Evaluation of Granada agar plate for detection of Streptococcus agalactiae in urine specimens from pregnant women

The Granada agar plate (GAP; Biomedics SL, Madrid, Spain) was evaluated for the detection of group B streptococci (GBS) in urine specimens from pregnant women submitted for testing for asymptomatic bacteriuria and was compared with blood agar (BA [Columbia agar with 5% sheep blood]; bioMérieux, Marcy l'Etoile, France). The GAP detected 103 out of 105 GBS, whereas BA detected only 50. Use of the GAP could be a good method for the detection of GBS in urine specimens from pregnant women.

Enhanced expression of Ang-(1-7) during pregnancy

Pregnancy is a physiological condition characterized by a progressive increase of the different components of the renin-angiotensin system (RAS). The physiological consequences of the stimulated RAS in normal pregnancy are incompletely understood, and even less understood is the question of how this system may be altered and contribute to the hypertensive disorders of pregnancy. Findings from our group have provided novel insights into how the RAS may contribute to the physiological condition of pregnancy by showing that pregnancy increases the expression of both the vasodilator heptapeptide of the RAS, angiotensin-(1-7) [Ang-(1-7)], and of a newly cloned angiotensin converting enzyme (ACE) homolog, ACE2, that shows high catalytic efficiency for Ang II metabolism to Ang-(1-7). The discovery of ACE2 adds a new dimension to the complexity of the RAS by providing a new arm that may counter-regulate the activity of the vasoconstrictor component, while amplifying the vasodilator component. The studies reviewed in this article demonstrate that Ang-(1-7) increases in plasma and urine of normal pregnant women. In preeclamptic subjects we showed that plasma Ang-(1-7) was suppressed as compared to the levels found in normal pregnancy. In addition, kidney and urinary levels of Ang-(1-7) were increased in pregnant rats coinciding with the enhanced detection and expression of ACE2. These findings support the concept that in normal pregnancy enhanced ACE2 may counteract the elevation in tissue and circulating Ang II by increasing the rate of conversion to Ang-(1-7). These findings provide a basis for the physiological role of Ang-(1-7) and ACE2 during pregnancy.

Urinary progesterone-induced blocking factor concentration is related to pregnancy outcome

Peripheral lymphocytes from healthy pregnant women secrete a mediator protein named the progesterone-induced blocking factor (PIBF) that exerts an immunomodulatory function and contributes to the maintenance of pregnancy in mice. The gene coding for PIBF mRNA has been cloned and sequenced, and now the recombinant human protein is available. The aim of this study was to develop an ELISA test for determining PIBF concentrations in biological samples of pregnant women. We determined urinary PIBF concentrations of 86 healthy nonpregnant individuals and from almost 500 pregnant women by ELISA. During normal pregnancy, the concentration of PIBF continuously increased until the 37th gestational week and was followed by a sharp decrease after the 41st week of gestation. In pathological pregnancies, urinary PIBF levels failed to increase. The onset of labor was predictable on the basis of this test, whether it was term or preterm delivery. In urine of patients with preeclampsia, PIBF concentrations were significantly lower than in normal pregnancy and showed a correlation with the number of symptoms presented. These data, in line with previous in vivo findings, suggest that PIBF production is a characteristic feature of normal pregnancy, and determination of PIBF concentration in urine might be of use for the diagnosis of threatened premature pregnancy termination.

A radioimmunoassay for measurement of 3,3'-diiodothyronine sulfate: Studies in thyroidal and nonthyroidal diseases, pregnancy, and fetal/neonatal life

Data suggesting that (1) sulfation of the phenolic hydroxyl of iodothyronines plays an important role in thyroid hormone metabolism and (2) maternal serum 3,3'-diiodothyronone sulfate (3,3'-T(2)S) may reflect on the status of fetal thyroid function stimulated us to develop a radioimmunoassay (RIA) for measurement of T(2)S. Our T(2)S RIA is highly sensitive, practical, and reproducible. T(4)S, T(3)S, and T(1)S crossreacted 3.1%, 0.81%, and 5.3%, respectively; thyroxine (T(4)), triiodothyronine (T(3)), and reverse (r)T(3), 3,3'-T(2) and 3'-T(1) crossreacted <0.1%. Although rT(3) sulfate (rT(3)S) crossreacted 55% in 3,3'-T(2)S RIA, its serum levels are very low and have little influence on serum T(2)S values reported here. T(2)S was measured in ethanol extracts of serum, amniotic fluid, and urine. Recovery of nonradioactive T(2)S added to serum was 96%. The dose-response curves of inhibition of binding of (125)I-T(2)S to anti-T(2)S by serial dilutions of ethanol extracts of serum or urine were essentially parallel to the standard curve. The detection threshold of the RIA varied between 0.17 and 0.50 nmol/L (or 10 and 30 ng/dL). The coefficient of variation (CV) averaged 9% within an assay and 13% between assays. The serum concentration of T(2)S was [mean +/- SE, nmol/L] 0.86 +/- 0.59 in 36 normal subjects, 2.2 +/- 0.06 in 10 hyperthyroid patients (P <.05), 0.73 +/- 0.10 in 11 hypothyroid patients (not significant [NS]), 6.0 +/- 1.5 in 16 patients with systemic nonthyroidal illness (P <.001), 18 +/- 2.5 in 16 newborn cord blood sera (P <.02), 2.7 +/- 0.32 in 25 pregnant women [15 to 40 weeks gestation, P <.001], 0.94 +/- 0.10 in 10 hypothyroid women receiving T(4) replacement therapy (NS), and 2.0 +/- 0.38 in 11 hypothyroid women treated with T(4) replacement and oral contraceptives (P <.02); serum T(2)S levels in the third trimester of pregnancy were similar to those in the second trimester of pregnancy. T(2)S concentration in amniotic fluid was 12.5 +/- 2.7 nmol/L (n = 7) at 15 to 20 weeks gestation, and it decreased markedly to 3.3 +/- 1.3 nmol/L (n = 3) at 35 to 38 weeks gestation. Urinary excretion of T(2)S in random urine samples of 19 normal subjects was 10.9 +/- 1.3 nmol/g creatinine. (1) T(2)S is a normal component of human serum, urine, and amniotic fluid, and serum T(2)S levels change substantially in several physiologic and pathologic conditions; (2) high serum T(2)S in pregnancy may signify increased transfer of T(2)S from fetal to maternal compartment, estrogen-induced increase in T(2)S production, decreased clearance, or a combination of these factors. The data do not support the notion that fetal thyroid function is the only or the predominant factor responsible for high serum T(2)S in pregnant women.

Effects of night work on urinary excretion rates of 6-sulfatoxymelatonin, norepinephrine and estriol in pregnant women

It has been suggested that shift work, night work in particular, affects worker's psychophysical health. However, the effects of night work on the health of pregnant women are not physiologically well elucidated. The effects of night work on the biological function of pregnant women were studied in the present study. Three pregnant and six non-pregnant nurses that engaged in fast-rotating shift system cooperated for the study. The 24-h urine samples were collected in two time frames, daytime (07:00 to 23:00) and nighttime (23:00 to 07:00) on the day shift, the night shift and the days off. Urinary concentrations of 6-sulfatoxymelatonin and norepinephrine were measured by enzyme-linked immunosorbent assay and estriol by radioimmunoassay. The excretion profiles of urinary 6-sulfatoxymelatonin in the pregnant and the non-pregnant women were altered on the night shift, which might relate the derangement of circadian rhythm of melatonin secretion. The urinary norepinephrine level during the night work was considerably higher in the pregnant women, which indicated the presence of higher physical burden in them due to the night work. The urinary estriol level was not significantly affected by shift, day/night and individual factors, and the effect of night work on urinary estriol level of the pregnant women remained uncertain. The results of the present study suggested that the night work of the pregnant shift workers should be much more relieved.

Decreasing resistance in the maternal uterine and peripheral arterial system is apparently unrelated to plasma and urinary levels of nitrite/nitrate and cyclic-guanosinmonophosohate during the course of normal pregnancies

AIMS

The aim of the presented study was to clarify the relationship between the pulsatility index of the uterine arteries and the maternal cubital artery and peripheral concentrations of the metabolites of nitric oxide (NO) and its second messenger cyclic guanosinmonophophate (cGMP) during the normal course of pregnancy and postpartum.

METHODS

49 uncomplicated pregnancies were investigated every 4-6 weeks until delivery, 29 of them were additionally investigated postpartum. Paralleling each Doppler sonographic investigation maternal blood and urine samples were taken. The measurements of nitrite/nitrate and cGMP were performed with a colorimetric and radio immuno assay. We demonstrate a significant decrease of the PI of the uterine arteries and of the cubital artery with inverse correlation to advancing gestational age.

RESULTS

The concentrations of nitrite/nitrate and cGMP remain stable during gestation and do not correlate to the PI of the uterine and cubital artery. Postpartum a re-increase in the uterine and peripheral resistance can be shown. The concentrations of urinary cGMP and nitrite/nitrate as well as plasma cGMP remain unchanged, whereas plasma nitrite/nitrate decreases postpartum.

CONCLUSIONS

The status of NO biosyntheses in normal pregnancy remains controversial. We hypothesize further systemically acting mediators which contribute to the decreasing vascular resistance.

Profile of urinary arsenic metabolites during pregnancy

Chronic exposure to inorganic arsenic (In-As) from drinking water is associated with different health effects, including skin, lung, bladder, and kidney cancer as well as vascular and possibly reproductive effects. In-As is metabolized through the process of methylation, resulting in the production and excretion of methylated species, mainly monomethylarsenate (MMA) and dimethylarsenate (DMA). Because a large percentage of the dose is excreted in urine, the distribution of urinary In-As, MMA, and DMA is considered a useful indicator of methylation patterns in human populations. Several factors affect these patterns, including sex and exposure level. In this study, we investigated the profile of urinary In-As, MMA, and DMA of pregnant women. Periodic urine samples were collected from early to late pregnancy among 29 pregnant women living in Antofagasta, Chile, who drank tap water containing 40 micro g/L In-As. The total urinary arsenic across four sampling periods increased with increasing weeks of gestation, from an initial mean value of 36.1 to a final value of 54.3 micro g/L. This increase was mainly due to an increase in DMA, resulting in lower percentages of In-As and MMA and a higher percentage of DMA. Our findings indicate that among women exposed to moderate arsenic from drinking water during pregnancy, changes occur in the pattern of urinary arsenic excretion and metabolite distribution. The toxicologic significance of this is not clear, given recent evidence suggesting that intermediate methylated species may be highly toxic. Nevertheless, this study suggests that arsenic metabolism changes throughout the course of pregnancy, which in turn may have toxicologic effects on the developing fetus. Key words: arsenic, arsenic metabolism, arsenic methylation, Chile, pregnancy, urinary arsenic.

The level of maternal methemoglobin during pregnancy in an air-polluted environment

The objective of this prospective study was to determine if a correlation could be established between the ground-level concentrations of sulfur dioxide and methemoglobin concentrations in pregnant women when a coal-powered thermoelectric power plant was in operation ("dirty" period) and when it was closed ("clean" period). The location of the power plant, Plomin 1, in Labin, Croatia, was taken into consideration. Blood and urine samples of each pregnant woman in the study were tested three times in the clean period (n = 138) and three times in the dirty period (n = 122), with 1 month between each test. I observed a correlation between the increase in mean values of methemoglobin and the ground-level concentration of SO(2) on corresponding dates during the dirty period (r = 0.72, p < 0.01). In the clean period, the negative mean value of methemoglobin was significant (r = -0.60, p <or=0.05), whereas in the dirty period, the positive mean value of methemoglobin was significant (r = 0.73, p 0.01). The increase of maternal methemoglobin could be a useful biomarker to determine when the health of pregnant women is threatened by toxic substances in the environment.

Pregnancy and use of oral contraceptives reduces the biotransformation of proguanil to cycloguanil

OBJECTIVE

To determine the effects of late pregnancy and also oestrogen supplementation on the CYP2C19-mediated biotransformation of proguanil (PG) to its active antifol triazine metabolite cycloguanil (CG).

METHODS

Case control study conducted on the NW border of Thailand; a single dose of PG (4 mg/kg) was administered to Karen women in late pregnancy and a single blood and urine sample taken 6 h later. Women were studied in late pregnancy (>36 weeks) and restudied 2 months after delivery. A separate cohort of Karen women newly attending a birth-control clinic were studied before and 3 weeks into their first course of oral contraceptives (OCP: levonorgestrel 0.15 mg and ethinyloestradiol 0.03 mg). Forty-five pregnant women and forty-two healthy OCP users were studied.

RESULTS

The results were similar in both groups; pregnancy and OCP use were both associated with reduced formation of cycloguanil (CG). Impaired PG biotransformation was seen in women with the "extensive metaboliser" phenotype (urine PG/CG ratio <10). CG levels, adjusted for dose, were a median (range) 73% (-59 to 420%) higher following the pregnancy than during the pregnancy in women characterised as extensive metabolisers ( P<0.001). CG levels in women characterised as extensive metabolisers were 34% (-54 to 323%) higher before than while taking the OCP ( P<0.01).

CONCLUSION

Late pregnancy and OCP use impair biotransformation of the active antimalarial metabolite CG from the parent PG. This may be mediated by oestrogen inhibition of CYP2C19 activity. The dose of PG should be increased by 50% in these groups.

What happens to women's self-reported cigarette consumption and urinary cotinine levels in pregnancy?

AIMS

To describe the pattern of self-reported cigarette consumption and nicotine consumption, measured by urinary cotinine concentration, in a cohort of pregnant women who did not stop smoking.

DESIGN

Cohort study.

SETTING

Randomly selected general practices from the West Midlands, UK.

PARTICIPANTS

Five hundred and fifty-nine pregnant women in a clinical trial who were enrolled at booking for maternity care (about 12 weeks of gestation), who were followed up in mid and late pregnancy and 10 days post-natal and who did not stop smoking during that period.

MEASUREMENTS

Retrospectively collected self-reported cigarette consumption prior to pregnancy and contemporaneously collected self-reported cigarette consumption and urinary cotinine concentrations at booking for maternity care, 20 weeks of gestation, 30 weeks of gestation and 10 days post-natal.

FINDINGS

Women reported smoking a median of 10-19 cigarettes per day prior to pregnancy and a median of 5-9 cigarettes per day at booking for maternity care. At booking, women reported consuming a mean [95% confidence interval (CI)] of 6.3 (5.6-7.0) cigarettes per day. At 20 weeks of pregnancy this had risen to mean (95% CI) 11.5 (10.9-12.2), and remained at 11 cigarettes per day when measured again at 30 weeks of gestation and 10 days post-natal. Mean (95% CI) urinary cotinine levels at booking were 6.0 (5.4-6.6) microg/mL, and did not change much through pregnancy. There were statistically significant associations between urinary cotinine and reported cigarette consumption at all time points except at booking.

CONCLUSIONS

Women smokers report lower cigarette consumption at booking for maternity care than they do prior to pregnancy or from mid pregnancy onwards, but cotinine data imply that their intake of toxins does not change throughout pregnancy. Reports suggesting many women reduce their smoking in pregnancy have probably been over-optimistic.

Seasonality in urinary and household salt iodine content among pregnant and lactating women of the plains of Nepal

OBJECTIVE

To determine the extent and causes of iodine deficiency among women during pregnancy and lactation in the southeastern plains of Nepal.

DESIGN, SETTING AND SUBJECTS

Urinary iodine (UI) was assessed as an indicator of iodine status in spot urine samples of women participating in a field trial in three rural communities in the plains of southeastern Nepal. Samples were collected during pregnancy (n=1021) and during lactation at 3-4 months postpartum (n=1028) at a central clinic; 613 women were assessed at both times. Salt iodine (SI) content was assessed semiquantitatively at 6-7 months postpartum in households (n=1572).

RESULTS

During pregnancy and lactation, median UI concentrations were 0.756 and 0.483 micromol/l, respectively, indicating mild iodine deficiency. UI and SI concentrations covaried markedly by season and were highest during hot, dry, premonsoon months and lowest during and following the humid monsoon season. Within women who contributed urine samples during both pregnancy and the postpartum period, iodine status determined by UI was not correlated. The percentage of households with adequately iodized salt (30 ppm) ranged from 85 to 44% from the hot, dry to the humid seasons, respectively.

CONCLUSIONS

In the rural southern plains of Nepal, iodine deficiency remains a mild-to-moderate public health problem among pregnant and lactating women despite the availability of iodized salt. Marked seasonality in SI content may account for the lack of intraindividual correlation between maternal iodine status during pregnancy and postpartum periods and contribute to periodicity in the risk of iodine deficiency.

Direct determination of estriol 3- and 16-glucuronides in pregnancy urine by column-switching liquid chromatography with electrospray tandem mass spectrometry

Using column-switching liquid chromatography/tandem mass spectrometry (LC-MS/MS), we developed an improved analytical method of urinary estriol glucuronides. This new method is derived predominantly from maternal and fetal precursors in pregnancy. We used in the following procedure: first, we filtered urine samples with a membrane filter. Next, we directly injected the 50 microL aliquot of urine samples onto a pre-column. Then, after activating the column-switching valve, we backflushed the loaded samples onto the C(18) analytical column. Urine samples can be assayed within 20 min without any sample preparation steps. We monitored separated estriol glucuronides by negative electrospray ionization (ESI) and selected-reaction monitoring (SRM). The calibration range of estriol-3-glucuronide (E3-3G) and estriol-16-glucuronide (E3-16G) was 0.1-20 microg/mL and the linearity of the method was 0.9984 for E3-3G and 0.9987 for E3-16G. The limits of detection at a signal-to-noise (S/N) ratio of 3 were 10 ng/mL (E3-3G) and 5 ng/mL (E3-16G). The analytical recovery was over 85% and, in general, inter-day and intra-day variability for precision and accuracy were less than 10%. When applied to a pregnancy urine sample to biomedical monitoring of the function of the maternal/fetal unit, the proposed method allowed rapid and sensitive screening for the detection of E3-3G and E3-16G.

[Detection of cell-free fetal DNA in the urine of pregnant women by nested polymerase chain reaction]

OBJECTIVE

To investigate the clinical feasibility of fetal sex determination by using nested polymerase chain reaction (PCR) to detect cell-free fetal DNA in the urine of pregnant women.

METHODS

The urine specimens of 40 healthy predelivery women were centrifuged. The DNA in the specimens of supernatant was extracted by using of QIAamp Viral RNA Mini Kits. Nested PCR was used to specifically amplify the SRY gene, 300 bp in length, on Y chromosome in order to detect the fetal DNA from the women bearing male fetuses. One specimen of normal man's urine and one specimen of non-pregnant woman's urine were used as controls for each specimen from pregnant women. The results were confirmed by the sexes of neonates examined after birth.

RESULTS

Amplified band of SRY was found in 6 specimens. Sex examination after delivery showed 21 male neonates and 19 female neonates. The positive rate of detection of SRY gene was 28.6% (6/21) and the false negative rate was 71.4%, and false positive rate was 0. Five out of the 6 cases with positive results showed positive 2 times and one out of the 6 cases only showed positive at the second time.

CONCLUSION

There is cell-free fetal DNA in the urine of pregnant women. Nested PCR is useful in detection of fetal sex, however, still with a rather low positive rate.

Urinary iodine excretion in pregnant women residing in areas with adequate iodine intake

OBJECTIVE

Pregnancy is accompanied by profound alterations in thyroid economy and relative iodine deficiency. The aim of this study was to evaluate urinary iodine excretion of pregnant women in cities with adequate and more than adequate iodine intake.

METHODS

A cross-sectional study was performed on schoolchildren and pregnant women in four cities in the Islamic Republic of Iran. Urinary iodine excretion was measured for 438 schoolchildren and 403 pregnant women. In addition, in Isfahan City, thyroid volume was measured by sonography for 30 pregnant women in each trimester of pregnancy and for 90 non-pregnant women who also had urinary iodine measurement.

RESULTS

Median urinary iodine of schoolchildren was 31.2, 25.0, 20.2 and 19.3 microg/dl in Rasht, Isfahan, Ilam and Tehran, respectively. Corresponding values for pregnant women were 33.8, 21.2, 19.0 and 18.6 microg/dl. The percentage of pregnant women with urinary iodine below 20 microg/dl was 16, 45, 55 and 54, and below 10 microg/dl was 1, 7, 7 and 13, in Rasht, Isfahan, Ilam and Tehran, respectively. In Isfahan, urinary iodine was significantly decreased in the third trimester of pregnancy, compared with controls. Mean thyroid volume was 7.8 +/- 3.1 ml and 7.8 +/- 2.8 ml in pregnant and non-pregnant women, respectively.

CONCLUSION

Recommended values for dietary iodine through universal salt iodisation may not be adequate for pregnant women, and the specific problem of iodine and pregnancy should be considered further in the light of the latest recommendations.

Urinary microalbumin/creatinine ratios: reference range in uncomplicated pregnancy

During uncomplicated pregnancy, the development of proteinuria is accepted as a poor prognostic sign and is associated with increasing maternal and perinatal mortality and morbidity. Physiological proteinuria increases with increasing gestation and one of its largest constituents is albumin. The reference range for the (micro)albumin/creatinine ratio (ACR) has not been described for normal pregnancy. This prospective cross-sectional study describes the gestation-specific 95% reference ranges for urinary microalbumin concentration, creatinine concentration and ACR in uncomplicated pregnancy. There is a significant increase ( P =0.016) in the ACR in the third trimester. The mean difference is 0.091 mg of albumin/mmol of creatinine (95% confidence interval, 0.014-0.168). Our results describe the first well-defined gestation-specific 95% reference range for a point-of-care measurement of the ACR. These data are essential if such testing is to be employed in antenatal care.

Low-dose aspirin in pregnancy: maternal and neonatal aspirin concentrations and neonatal prostanoid formation

OBJECTIVE

To evaluate maternal and neonatal plasma concentrations of acetylsalicylic acid and salicylic acid and the neonatal endogenous prostanoid formation during low-dose aspirin prophylaxis (LDA; 100 mg daily) in pregnant women.

METHODS

Concentrations of acetylsalicylic acid and salicylic acid in maternal plasma after at least 4 weeks of LDA (n = 14) and in umbilical cord plasma of newborns after maternal LDA (n = 7) were determined by gas chromatography-mass spectrometry. Platelet and renal formation of thromboxane A2 and the formation of prostaglandin E2 and prostacyclin were evaluated in vivo by quantification of index metabolites in plasma and urine by gas chromatography-mass spectrometry in neonates after maternal LDA (n = 14) and in a control group.

RESULTS

In the pregnant women, acetylsalicylic acid and salicylic acid concentrations rapidly increased after ingestion of LDA. Acetylsalicylic acid was completely eliminated within 4 hours, whereas salicylic acid was detected with low concentrations at 18 and 21 hours after dosing. In the neonates, acetylsalicylic acid was not detected. Salicylic acid was detected in 1 infant only. Platelet thromboxane A2 formation in the newborn infants was significantly suppressed but recovered within 2 to 3 days after discontinuation of LDA. Renal thromboxane A2 formation and the formation of prostaglandin E2 and prostacyclin were not affected by LDA.

CONCLUSION

In pregnant women who are treated with LDA, acetylsalicylic acid is not completely inactivated in the portal circulation but reaches the uteroplacental circulation and exerts antiplatelet effects in the fetus and newborn.

Exposure to indoor pesticides during pregnancy in a multiethnic, urban cohort

Evidence is growing that indoor pesticide exposure is of considerable magnitude in the United States and that pesticide concentrations may be especially high in urban areas. Of particular concern is exposure of pregnant women because animal data suggest that exposure to pesticides during pregnancy and early life may impair neurodevelopment in the offspring. To investigate the relationship between prenatal exposure to indoor pesticides and infant growth and development, we are conducting a prospective, multiethnic cohort study of mothers and infants delivered at Mount Sinai Hospital in New York City. This article provides data on pesticide exposure based on questionnaire items and analysis of maternal urinary metabolite levels among 386 women. Both the questionnaire and laboratory data revealed that exposure to indoor pesticides was considerable. The proportion of women estimated from questionnaire data as having been exposed during pregnancy to indoor pesticides (approximately 70%) was somewhat lower than the 80-90% of American households who reportedly used pesticides in previous surveys, but some of the latter surveys included both indoor and outdoor pesticide use. Urinary metabolite levels of 3,5,6-trichloro-2-pyridinol (TCPy; median = 11.3 micro g/g creatinine), phenoxybenzoic acid (PBA; median =19.3 micro g/g creatinine), and pentachlorophenol (PCP; median =7.3 micro g/g creatinine) were higher than those reported in other studies of adults in the United States. Furthermore, no associations were evident between the pesticide questionnaire data and the urinary metabolites. Assessments of sociodemographic and building characteristics with questionnaire data and the metabolite levels revealed no consistent trends. Significant temporal variations were observed for urinary PBA but not TCPy or PCP. The temporal variations for PBA were consistent with seasonal spraying of pyrethroid pesticides. These data underscore the need to assess the potentially adverse effects of pesticide exposure on fetuses and infants and the importance of finding alternative methods for pest management to reduce pesticide exposures.

Role of Tamm-Horsfall protein and uromodulin in calcium oxalate crystallization

One of the defenses against nephrolithiasis is provided by macromolecules that modulate the nucleation, growth, aggregation and retention of crystals in the kidneys. The aim of the present study was to determine the behavior of two of these proteins, Tamm-Horsfall and uromodulin, in calcium oxalate crystallization in vitro. We studied a group of 10 male stone formers who had formed at least one kidney stone composed of calcium oxalate. They were classified as having idiopathic nephrolithiasis and had no well-known metabolic risk factors involved in kidney stone pathogenesis. Ten normal men were used as controls, as was a group consisting of five normal women and another consisting of five pregnant women. Crystallization was induced by a fixed supersaturation of calcium oxalate and measured with a Coulter Counter. All findings were confirmed by light and scanning electron microscopy. The number of particulate material deposited from patients with Tamm-Horsfall protein was higher than that of the controls (P<0.001). However, Tamm-Horsfall protein decreased the particle diameter of the stone formers when analyzed by the mode of the volume distribution curve (P<0.002) (5.64 +/- 0.55 microm compared to 11.41 +/- 0.48 microm of uromodulin; 15.94 +/- 3.93 microm and 12.45 +/- 0.97 microm of normal men Tamm-Horsfall protein and uromodulin, respectively; 8.17 +/- 1.57 microm and 9.82 +/- 0.95 microm of normal women Tamm-Horsfall protein and uromodulin, respectively; 12.17 +/- 1.41 m and 12.99 +/- 0.51 microm of pregnant Tamm-Horsfall protein and uromodulin, respectively). Uromodulin produced fewer particles than Tamm-Horsfall protein in all groups. Nonetheless, the total volume of the crystals produced by uromodulin was higher than that produced by Tamm-Horsfall protein. Our results indicate a different effect of Tamm-Horsfall protein and uromodulin. This dual behavior suggests different functions. Tamm-Horsfall protein may act on nucleation and inhibit crystal aggregation, while uromodulin may promote aggregation of calcium oxalate crystals.

Consumption of the folate breakdown product para-aminobenzoylglutamate contributes minimally to urinary folate catabolite excretion in humans: investigation using [(13)C(5)]para-aminobenzoylglutamate

Folate catabolism represents the major route of folate turnover in humans and involves cleavage of the C9-N10 bond producing a pterin and para-aminobenzoylglutamate (pABG). Thus, the quantitation of pABG and its acetylated more predominant counterpart para-acetamidobenzolyglutamate (apABG) may be useful in assessing folate status and requirements. However, until the in vivo fate of dietary pABG is understood, studies using pABG excretion parameters can not be fully interpreted. As part of a larger study, an oral dose (376 nmol or 100 micro g) of [(13)C(5)]pABG in 40 mL apple juice was ingested by pregnant women (2nd trimester, n = 2) and nonpregnant controls (n = 2) consuming controlled total folate intakes of 450 or 850 micro g/d. Urine collections (24 h) were obtained over the next 4 d and gas chromatography-mass spectrometry was used to measure urinary [(13)C(5)]pABG, [(13)C(5)]apABG and [(13)C(5)]folate. Of the 376 nmol [(13)C(5)]pABG administered, only 17.5 +/- 6.4 nmol; mean +/- SEM) or 4.6 +/- 1.7% of the dose was accounted for in the urine. Most of the excreted [(13)C(5)]pABG, in acetamido form (15.1 +/- 5.3 nmol), was excreted the day after the dose. No urinary [(13)C(5)]folate was detected. Folate intake did not seem to influence the urinary excretion of total pABG derived from oral pABG, whereas pregnancy may lessen total pABG excretion derived from oral pABG. Overall, these results suggest that the contribution of dietary pABG to the urinary excretion of pABG and apABG is small.

[Urine iodine excretion by healthy pregnant women after vitamin and microelement supplementation (Materna) in the first trimester]

OBJECTIVES

The aim of the study was the assessment of iodine turnover in healthy pregnant women supplemented by microelement and vitamin preparation Materna.

METHODS

To assess iodine supplementation, a modified PAAM method was used for measurement of iodine concentration in morning urine.

MATERIALS

50 pregnant healthy women were tested for Materna supplementation. Urine iodine concentration was measured starting from the I trimester of pregnancy and then after 1, 2 and 3 months of Materna administration.

RESULTS

It has been found, that 3 months of supplementation with Materna reduces iodine deficiency in 83% of primiparas, while in the same time urine iodine concentration was normal in only 30% of women in their third and next pregnancy.

CONCLUSION

In our opinion iodine urine concentration should be assessed in all multiparas using Materna after 1 month of supplementation in order to correct individual iodine supplementation doses.

What's new in defining hypertension and classifying hypertensive disorders in pregnancy

Hypertensive disorders are the most common medical problems encountered by women during pregnancy and remain a major cause of maternal and fetal mortality and morbidity throughout the world. This article provides an update on the definition and classifications of hypertension in pregnancy and discusses the recent consensus statement from the Australasian Society into the Study of Hypertension in Pregnancy (ASSHP). A review of the relevance of the traditional triad of symptoms in the assessment of women for hypertensive disorders in pregnancy is also presented. An understanding of these issues will help midwives accurately assess women and ensure that appropriate management of pregnancies complicated by hypertensive disorders occurs.