37.6+/-3.7 nmol/L; P<.001) and greater cumulative betamethasone exposure. The half-life of betamethasone in the fetal circulation was shorter after fetal injection (1.1+/-0.3 hours) than after maternal injection (8.5+/-2.0 hours; P=.006).

CONCLUSION

The duration of fetal and maternal exposure to betamethasone can be minimized by direct fetal intramuscular administration that, in sheep, affords lung maturation without adverse effects on fetal growth.

Intravenous angiotensin induces brain c-fos expression and vasopressin release in the near-term ovine fetus

The effect of intravenous angiotensin II (ANG II) on fetal brain c-fos expression and arginine vasopressin (AVP) release was studied in the near-term ovine fetus. Fetuses with chronically implanted catheters received an intravenous infusion of ANG II or saline. Fetal plasma AVP concentrations were significantly increased after the peripheral administration of ANG II, with peak levels (3-fold) at 30 min after the intravenous infusion. There was no change in fetal plasma osmolality, sodium, and hematocrit levels between the control and experimental groups or between the periods before and after the infusion of ANG II. Intravenous ANG II administration induced Fos immunoreactivity (Fos-IR) in the circumventricular organs and the median preoptic nucleus of the fetal brain. Fos-IR was also demonstrated in the fetal supraoptic nuclei (SON). Double labeling demonstrated that the AVP-containing neurons in the SON were expressing c-fos in response to intravenous ANG II. These results indicate that the peripheral ANG II in the fetus may play a significant role in stimulating the central hypothalamic-neurohypophysial system during late gestation. It supports the hypothesis that circulating ANG II may act at the fetal AVP neurons in the hypothalamus in body fluid balance via the circumventricular organs, which are situated outside the blood-brain barrier, and the central neural pathway between these two brain structures has been relatively established in utero, at least at near-term.

Absence of embryo-fetal toxicity in rats or rabbits following oral dosing with nelfinavir

The potential for nelfinavir mesylate (VIRACEPT) to induce maternal and embryo-fetal toxicity was evaluated in rats and rabbits following oral administration. The drug was administered by gavage to rats at doses of 200, 500, or 1000mg/kg/day on days 6-17 of gestation and to rabbits at doses of 200, 400, or 1000mg/kg/day on days 7-20 of gestation. Dams and does were euthanized on GD20 and 29, respectively, and the offspring were weighed and examined for external, visceral, and skeletal alterations. Maximum plasma nelfinavir concentrations (C(max)) in rats were comparable to C(max) values in humans and were 3- to 6-fold higher than the reported human trough levels, while plasma nelfinavir levels in rabbits were approximately 0.13-0.17x the human C(max) and 0.25-0.5x the human trough. In rats, no treatment-related maternal or embryo-fetal toxicity was observed at any dose level and the NOAEL for both maternal and fetal toxicity was considered to be 1000mg/kg/day. Two rabbits in the 400mg/kg/day group died prior to scheduled termination. Because no deaths occurred in the high dose group and there were no other treatment-related signs of clinical toxicity in any dose group, these deaths were considered unrelated to nelfinavir. Group mean body weight loss in rabbits was observed at 1000mg/kg/day on gestation days 7-10. Food consumption was also reduced in this treatment group throughout the dosing period. There were no treatment-related findings in other maternal or fetal parameters. Thus, the no-observed-adverse-effect-level (NOAEL) for maternal toxicity in the rabbit was considered to be 400mg/kg/day (based on maternal body weight loss in the high dose group), while the NOAEL for embryo-fetal toxicity in the rabbit was considered to be 1000mg/kg/day. Thus, under the conditions of this study, nelfinavir was not considered to be toxic to the rat or rabbit conceptus.

Effects of low concentrations of organochlorine compounds in women on calcium transfer in human placental syncytiotrophoblast

For most Canadians, food represents one of the major sources of environmental contaminants. Among them, organochlorine compounds (OCs) are known to affect calcium (Ca2+) homeostasis. They are neurotoxic by perturbation of Ca2+ channels and pumps, and they interfere with protein kinase C (PKC) and Ca2+ binding protein (CaBP). Ca2+ is an essential element to adequate fetal growth and development. The aim of the present study is to determine the relation between low environmental maternal exposure to OCs, such as polychlorinated biphenyls (PCB 153), Aroclor 1260, p,p'-dichlorodiphenyltrichloroethane (DDT) and p,p'-dichlorodiphenyl-dichloroethane (DDE), Ca2+ levels in serum and placenta, placental Ca2+ transfer, and newborn development. Total Ca2+ and OCs were measured in women's serum samples, as well as in umbilical cord's serum and placenta at term. Placentas were taken for trophoblast cells isolation and Ca2+ incorporation kinetic experiments. Our results were obtained from 30 pregnant women from the southwestern area of Quebec. Concentrations of Aroclor 1260, PCB 153, DDE, and DDT were respectively 6.1, 6.0, 3.1, and 2.9 times lower in the umbilical cord serum than in the mother's serum at term. In the placenta, DDE was accumulated at higher levels than other contaminants. A tendency towards an inverse relation was observed for in OCs found in three compartments and Ca2+ levels in maternal serum and in placental tissues. Maternal Ca2+ concentrations do not influence Ca2+ uptake by syncytiotrophoblast. Only DDE (>/=0.70 mug/l) in maternal serum significantly was associated with a small increase in Ca2+ uptake by syncytiotrophoblast. This study will help us determine if low OC contamination significantly modifies Ca2+ transfer in syncytiotrophoblast.

Alcohol use among pregnant African American women: ecological considerations

Alcohol use across pregnancy causes growth and other abnormalities in the offspring. Confirmation of pregnancy leads some women to discontinue alcohol use and other women to continue use. The study discussed in this article assessed alcohol use at the first and third trimesters and at delivery for 393 pregnant African American women in an urban area. At the first trimester, 118 women were moderate to heavy drinkers (one or more drinks per day), compared with 38 women who were at delivery. Socioenvironmental and psychological differences were identified for both women who reduced consumption and women who continued. An understanding of continued drinkers' vulnerability to factors that influence their drinking behaviors demands the development of appropriate, early, and effective intervention strategies. Social welfare implications are discussed.

Developmental toxicity evaluation of the new fluoroquinolone antibacterial DW-116 in rats

We have recently reported that the fluoroquinolone antibacterial DW-116 induces a significant developmental toxicity in rat. The present study was conducted to better understand the teratogenic effects of DW-116 at several developmental toxic doses in rats. DW-116 was orally administered to pregnant rats from gestational day (GD) 6 through 16 at dose levels of 0, 320, 400, and 500 mg/kg/day. All dams were subjected to caesarean section on GD 20 and their fetuses were examined for external, visceral, and skeletal abnormalities. At above 400 mg/kg, severe decreases in maternal body weight gain, food consumption, litter size, fetal weight and placental weight, and severe increases in resorption rate and fetal morphological alterations were observed. At 320 mg/kg, mild decreases in maternal body weight gain, food consumption, fetal weight and placental weight, and mild increases in fetal variations and retardations were observed. These results suggest that DW-116 is embryotoxic at above 320 mg/kg/day and is embryolethal and teratogenic at above 400 mg/kg in pregnant rats and that DW-116 is a selective developmental toxicant in rat conceptuses.

Long-term effects of maternal medication on global quality of life measured with SEQOL. Results from the Copenhagen Perinatal Birth Cohort 1959-61

The Copenhagen Perinatal Birth Cohort 1959-61 is a prospective longitudinal perinatal study that included all deliveries (over 20 weeks gestation, birthweight over 250 g) that took place at the University Hospital (Rigshospitalet) in Copenhagen, Denmark during the period of September 21, 1959 to December 21, 1961 and used in this follow-up study to investigate the connection between maternal medication during pregnancy and the quality of life of the child 31 to 33 years later. The latest follow-up study from the cohort was performed in 1993 and 7,222 of the surviving children were identified (now aged between 31 and 33 years) and contacted with a nonanonymous questionnaire on several aspects of quality of life issues. There were 4,626 usable responses (f = 2,489, m = 2,131) corresponding to a response rate of 64.1%. Of the 12 groups of medication taking during pregnancy we found, before controlling (using multiple linear regression), that analgesics, chemotherapy, and psychopharmacological showed links with the quality of life in the child 31 to 33 years later. Barbiturate use (95% was phenemal) showed significant connection to quality of life. After controlling for social and pregnancy factors there was no correlation between quality of life and medication taken by the mother during pregnancy. From this study it is concluded the fetal exposure to the drugs examined showed no measurable long-term effects on quality of life.

Lack of interaction of digoxin and P-glycoprotein inhibitors, quinidine and verapamil in human placenta in vitro

OBJECTIVE

To determine the effect of quinidine and verapamil, known antiarrhythmic agents and P-glycoprotein (Pgp) inhibitors, on digoxin transport from the maternal to the fetal compartment in the isolated perfused human placenta.

STUDY DESIGN

Isolated placental cotyledons from normal human placentae (n=20) were dually perfused with M199 medium enriched with albumin (0.3%) and glucose (0.1%). The maternal and the fetal circulation flow rates were 12 and 6 ml/min, respectively. Closed circulations were used to evaluate steady state transplacental gradient formation. In six placentae quinindine was added to the maternal circuit; after 45 min of perfusion, digoxin was added to the maternal circulation. The effect of verapamil on digoxin transfer from the maternal to the fetal compartments was explored in five placentae. In six additional placentae the transfer of digoxin was studied in the absence of quinidine. Transplacental passage of digoxin was calculated from repeated fetal and maternal perfusate samples. Digoxin levels were determined in perfusate samples by fluorescence polarization immunoassay. Antipyrine was added to the maternal reservoir of all placentae as reference substance.

RESULTS

The transfer of digoxin (alone) and in the presence of quinidine or verapamil was 10.93+/-3.71, 9.00+/-5.2 and 12.94+/-4.86%, respectively. The levels of digoxin in the fetal compartment, 0.62+/-0.20, 0.48+/-0.29 and 0.60+/-0.26 ng/ml, respectively, were not significantly affected by quinidine and verapamil. These Pgp modulators, also did not influence significantly the steady state levels of digoxin in the maternal compartment.

CONCLUSION

Neither quinidine nor verapamil affected the transplacental transfer of digoxin in vitro in normal human placentae. In contrast to the other tissues, they do not inhibit Pgp activity in term human placentae.

Maternal-fetal distribution and prenatal toxicity of 2,2,4-trimethyl-1,2-dihydroquinoline in the rat

BACKGROUND

Polnoks R (poly-2,2,4-trimethyl-1,2-dihydroquinoline) is used as an antioxidant in elastomer processing. It is an embryotoxic and fetotoxic agent. This chemical given per os to female rats induces also teratogenic effect but only at doses toxic to the mother. The aim of the study was to evaluate prenatal development and tissue distribution in rats exposed to 2,2,4-trimethyl-1,2-dihydroquinoline (TMDHQ), a monomer of Polnoks R.

METHODS

Females were exposed orally to unlabeled TMDHQ during organogenesis at doses 50-400 mg/kg to asses prenatal toxicity and to radiolabeled 14C monomer at a dose 210 mg/kg to evaluate tissues distribution.

RESULTS

TMDHQ administered to pregnant females per os at doses 100 mg/kg and higher produced teratogenic effect (cleft palate, wavy ribs, kyphoscoliosis, exencephaly, external hydrocephalus, hydronephrosis, and renal hypoplasia). Peak 14C-radioactivity was found in mothers' plasma about 10 hr after administration of this compound at dose 210 mg/kg. The accretion of 14C proceeded with a kinetic constant of 0.35 hr(-1) and a half-life of 53.3 hr. Kidneys are the main organs of monomer excretion. The highest concentration of 14C in maternal tissues 24 hr after oral dosing was found in adipose tissue, sciatic nerve, muscles, kidneys, and liver. Radiocarbon retention in fetuses was the highest in kidneys at all time points after dosing.

CONCLUSIONS

This study has demonstrated that transplacental exposure to Polnoks R monomer is teratogenic in rats. 14C retention in placenta, amniotic fluid, and fetal tissues indicates that this compound or its metabolites penetrate into placenta to the fetus.

The effects of repeated endotoxin exposure on placental structure in sheep

Intrauterine infection has been associated with fetal brain injury and preterm birth. We have recently shown that repeated exposure to bacterial endotoxin leads to hypoxia and brain injury in the preterm ovine fetus and we considered it possible that endotoxin could also damage the placenta. Our aim therefore was to assess placental structure following repeated exposure to endotoxin. Endotoxin was administered on 3-5 occasions (1 microg/kg, i.v.) over 5 days from 95-99 days of gestation (term approximately 147 days) to 6 fetal sheep and placental structure assessed at 105 days. In LPS-exposed animals there was a 17 per cent reduction (P<0.05) in placental weight and the average cross-sectional area of placentomes was reduced (P<0.05) by 20 per cent. In addition, all LPS-exposed placentae showed significant injury as evidenced by calcium deposits associated with areas of infarcted tissue. We conclude that repeated endotoxin exposure results in damage to the placenta which could lead to persistent alterations in placental exchange function.

[Influence of valproic acid (depakine I.V.) on human placenta metabolism--experimental model]

OBJECTIVES

The pregnancy in women with epilepsy is associated with an increased incidence of congenital malformations in offspring. Currently, anti-epileptic drugs (AEDs) are concerned to be a major etiologic factor of abnormal fetal development but the pathomechanism of teratogenicity of AEDs is complex and not well understood. The purpose of this study was to evaluate an influence of one of the AED-valproic acid (VPA) on placental metabolism (glucose consumption and lactate production).

MATERIAL AND METHODS

Term human placental cotyledons were perfused in vitro using a recycling perfusion of maternal and fetal circulations. A total 18 placentas were perfused either with 75 micrograms/ml of VPA (therapeutic dose) or with 225 micrograms/ml of VPA (toxic dose). Eight placentas were perfused with a medium without VPA and served as controls. During 2.5 h of experiment, both maternal and fetal glucose consumption and lactate production were measured every 30 minutes.

RESULTS

The introduction of different concentrations of VPA into the perfusion system did not effect placental glucose consumption and lactate production rates in both maternal and fetal compartments.

CONCLUSIONS

The teratogenic effect of valproic acid is not associated with metabolic disturbances of glucose or lactate in the placental tissue.

Leptin distribution and metabolism in the pregnant rat: transplacental leptin passage increases in late gestation but is reduced by excess glucocorticoids

Leptin is essential for the establishment of pregnancy and appears to promote fetal growth, but the mechanisms regulating fetal leptin exposure remain unclear. In rodents, indirect evidence suggests that fetal leptin is partly derived from the maternal circulation via transplacental passage. Indeed, the placenta expresses mRNA for Ob-Ra, one of the short forms of the leptin receptor (Ob-R(S)) important in leptin transport, and this expression increases markedly in late pregnancy. Therefore, we determined the transplacental passage of maternal leptin to the fetus in the rat and whether this transport increases near term in association with a rise in placental expression of Ob-R(S) protein. Because of the proposed role of leptin in promoting fetal growth, we also assessed the effect of glucocorticoid-induced fetal growth retardation on placental leptin transport. Anesthetized rats received a constant infusion of (125)I-leptin via a jugular cannula before and at d 16 and 22 of pregnancy (term = d 23); plasma samples were obtained at 10, 20, 40, 60, 80, and 100 min, and fetuses and placentas were collected at the time of the final sample. The metabolic clearance rate of leptin fell (P < 0.01) from 3.08 +/- 0.23 ml/min per kg in nonpregnant rats to 2.36 +/- 0.13 ml/min per kg by d 22. Transplacental passage of (125)I-leptin, estimated from its concentration in the whole fetus relative to maternal plasma, increased 10-fold (P < 0.005) between d 16 and d 22 of pregnancy. Over this same period, Ob-R(S) protein expression in the placental labyrinth zone increased by almost 2-fold. Transplacental leptin passage was reduced (P < 0.05) by 77% after maternal dexamethasone treatment, whereas suppression of endogenous glucocorticoid synthesis (by metyrapone) increased (P < 0.05) the transfer of maternal leptin to the fetus by 55%. These data show that transplacental passage of maternal leptin is a significant source of fetal leptin and increases markedly during late pregnancy. Consistent with the proposed role of leptin as a fetal growth factor, transplacental leptin passage is reduced in association with glucocorticoid-induced fetal growth retardation.

Decreased anogenital distance and increased incidence of undescended testes in fetuses of rats given monobenzyl phthalate, a major metabolite of butyl benzyl phthalate

The objective of this study was to determine the adverse effects of monobenzyl phthalate (MBeP), a major metabolite of butyl benzyl phthalate (BBP), on the development of the reproductive system, and to assess the role of MBeP in the antiandrogenic effects of BBP. Pregnant rats were given MBeP by gavage at 167, 250, or 375 mg/kg on days 15-17 of pregnancy. Fetuses were examined on day 21 of pregnancy. Maternal body weight gain and food consumption were significantly decreased at 167 mg/kg and higher. Fetal weight was significantly decreased at 375 mg/kg. A significant increase in the incidence of undescended testes and decrease in the anogenital distance (AGD) and ratio of AGD to the cube root of body weight was found in male fetuses at 250 mg/kg and higher. The AGD and ratio of AGD to the cube root of body weight of female fetuses in the MBeP-treated groups were comparable to those in the control group. The present data indicate that MBeP produces adverse effects on the development of the reproductive system in male offspring and suggest that MBeP may be responsible for the antiandrogenic effects of BBP.

Over-the-counter medications in pregnancy

Pregnant women commonly use over-the-counter medications. Although most over-the-counter drugs have an excellent safety profile, some have unproven safety or are known to adversely affect the fetus. The safety profile of some medications may change according to the gestational age of the fetus. Because an estimated 10 percent or more of birth defects result from maternal drug exposure, the U.S. Food and Drug Administration has assigned a risk category to each drug. Many drugs have not been evaluated in controlled trials and probably will not be because of ethical considerations. Of the commonly used over-the-counter medications, acetaminophen, chlorpheniramine, kaolin and pectin preparations, and most antacids have a good safety record. Other drugs, such as histamine H2-receptor blockers, pseudoephedrine, and atropine/diphenoxylate should be used with caution. If use of smoking cessation products is desired, the intermediate-release preparations minimize the amount of nicotine while maintaining efficacy. With all over-the-counter medications used during pregnancy, the benefit of the drug should outweigh the risk to the fetus.

Smoking during pregnancy and newborn neurobehavior

OBJECTIVE

This was a prospective study of the effects of maternal smoking during pregnancy on newborn neurobehavior, including dose-response relationships using self-report and a bioassay of nicotine exposure.

METHODS

The sample included 27 nicotine exposed and 29 unexposed full-term newborn infants with no medical problems from comparable social class backgrounds. Mothers were excluded for using illegal drugs during pregnancy, using antidepressant medication, or if they consumed >3 alcoholic drinks per month. Nicotine exposure was determined by maternal self-report and cotinine in maternal saliva. The NICU Network Neurobehavioral Scale (NNNS) was administered by masked examiners in hospital to measure neurobehavioral function. NNNS scores were compared between nicotine-exposed and -unexposed groups including adjustment for covariates. Dose-response relationships with NNNS scores were computed for maternal salivary cotinine and maternal report of number of cigarettes per day during pregnancy.

RESULTS

After adjustment for covariates, the tobacco-exposed infants were more excitable and hypertonic, required more handling and showed more stress/abstinence signs, specifically in the central nervous system (CNS), gastrointestinal, and visual areas. Dose-response relationships showed higher maternal salivary cotinine values related to more stress/abstinence signs (r =.530) including CNS (r =.532) and visual stress (r =.688) and higher excitability scores (r =.617). Cigarettes per day during pregnancy was related to more stress/abstinence signs (r =.582) including CNS (r =.561) and visual stress (r =.640).

CONCLUSIONS

These findings suggest neurotoxic effects of prenatal tobacco exposure on newborn neurobehavior. Dose-response relationships could indicate neonatal withdrawal from nicotine. Research directed at understanding the effects of cigarette smoking during pregnancy on infants can lead to improved public health outcome.

Effect of ursodeoxycholic acid on the impairment induced by maternal cholestasis in the rat placenta-maternal liver tandem excretory pathway

We investigated the effects of ursodeoxycholic acid (UDCA; 60 microg/day/100 g b.wt.) on the impairment induced by maternal obstructive cholestasis during pregnancy (OCP) in the rat placenta-maternal liver tandem excretory pathway. A blunted catheter was implanted in the common bile duct on day 14 of pregnancy, and the tip was cut on day 21. [(14)C]Glycocholate (GC) was then administered through the umbilical artery of "in situ" perfused placenta (placental transfer test) or through the maternal jugular vein (biliary secretion test), and GC bile output was measured. OCP impaired both GC placental transfer and maternal biliary secretion. UDCA moderately improved the latter but had a more marked beneficial effect on GC placental transfer. Histological examination revealed trophoblast atrophy and structural alterations, e.g., loss of apical membrane microvilli in OCP placentas. Gene expression level was investigated by real-time quantitative reverse transcription-polymerase chain reaction and Western blot analysis. OCP reduced both placental lactogen II (a trophoblast-specific gene) mRNA and the functional amount of epithelial tissue, determined by transplacental diffusion of antipyrin. Using a rapid filtration technique, impairment in the ATP-dependent GC transport across trophoblast apical plasma membranes obtained from OCP placentas was found. UDCA partially prevented all these changes. The expression level of organic anion transporters Oatp1, Oatp2, and Oatp4, and multidrug resistance-associated proteins Mrp1, Mrp2, and Mrp3 in whole placenta were not affected or were moderately affected by OCP but greatly enhanced by UDCA. In summary, UDCA partially prevents deleterious effects of OCP on the rat placenta-maternal liver tandem excretory pathway, mainly by preserving trophoblast structure and function.

Changes in umbilical artery flow velocity waveforms following maternal administration of betamethasone

In a retrospective cohort study we have previously shown that administration of betamethasone to women with a pregnancy complicated by absent end-diastolic flow in the umbilical artery (UA) is associated with altered UA flow velocity waveforms. To examine this phenomenon further we undertook a prospective study of 30 similar singleton pregnancies. Umbilical artery FVWs were recorded before and after betamethasone administration using real-time pulsed wave colour flow Doppler. The results of this prospective cohort were similar to those of the retrospective study allowing pooling of the data. Of the 55 total pregnancies with umbilical artery AEDF studied betamethasone administration was associated with the return of end-diastolic flow in 39 (71 per cent; 95 per centCI: 59-83 per cent). The median (range) duration of this change was 3 (1-10) days. There is no evidence that this change has either a beneficial or detrimental effect on foetal health. Administration of betamethasone to women with a pregnancy complicated by umbilical artery AEDF is associated with the transient return of end-diastolic flow in most cases. While the mechanisms underlying this effect are yet to be fully elucidated it has implications for foetal surveillance in these high-risk pregnancies.

Potentiation of the maternal immune system may modify the apoptotic process in embryos exposed to developmental toxicants

PROBLEM

We have previously shown that teratogen-induced embryonic maldevelopment may result from excessive apoptosis in affected organs, but the mechanisms underlying this process are not well understood. Here we investigate the ability of maternal immunopotentiation to affect the apoptotic process and its regulatory genes p53 and bcl-2 in embryos exposed to a teratogenic insult.

METHOD OF STUDY

Potentiation of the immune system in pregnant females was performed with xenogeneic rat splenocytes or with granulocyte macrophage-colony stimulating factor (GM-CSF). The animals were exposed to cyclophosphamide (CP) and the reproductive performance in the various experimental groups was recorded. The level of apoptosis was assessed in the embryonic head and liver by TdT-mediated dUTP-biotin nick end labeling and fluorescence-activated cell sorter (FACS) analysis, while p53 and bcl-2 expression was evaluated by FACS and immunohistochemistry.

RESULTS

In CP-treated females, a decrease in embryonic weight and an increase in the resorption rate and the percentage of embryos exhibiting head malformations were noted. These effects of CP were accompanied by the appearance of apoptotic cells in the head but not in the liver and an increased expression of p53 in embryonic organs, while bcl-2 expression was found to be decreased in the head and increased in the liver. Immunopotentiation with rat splenocytes or GM-CSF was shown to partially normalize the teratogenic effect of CP. It was also found to partially decrease the CP-induced apoptotic process and exhibited a tendency to normalize the expression of p53 and bcl-2 in the embryonic head and liver.

CONCLUSION

Our results suggest a possible role for maternal immunopotentiation in protecting the embryo from teratogenic insults, possibly through regulation of the CP-induced apoptotic process and the expression of p53 and bcl-2.

Recent environmental toxic effect in the Polish copper mining territory on human reproduction. Part I. Response of the placenta to the chemical stress

This study examined morphochemical differences between 49 full term human placentas collected from healthy non-smoking women living in the high polluted region, i.e. the Copper Mining Territory (CMT) and the 38 control placentas (C) obtained from little polluted eastern Carpathian regions. The placentas were studied by histochemical, immunohistochemical and morphometric methods. In CMT placentas a decrease in the cytochrome c oxidase and glucose-6-phosphate activities and the immunoreactivity of glutathione S-transferase pi in the villous syncytiotrophoblast and amniotic epithelium was noted. All CMT placentas showed abundance of mineral and fibrinoid deposits and of lipid droplets. This produced a compensatory increase in the mother-fetus exchange area due to excessive proliferation of placental villi which in turn decreased the intervillous space and thus the influx of indispensable maternal blood. Lately slight signs of increase in the cytochrome c oxidase activity accompanied by a noticeable decrease in number of the thinnest (most abundant) terminal villi is observed.

Oral hypoglycemic agents in pregnancy: their time has come

Oral agents are the mainstay of pharmacological treatment for non-pregnant women with type 2 diabetes. It has been proposed that, owing to the similarity between gestational and type 2 diabetes, some of these drugs could be used effectively and safely as alternatives to insulin therapy. This efficacious alternative provides the physician with more choices that, in turn, translate into more complex decision-making for the management of gestational diabetes. This article illustrates the pharmacological characteristics of oral hypoglycemic agents and placental transfer, provides evidence for the lack of association between congenital anomalies and the drugs, and reviews current studies and the clinical outcomes when these drugs are used.

Exposure to naturally circulating androgens during foetal life incurs direct reproductive costs in female spotted hyenas, but is prerequisite for male mating

Among all extant mammals, only the female spotted hyena (Crocuta crocuta) mates and gives birth through the tip of a peniform clitoris. Clitoral morphology is modulated by foetal exposure to endogenous, maternal androgens. First births through this organ are prolonged and remarkably difficult, often causing death in neonates. Additionally, mating poses a mechanical challenge for males, as they must reach an anterior position on the female's abdomen and then achieve entry at the site of the retracted clitoris. Here, we report that interfering with the actions of androgens prenatally permanently modifies hyena urogenital anatomy, facilitating subsequent parturition in nulliparous females who, thereby, produce live cubs. By contrast, comparable, permanent anatomical changes in males probably preclude reproduction, as exposure to prenatal anti-androgens produces a penis that is too short and has the wrong shape necessary for insertion during copulation. These data demonstrate that the reproductive costs of clitoral delivery result from exposure of the female foetus to naturally circulating androgens. Moreover, the same androgens that render an extremely unusual and laborious process even more reproductively costly in the female are apparently essential to the male's physical ability to reproduce with a normally masculinized female.

Indoleamine 2,3-dioxygenase, immunosuppression and pregnancy

Pharmacologic inhibition of indoleamine 2,3-dioxygenase (IDO) activity during murine pregnancy results in maternal T-cell-mediated rejection of allogeneic but not syngeneic conceptuses. Increased risk of allogeneic pregnancy failure induced by exposure to IDO inhibitor is strongly correlated with maternal C3 deposition at the maternal-fetal interface. Here we review evidence that cells expressing IDO contribute to immunosuppression by inhibiting T-cell responses to tumor antigens and tissue allografts, as well as fetal tissues.

The cyclooxygenase inhibitor ibuprofen and the FLAP inhibitor MK886 inhibit pancreatic carcinogenesis induced in hamsters by transplacental exposure to ethanol and the tobacco carcinogen NNK

PURPOSE

Pancreatic cancer is the fourth leading cause of cancer death in men and women. Smoking is a documented risk factor for pancreatic cancer, and the risk is increased in smokers who also consume alcohol. Arachidonic acid (AA)-metabolizing enzymes have been implicated in aggressive clinical behavior of pancreatic cancer while mutations in the Ki- ras gene have been associated with prolonged survival and responsiveness to therapy. Using a hamster model of exocrine pancreatic cancer induced by transplacental exposure to ethanol and the tobacco-carcinogen NNK, we have analyzed these tumors for mutations in the ras and p53 genes and tested the modulating effects of the COX inhibitor, ibuprofen, and the FLAP inhibitor, MK886, on the development of pancreatic cancer in this animal model.

METHODS

Hamsters were given 10% ethanol in the drinking water from the fifth to the last day of their pregnancy and a single dose of NNK on the last day. Starting at 4 weeks of age, groups of offspring were given either the COX inhibitor ibuprofen (infant Motrin oral suspension) or the FLAP-inhibitor MK886 (dissolved in carboxymethylcellulose orally) for life while a group of offspring not receiving any treatment served as positive controls.

RESULTS

None of the induced pancreatic cancers demonstrated mutations in the Ki-, N-, or H- ras or p53 genes. The development of pancreatic cancer in offspring who had been given ibuprofen or MK886 was reduced by 50% or 30%, respectively.

CONCLUSION

In conjunction with the documented over-expression of COX-2 and LOX in human pancreatic cancer, our findings suggest an important role of the AA-cascade in the genesis of this cancer type and indicate that pharmacological or dietary measures that reduce AA-metabolism may be useful for the prevention and clinical management of pancreatic cancer.

Steroid use during pregnancy

Health care providers and pregnant women share a concern for protecting the fetus from unnecessary and potentially teratogenic influences. Since the introduction of steroids for the induction of fetal surfactant production, there has been considerable experience in the use of corticosteroids during pregnancy. While the use of corticosteroids for surfactant induction in the preterm fetus has become commonplace, steroids are used for other obstetric and medical indications during pregnancy. Thus, finding a balance between drug benefits and possible side effects remains a critical issue.

Effect of increased glucose load on maternal-fetal transport of alpha-aminoisobutyric acid in the perfused human placenta: in vitro study

The role of hyperglycemia on modulation of maternal-fetal transport of amino acids in humans is little understood. Hence, we have explored the effect of increased glucose load on transport kinetics of a model non-metabolizable amino acid, alpha-aminoisobutyric acid (AIB), in the human placenta in vitro. Transport kinetics of AIB in maternal-fetal direction was studied using perfusion of isolated human placental lobules. NCTC (National Culture and Tissue Collection)-135 medium, diluted with Earle's buffered salt solution was used as the perfusate and tritiated water was used as the reference marker. Effect of increased glucose load on transport kinetics of study and reference substances was studied in normal term placentae (n=5; gestational age, 38.5 +/- 0.5 weeks) in succeeding experimental phases, after a control perfusion phase with physiological glucose concentration. AIB transport fraction (TF), relative to tritiated water TF, averaged 54.8% in control euglycemic phase while in hyperglycemic concentration phases of 27.8 and 55.6 mM, the AIB TF index averaged 42.4% and 38.2%, respectively. Analysis of variance revealed that the difference was statistically significant. Similarly, absorption rate index of the amino acid was also significantly lower in the hyperglycemic perfusion phases compared to control euglycemic phase. We conclude that hyperglycemia may play a deleterious role in limiting maternal-fetal transport of A-type amino acids in the in vivo state.

Maternal-fetal effects of magnesium sulfate on serum osmolality in pre-eclampsia

OBJECTIVE

To determine the effects of magnesium sulfate therapy on maternal and fetal osmolality in pre-eclampsia.

METHODS

A total of 34 pre-eclamptic women and 22 normal pregnant women participated in the study. Venous blood was drawn upon admission to the labor and delivery unit. Pre-eclamptic patients received standard magnesium sulfate therapy and had a second sample of venous blood drawn 4 h following the beginning of therapy. Fetal umbilical vein blood was obtained immediately following delivery in both groups. Osmolality was measured using a vapor pressure osmometer. Electrolyte levels were measured with a NOVA 8 biomedical analyzer. Data were analyzed via Student's t test, linear regression and correlation with significance established at p < 0.05.

RESULTS

We found no significant difference between the maternal osmolalities of the control and pre-eclamptic groups. Interestingly, fetal cord blood osmolality was significantly lower than maternal osmolality in the normal pregnant women. Sodium levels were also lower, while potassium and ionized calcium levels were higher in the fetal blood. In women with pre-eclampsia treated with magnesium sulfate, there was no difference between the osmolality of the maternal and fetal blood, while potassium and ionized calcium levels were still higher in the fetal blood. Finally, we found no correlation between maternal osmolality and blood pressure.

CONCLUSIONS

High blood pressure in pre-eclampsia is not associated with altered osmolality. An absence of the normal decrease in fetal osmolality is observed in pre-eclamptic women treated with magnesium sulfate.

The effect of maternal smoking and ethanol on fatty acid transport by the human placenta

The role of the placenta in controlling the supply of fatty acids to the fetus was investigated in term placentas from non-smokers (n 5), smokers (>ten cigarettes/d; n 5) and after addition of ethanol at 2 mg/ml (n 4). The maternal side was of the placenta was perfused ex vivo for 90 min with a physiological mixture of fatty acids and fatty acid:human albumin ratio. There was no effect of smoking on the transfer of linoleic (LA, 18: 2 n-6), alpha-linolenic (alphaLN, 18: 3 n-3), arachidonic (AA, 20: 4 n-6) or docosahexaenoic acid (DHA, 22: 6 n-3), expressed per perfused area (calculated from H2(18)O exchange). However, the presence of ethanol in the perfusate at a concentration of 2 mg/ml significantly reduced (P<0.01) the absolute rate of transfer of the two n-3 polyunsaturated fatty acids, alphaLN and DHA. This specific effect of ethanol on alphaLN and DHA also resulted in an altered selectivity for transfer of individual fatty acids. In the non-smoking control group the placenta selectively transferred polyunsaturated fatty acids to the fetus in the order DHA > AA > alphaLN > LA. The order of selectivity was unaltered in placentas from smokers, but the addition of ethanol to the perfusion medium altered the order of selectivity to AA > alphaLN > LA > DHA. The presence of ethanol in the perfusate was also associated with a significant reduction (P<0.05) in the clearance of H2(18)O. These results suggest that the presence of ethanol at a concentration of 2mg/ml may reduce the availability of polyunsaturated fatty acids to the developing fetus.

Effects of antibacterials on the unborn child: what is known and how should this influence prescribing

Antibacterials are among the most commonly prescribed drugs worldwide. In general, infections occur in pregnant women at much the same rate as in the general population. However, as a result of physiological changes brought about by pregnancy, some infections, such as those of the urinary tract, may have an increased incidence. It is important to remember that almost every drug crosses the placenta, ensuring that the unborn fetus is also exposed. When prescribing an antibacterial agent to a pregnant woman, it is important that the mother is treated appropriately while at the same time protecting the unborn child. Certain factors need to be addressed, such as the possible teratogenic risk, changes in pharmacokinetics and the potential toxicity of the drug. In this paper we have reviewed various classes of antibacterials which are commonly used during pregnancy, including penicillins, beta-lactam inhibitors, cephalosporins, macrolides, aminoglycosides, tetracyclines, lincosamides, fluoroquinolones, sulfonamides, nitrofurans, and anti-tubercular agents. Some of these drugs have been on the market for many years, whereas others are relatively new and increasingly popular, despite the fact that the older drugs remain very effective. After reviewing the evidence-based information from epidemiological studies, it appears that most antibacterial agents can be used relatively safely during pregnancy. Women who are pregnant should not be denied appropriate antibacterial therapy because of a lack of information. It is possible to treat the mother, while protecting the unborn child, by prescribing an agent that the causative bacteria is sensitive to, rather than a perceived 'safer' option that may not effectively treat the infection and which may also add to the growing problem of bacterial resistance.