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Gundacker A, Cuenca Rico L, Stoehrmann P, Tillmann KE, Weber-Stadlbauer U, Pollak DD. Interaction of the pre- and postnatal environment in the maternal immune activation model. DISCOVER MENTAL HEALTH 2023; 3:15. [PMID: 37622027 PMCID: PMC10444676 DOI: 10.1007/s44192-023-00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
Adverse influences during pregnancy are associated with a range of unfavorable outcomes for the developing offspring. Maternal psychosocial stress, exposure to infections and nutritional imbalances are known risk factors for neurodevelopmental derangements and according psychiatric and neurological manifestations later in offspring life. In this context, the maternal immune activation (MIA) model has been extensively used in preclinical research to study how stimulation of the maternal immune system during gestation derails the tightly coordinated sequence of fetal neurodevelopment. The ensuing consequence of MIA for offspring brain structure and function are majorly manifested in behavioral and cognitive abnormalities, phenotypically presenting during the periods of adolescence and adulthood. These observations have been interpreted within the framework of the "double-hit-hypothesis" suggesting that an elevated risk for neurodevelopmental disorders results from an individual being subjected to two adverse environmental influences at distinct periods of life, jointly leading to the emergence of pathology. The early postnatal period, during which the caregiving parent is the major determinant of the newborn´s environment, constitutes a window of vulnerability to external stimuli. Considering that MIA not only affects the developing fetus, but also impinges on the mother´s brain, which is in a state of heightened malleability during pregnancy, the impact of MIA on maternal brain function and behavior postpartum may importantly contribute to the detrimental consequences for her progeny. Here we review current information on the interaction between the prenatal and postnatal maternal environments in the modulation of offspring development and their relevance for the pathophysiology of the MIA model.
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Affiliation(s)
- Anna Gundacker
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse, 17, 1090 Vienna, Austria
| | - Laura Cuenca Rico
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse, 17, 1090 Vienna, Austria
| | - Peter Stoehrmann
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse, 17, 1090 Vienna, Austria
| | - Katharina E. Tillmann
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse, 17, 1090 Vienna, Austria
| | - Ulrike Weber-Stadlbauer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Daniela D. Pollak
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse, 17, 1090 Vienna, Austria
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Ruhighira JJ, Mashili FL, Tungu AM, Mamuya S. Spirometry profiles among pregnant and non-pregnant African women: a cross-sectional study. BMC Womens Health 2022; 22:483. [PMID: 36461083 PMCID: PMC9716166 DOI: 10.1186/s12905-022-02081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Spirometry is a commonly used lung function test. It assesses respiratory functions by measuring the air volume and the rate at which a person can exhale from lungs filled to their total capacity. The most helpful spirometry parameters are: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF). Pregnancy derives an altered physiological state due to hormonal and anatomical changes that affect the respiratory system. Despite that, spirometry is less commonly done during pregnancy, and if done, test results are evaluated against non-pregnancy references. OBJECTIVE This study aimed to explore spirometry profiles in pregnant and non-pregnant women and describe their differences. METHODOLOGY This cross-sectional study involved age-matched pregnant and non-pregnant participants recruited from Mnazi Moja ANC and Muhimbili University (MUHAS). A digital spirometer was used to assess respiratory function. Data were entered and analyzed using SPSS version 23. The mean spirometry values of pregnant participants were compared to those of non-pregnant participants using an independent sample t-test. A p-value of < 0.05 was considered statistically significant. RESULTS The study included 92 pregnant and 98 non-pregnant participants subjected to spirometry. Both FVC and FEV1 values were significantly lower in pregnant than in non-pregnant participants (2.7 ± 0.5 L vs. 2.9 ± 0.5 L; p < 0.01 and 2.2 ± 0.4 L vs. 2.5 ± 0.4 L; p < 0.01 respectively). In addition, pregnant participants had significantly lower mean PEF values than their non-pregnant counterparts (303 ± 84 L/min versus 353 ± 64 L/min; p < 0.01). CONCLUSION Spirometry test values are lower in pregnancy than in non-pregnant participants. RECOMMENDATIONS Interpreting the spirometry test values of pregnant women using references obtained from non-pregnant women may be inappropriate. Future studies should evaluate the appropriateness of predicting spirometry values of pregnant women using reference equations derived from non-pregnant women.
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Affiliation(s)
- Jacktan Josephat Ruhighira
- grid.442459.a0000 0001 1998 2954Department of Physiology, University of Dodoma, P. O Box 395, Dodoma, Tanzania
| | - Fredirick L. Mashili
- grid.25867.3e0000 0001 1481 7466Department of Physiology, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
| | - Alexander Mtemi Tungu
- grid.25867.3e0000 0001 1481 7466Department of Physiology, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
| | - Simon Mamuya
- grid.25867.3e0000 0001 1481 7466Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania
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Zairina E, Stewart K, Abramson MJ, George J. The effectiveness of non-pharmacological healthcare interventions for asthma management during pregnancy: a systematic review. BMC Pulm Med 2014; 14:46. [PMID: 24642132 PMCID: PMC3994784 DOI: 10.1186/1471-2466-14-46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While reviews have been published on asthma management in pregnant women, none has examined the effectiveness of non-pharmacological healthcare interventions for optimizing asthma management in pregnant women. This systematic review aims to identify non-pharmacological healthcare interventions for optimizing asthma management during pregnancy and to examine their effects on maternal asthma control and neonatal outcomes. METHODS The Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL Plus and International Pharmaceutical Abstracts (IPA) were searched. Two reviewers independently assessed the identified studies against the eligibility criteria and extracted relevant information. The effects of the intervention were assessed qualitatively. RESULTS Nine studies were identified, of which six were rejected according to the exclusion criteria. The three studies included in the final review described an education program, progressive muscle relaxation (PMR) and Fraction of exhaled Nitric Oxide (FeNO) guided management of asthma in pregnant women. The PMR and FeNO-guided interventions showed significant improvements in maternal asthma control (lung function and quality of life) and neonatal outcomes (birth weight). CONCLUSIONS Further evidence from well-designed studies evaluating non-pharmacological healthcare interventions for optimizing asthma management in pregnant women is required.
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Affiliation(s)
- Elida Zairina
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
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Namazy JA, Schatz M. Management of asthma during pregnancy. ACTA ACUST UNITED AC 2012; 2:405-13. [PMID: 19803912 DOI: 10.2217/17455057.2.3.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The prevalence of asthma in pregnant women appears to be increasing. Recent evidence demonstrates that pregnant asthmatic women with moderate-to-severe asthma may have an increased risk of adverse perinatal outcomes. The goal of asthma management during pregnancy is to optimize maternal and fetal health.
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Affiliation(s)
- Jennifer Altamura Namazy
- Department of Allergy, Kaiser Permanente Medical Center, 7060 Clairemont Mesa BoulevardSan Diego, CA 92111, USA.
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Streck MR, Blaiss MS. Quality of care of asthma during pregnancy. Expert Rev Pharmacoecon Outcomes Res 2012; 6:67-77. [PMID: 20528540 DOI: 10.1586/14737167.6.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of asthma management during pregnancy is to keep the mother symptom free and to prevent complications in the fetus. Asthma is a common chronic condition in pregnancy that, if inadequately treated, has the potential to cause adverse effects for both mother and fetus. Aggressive treatment during pregnancy can decrease costs associated with asthma now and additional costs later if the fetus has a poor outcome due to maternal asthma. A stepwise approach to the management of asthma during pregnancy has been developed and is not unlike the management of the nonpregnant patient. Although there are no double-blind, placebo-controlled studies on asthma medications in pregnant women, large cohort studies have shown the efficacy of aggressive management. With adequate control of asthma from the preconception time through delivery, studies have shown similar outcomes in asthmatic patients compared with nonasthmatics, thus obtaining the goal of a symptom-free mother and a healthy baby.
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Affiliation(s)
- Maria R Streck
- University of Tennessee Center for the Health Sciences, College of Medicine, 50 North Dunlap Street, 4th Floor, West Patient Tower, Memphis, TN 38103, USA.
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Schramel J, Nagel C, Auer U, Palm F, Aurich C, Moens Y. Distribution of ventilation in pregnant Shetland ponies measured by Electrical Impedance Tomography. Respir Physiol Neurobiol 2012; 180:258-62. [DOI: 10.1016/j.resp.2011.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 11/10/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
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Roberge RJ. Physiological Burden Associated with the Use of Filtering Facepiece Respirators (N95 Masks) during Pregnancy. J Womens Health (Larchmt) 2009; 18:819-26. [DOI: 10.1089/jwh.2008.1072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Raymond Joseph Roberge
- National Personal Protective Technology Laboratory/National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania
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Abstract
Critically ill pregnant and postnatal women admitted to intensive care units (ICUs) require highly specialised care, components of which many critical care nurses are unfamiliar with. There are no specialist critical care obstetric centres in Australia, with critically ill obstetric patients admitted to general ICUs. There are no published guidelines and little research that assist critical care nurses to care for such women. Furthermore, the admission of pregnant or postnatal women to ICUs is likely to increase with emerging childbearing patterns in Australia. It is therefore timely to review what we know about caring for critically ill pregnant and postnatal women. This paper analyses the literature on intensive care utilisation by obstetric patients and provides an overview regarding which pregnant and postpartum women require intensive care. The key areas of providing mechanical ventilation to pregnant women and assessment of fetal wellbeing are explored in detail. The most frequent conditions and their treatment, preeclampsia and obstetric haemorrhage, are also reviewed. The establishment of lactation is also considered as the critical carenurse is commonly involved in supporting the woman's endeavour to breastfeed.
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Abstract
In summary, the major physiologic changes that occur in pregnancy are the increased minute ventilation, which is caused by increased respiratory center sensitivity and drive; a compensated respiratory alkalosis; and a low expiratory reserve volume. The vital capacity and measures of forced expiration are well preserved. Patients who have many lung diseases tolerate pregnancy well, with the exception of those who have pulmonary hypertension or chronic respiratory insufficiency from parenchymal or neuromuscular disease.
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Affiliation(s)
- Robert A Wise
- Department of Medicine (Pulmonary and Critical Care Medicine), Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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Curran CA. The effects of rhinitis, asthma, and acute respiratory distress syndrome as acute or chronic pulmonary conditions during pregnancy. J Perinat Neonatal Nurs 2006; 20:147-54, quiz 155-6. [PMID: 16714914 DOI: 10.1097/00005237-200604000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary complications from both obstetrical and non-obstetrical causes contribute to a mortality rate as high as 80% in the pregnant population. The effect of numerous mechanical and biochemical physiologic alterations during pregnancy can influence the maternal and fetal outcomes in a woman with a pulmonary complication. Progesterone, the primary hormone of pregnancy, is a respiratory stimulant that enhances carbon dioxide release and alters the maternal pH in favor of releasing oxygen to the fetus. During systemic compromise, which may be experienced as an acute asthmatic attack or respiratory distress syndrome, desaturation and carbon dioxide retention ensue. Under these conditions, the fetus is at risk for perinatal hypoxemia. Although prompt recognition and treatment are important to minimize maternal, fetal, and neonatal morbidity and mortality, evidence-based literature regarding critical care techniques that promote optimal obstetrical outcomes is limited. Therefore, a collaborative approach to the care of these women is warranted. In addition to critical care, emergency medicine, and obstetrical nurses, the medical team may include an obstetrician, a perinatologist, a neonatologist, a pulmonologist, an intensivist, and an immunologist.
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Affiliation(s)
- Carol A Curran
- CNSA/Clinical Nurse Specialists & Associates, Virginia Beach, Va 23452, USA.
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Abstract
Pulmonary edema is a secondary disease process characterized by an excess accumulation of fluid in the pulmonary interstitial and alveolar spaces, preventing adequate diffusion of both oxygen and carbon dioxide. The excess fluid accumulation interferes with maternal oxygenation and, if not identified and corrected, can lead to maternal and fetal hypoxemia. The purpose of this article is to review principles of oxygen transport and the pathophysiology, diagnosis, management, and nursing implications of acute pulmonary edema in pregnancy.
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Affiliation(s)
- Judith H Poole
- Presbyterian Healthcare System, and the Birthing Care Unit, Women's Services, Presbyterian Hospital, Charlotte, NC, USA.
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Blaiss MS. Managing asthma during pregnancy. The whys and hows of aggressive control. Postgrad Med 2004; 115:55-8, 61-4. [PMID: 15171078 DOI: 10.3810/pgm.2004.05.1505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma occurs in about 4% of pregnancies and can worsen during pregnancy. Aggressive treatment is needed because failure to control asthma during pregnancy can lead to poor outcomes for both mother and child. At the same time, the risk-benefit profile of various asthma medications should be considered to avoid any adverse effects. In this article, Dr Blaiss discusses the foundations for management of asthma during pregnancy: environmental control, pharmacotherapy, and allergen immunotherapy.
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Affiliation(s)
- Michael S Blaiss
- University of Tennessee Health Science Center, College of Medicine, Memphis, USA.
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Abstract
OBJECTIVES To objectively critique recent available data on the proper management of allergy and asthma during pregnancy, with an emphasis on understanding the risk and benefit of medications used during pregnancy for these disorders. DATA SOURCES Data for this article were obtained from a MEDLINE search of literature from 1975 until the present published in English. STUDY SELECTION It was the expert opinion of the author to select and synthesize recently published articles and reviews on this broad subject. RESULTS Asthma is estimated to affect up to 4% of pregnancies, whereas rhinitis complicates up to 20%. The cornerstones of management are environmental avoidance procedures, pharmacologic treatment, and allergen immunotherapy. Pharmaceutical treatment for allergic rhinitis should start with the first-generation antihistamines, chlorpheniramine and tripelennamine. In pregnant women, who cannot tolerate first-generation antihistamines, use of a second-generation agent, either loratadine or cetirizine, should be considered. Though data are lacking, intranasal corticosteroids appear to be safe during pregnancy. For pregnant women with persistent asthma, the use of inhaled cromolyn should be the first-line therapy, followed by inhaled budesonide if symptoms worsen. Other agents such as salmeterol, leukotriene modifiers, and newer inhaled corticosteroids may be considered in women who exhibited a good response to these agents before pregnancy. Immunotherapy is the only disease-modifying treatment for allergic rhinitis and asthma. It can be continued during pregnancy. CONCLUSIONS Understanding the important differences in treatment for the pregnant patient is vital for all physicians caring for these patients. Proper medical management needs to take into consideration possible adverse effects of different agents used in asthma and rhinitis.
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Affiliation(s)
- Michael S Blaiss
- University of Tennessee Health Science Center, College of Medicine, South Memphis, Tennessee 38018, USA.
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