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de Jong IEM, Wells RG. In Utero Extrahepatic Bile Duct Damage and Repair: Implications for Biliary Atresia. Pediatr Dev Pathol 2024; 27:291-310. [PMID: 38762769 PMCID: PMC11340255 DOI: 10.1177/10935266241247479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
Biliary atresia (BA) is a cholangiopathy affecting the extrahepatic bile duct (EHBD) of newborns. The etiology and pathophysiology of BA are not fully understood; however, multiple causes of damage and obstruction of the neonatal EHBD have been identified. Initial damage to the EHBD likely occurs before birth. We discuss how different developmental stages in utero and birth itself could influence the susceptibility of the fetal EHBD to damage and a damaging wound-healing response. We propose that a damage-repair response of the fetal and neonatal EHBD involving redox stress and a program of fetal wound healing could-regardless of the cause of the initial damage-lead to either obstruction and BA or repair of the duct and recovery. This overarching concept should guide future research targeted toward identification of factors that contribute to recovery as opposed to progression of injury and fibrosis. Viewing BA through the lens of an in utero damage-repair response could open up new avenues for research and suggests exciting new therapeutic targets.
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Affiliation(s)
- Iris E. M. de Jong
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering MechanoBiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca G. Wells
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering MechanoBiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
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Simon-Szabo Z, Fogarasi E, Nemes-Nagy E, Denes L, Croitoru M, Szabo B. Oxidative stress and peripartum outcomes (Review). Exp Ther Med 2021; 22:771. [PMID: 34055070 DOI: 10.3892/etm.2021.10203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022] Open
Abstract
Pregnancy, labor and childbirth are accompanied by excessive oxidative aggression. The excessive formation of free radicals [reactive oxygen species (ROS), reactive nitrogen species (RNS), chlorine reactive species (CRS)] causes cellular oxidative damage, which can be scavenged by enzymatic or non-enzymatic antioxidants in normal healthy pregnancy, physiological labor and delivery without any complications. An imbalance between the pro-oxidant and antioxidant factors may lead to oxidative stress, which contributes to the development of many diseases. This oxidative aggression can be a precursor for pathologies in the pregnant woman including eclampsia, miscarriage, preterm labor, and intrauterine growth retardation; in the offspring it may lead to bronchopulmonary dysplasia/chronic lung disease, necrotizing enterocolitis, retinopathy of prematurity, and periventricular leukomalacia. This review summarizes the studies conducted to identify the mechanisms of oxidative stress and the effect of cell membrane oxidation, the mechanisms that are behind oxidative stress-related diseases, and also those studies which have demonstrated the effect of antioxidants in preventing diseases or diminishing the effects of oxidative stress in the body, in obstetrics and neonatology.
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Affiliation(s)
- Zsuzsanna Simon-Szabo
- Department of Obstetrics-Gynecology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Erzsebet Fogarasi
- Department of Toxicology and Biopharmacy, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Eniko Nemes-Nagy
- Department of Chemistry and Medical Biochemistry, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Lorand Denes
- Department of Anatomy, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Mircea Croitoru
- Department of Toxicology and Biopharmacy, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Bela Szabo
- Department of Obstetrics-Gynecology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
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Davies KL, Camm EJ, Atkinson EV, Lopez T, Forhead AJ, Murray AJ, Fowden AL. Development and thyroid hormone dependence of skeletal muscle mitochondrial function towards birth. J Physiol 2020; 598:2453-2468. [PMID: 32087026 PMCID: PMC7317365 DOI: 10.1113/jp279194] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
Key points Skeletal muscle energy requirements increase at birth but little is known regarding the development of mitochondria that provide most of the cellular energy as ATP. Thyroid hormones are known regulators of adult metabolism and are important in driving several aspects of fetal development, including muscle fibre differentiation. Mitochondrial density and the abundance of mitochondrial membrane proteins in skeletal muscle increased during late gestation. However, mitochondrial functional capacity, measured as oxygen consumption rate, increased primarily after birth. Fetal hypothyroidism resulted in significant reductions in mitochondrial function and density in skeletal muscle before birth. Mitochondrial function matures towards birth and is dependent on the presence of thyroid hormones, with potential implications for the health of pre‐term and hypothyroid infants.
Abstract Birth is a significant metabolic challenge with exposure to a pro‐oxidant environment and the increased energy demands for neonatal survival. This study investigated the development of mitochondrial density and activity in ovine biceps femoris skeletal muscle during the perinatal period and examined the role of thyroid hormones in these processes. Muscle capacity for oxidative phosphorylation increased primarily after birth but was accompanied by prepartum increases in mitochondrial density and the abundance of electron transfer system (ETS) complexes I–IV and ATP‐synthase as well as by neonatal upregulation of uncoupling proteins. This temporal disparity between prepartum maturation and neonatal upregulation of mitochondrial oxidative capacity may protect against oxidative stress associated with birth while ensuring energy availability to the neonate. Fetal thyroid hormone deficiency reduced oxidative phosphorylation and prevented the prepartum upregulation of mitochondrial density and ETS proteins in fetal skeletal muscle. Overall, the data show that mitochondrial function matures over the perinatal period and is dependent on thyroid hormones, with potential consequences for neonatal viability and adult metabolic health. Skeletal muscle energy requirements increase at birth but little is known regarding the development of mitochondria that provide most of the cellular energy as ATP. Thyroid hormones are known regulators of adult metabolism and are important in driving several aspects of fetal development, including muscle fibre differentiation. Mitochondrial density and the abundance of mitochondrial membrane proteins in skeletal muscle increased during late gestation. However, mitochondrial functional capacity, measured as oxygen consumption rate, increased primarily after birth. Fetal hypothyroidism resulted in significant reductions in mitochondrial function and density in skeletal muscle before birth. Mitochondrial function matures towards birth and is dependent on the presence of thyroid hormones, with potential implications for the health of pre‐term and hypothyroid infants.
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Affiliation(s)
- K L Davies
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - E J Camm
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - E V Atkinson
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - T Lopez
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - A J Forhead
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK.,Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK
| | - A J Murray
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - A L Fowden
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
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Levin G, Mankuta D, Eventov-Friedman S, Ezra Y, Koren A, Yagel S, Rottenstreich A. Factors associated with the severity of neonatal subgaleal haemorrhage following vacuum assisted delivery. Eur J Obstet Gynecol Reprod Biol 2020; 245:205-209. [DOI: 10.1016/j.ejogrb.2019.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022]
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Kutlesic MS, Kocic G, Kutlesic RM. [The effects of remifentanil used during cesarean section on oxidative stress markers in correlation with maternal hemodynamics and neonatal outcome: a randomized controlled trial]. Rev Bras Anestesiol 2019; 69:537-545. [PMID: 31796304 DOI: 10.1016/j.bjan.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/11/2019] [Accepted: 05/23/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Remifentanil is used to attenuate maternal hemodynamic response to intubation and surgical stress during Induction-Delivery period of cesarean section. The goal was to compare the effects of two remifentanil dosing regimens on oxidative stress level, in correlation with its hemodynamic and neonatal effects. METHODS Fifty-one patients, 17 per group, enrolled for elective cesarean section were randomly divided by computer-generated codes into three parallel groups: (A) patients received a 1μg.kg-1 remifentanil bolus immediately before induction, followed by 0.15μg.kg-1.min-1 infusion, that was stopped after skin incision; (B) patients received a 1μg.kg-1 remifentanil bolus immediately before induction; (C) (control), patients did not receive remifentanil until delivery. Maternal venous blood samples were taken at basal time, at extraction and 30minutes after the end of operation for spectrophotometrical determination of malondialdehyde and advanced oxidation protein products concentration. The same was conducted for umbilical venous sample. RESULTS Systolic blood pressure and heart rate remained significantly lower in group A compared to B and C during entire Induction-Delivery period (p<0.001, p=0.02 after intubation; p=0.006, p=0.03 after skin incision; p=0.029, p=0.04 after extraction; respectively). Malondialdehyde concentration was lower at time of extraction in maternal blood in group A compared to B and C (p=0.026). All neonatal Apgar scores were ≥ 8 and umbilical acid-base values within normal range. CONCLUSIONS The remifentanil dosing regimen applied in group A significantly attenuated lipid peroxidation and maternal hemodynamic response during entire I-D period, without compromising neonatal outcome.
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Affiliation(s)
- Marija S Kutlesic
- University Clinical Centre Nis, Clinic of Anaesthesiology, Niš, Sérvia.
| | | | - Ranko M Kutlesic
- University of Niš, Faculty of Medicine, Niš, Sérvia; University Clinical Centre Niš, Clinic of Obstetrics and Gynaecology, Niš, Sérvia
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D'Angelo G, Granese R, Marseglia L, Impellizzeri P, Alibrandi A, Palmara A, La Rosa MA, Manti S, Salpietro C, Spina E, Reiter RJ, Falsaperla R, Corsello G, Gitto E. High mobility group box 1 and markers of oxidative stress in human cord blood. Pediatr Int 2019; 61:264-270. [PMID: 30715770 DOI: 10.1111/ped.13795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/31/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Parturition induces considerable oxidative stress and many inflammatory mediators, such as high mobility group box 1 (HMGB1), are involved from the beginning of the pregnancy to birth. The aim of the present study was to evaluate serum cord blood concentration of diacron-reactive oxygen metabolites (d-ROM), biological antioxidant potential (BAP), and HMGB1 to investigate the perinatal oxidative status of neonates and correlation with mode of delivery, as well as the influence of labor. METHODS The subjects consisted of 214 neonates delivered at University Hospital "G. Martino", Messina, in a 6 months period. Venous blood samples were collected from the umbilical cord after cord separation. RESULTS Umbilical cord venous blood HMGB1 was significantly higher in the spontaneous vaginal delivery (SVD) group than in the elective or emergency cesarean section (CS) group (P = 0.018). Regarding labor, there was no significant difference in HMGB1 concentration in umbilical vein blood between the spontaneous and induced labor groups (P = 0.250). Furthermore, d-ROM was significantly different between the SVD group and the elective or emergency CS group (P = 0.044). BAP concentration, however, was not significantly different, not even with regard to mode of labor. CONCLUSION Oxidation is higher in newborns delivered by SVD than in those delivered by CS, and HMGB1 may be involved in the mechanisms of birth, and responsible for decidual modifications that lead to birth.
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Affiliation(s)
- Gabriella D'Angelo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Neonatal Intensive Care Unit, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Roberta Granese
- Obstetrics and Gynecology Unit, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Lucia Marseglia
- Neonatal Intensive Care Unit, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Pietro Impellizzeri
- Unit of Paediatric Surgery, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Antonella Palmara
- Neonatal Intensive Care Unit, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Maria Angela La Rosa
- Unit of Paediatric Genetics and Immunology, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Sara Manti
- Unit of Paediatric Genetics and Immunology, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Carmelo Salpietro
- Unit of Paediatric Genetics and Immunology, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Russel J Reiter
- Department of Cell Systems and Anatomy, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Raffaele Falsaperla
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
| | - Giovanni Corsello
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Eloisa Gitto
- Neonatal Intensive Care Unit, Gaetano Barresi Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
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Bullens LM, Hulsenboom ADJ, Moors S, Joshi R, van Runnard Heimel PJ, van der Hout-van der Jagt MB, van den Heuvel ER, Guid Oei S. Intrauterine resuscitation during the second stage of term labour by maternal hyperoxygenation versus conventional care: study protocol for a randomised controlled trial (INTEREST O2). Trials 2018; 19:195. [PMID: 29566729 PMCID: PMC5865381 DOI: 10.1186/s13063-018-2567-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 03/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Perinatal asphyxia is, even in developed countries, one the major causes of neonatal morbidity and mortality. Therefore, if foetal distress during labour is suspected, one should try to restore foetal oxygen levels or aim for immediate delivery. However, studies on the effect of intrauterine resuscitation during labour are scarce. We designed a randomised controlled trial to investigate the effect of maternal hyperoxygenation on the foetal condition. In this study, maternal hyperoxygenation is induced for the treatment of foetal distress during the second stage of term labour. METHODS/DESIGN This study is a single-centre randomised controlled trial being performed in a tertiary hospital in The Netherlands. From among cases of a suboptimal or abnormal foetal heart rate pattern during the second stage of term labour, a total of 116 patients will be randomised to the control group, where normal care is provided, or to the intervention group, where before normal care 100% oxygen is supplied to the mother by a non-rebreathing mask until delivery. The primary outcome is change in foetal heart rate pattern. Secondary outcomes are Apgar score, mode of delivery, admission to the neonatal intensive care unit and maternal side effects. In addition, blood gas values and malondialdehyde are determined in umbilical cord blood. DISCUSSION This study will be the first randomised controlled trial to investigate the effect of maternal hyperoxygenation for foetal distress during labour. This intervention should be recommended only as a treatment for intrapartum foetal distress, when improvement of the foetal condition is likely and outweighs maternal and neonatal side effects. TRIAL REGISTRATION EudraCT, 2015-001654-15; registered on 3 April 2015. Dutch Trial Register, NTR5461; registered on 20 October 2015.
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Affiliation(s)
- Lauren M Bullens
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands. .,Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands.
| | - Alexandra D J Hulsenboom
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - Suzanne Moors
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - Rohan Joshi
- Department of Clinical Physics, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Pieter J van Runnard Heimel
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
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Babooa N, Shi WJ, Chen C. Factors relating caesarean section to persistent pulmonary hypertension of the newborn. World J Pediatr 2017; 13:517-527. [PMID: 29058246 DOI: 10.1007/s12519-017-0056-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have clearly demonstrated a significantly higher incidence of persistent pulmonary hypertension of the newborn (PPHN) in neonates delivered by caesarean section (CS) compared to those delivered vaginally. The pathophysiological factors underlying the link between CS and PPHN are still poorly understood. In this review, we describe the mechanisms that could explain the association between CS delivery and subsequent PPHN, as well as potential preventive measures. DATA SOURCES A literature search was conducted by electronic scanning of databases such as PubMed and Web of Science using the key words "persistent pulmonary hypertension of the newborn", "caesarean section", "iatrogenic prematurity", "oxidative stress", "late preterm", "labor" and "vasoactive agents". RESULTS Iatrogenic prematurity, higher rates of late preterm delivery and lack of physiological changes of labor play an important role in the association between CS and PPHN. CS delivery also results in limited endogenous pulmonary vasodilator synthesis and lower levels of protective anti-oxidants in the neonates. In addition, CS delivery exposes infants to a higher risk of respiratory distress syndrome and its concomitant increase in endothelin-1 levels, which might indirectly lead to a higher risk of developing PPHN. We believe that neonates delivered by CS are exposed to a combination of these pathophysiological events, culminating in an endpoint of respiratory distress, hypoxia, acidosis, and delayed transition and thereby increased risks of PPHN. The use of antenatal corticosteroids prior to elective CS in late preterm deliveries, promoting accurate informedconsent process, delaying elective CS to 39 weeks of gestation or beyond and antenatal maternal anti-oxidant supplementation could potentially mitigate the effects of CS delivery and minimize CS-related PPHN. CONCLUSIONS The link between CS delivery and PPHN is complex. In view of the rising rates of CS worldwide, there is an urgent need to further explore the mechanisms linking CS to PPHN and experimentally test therapeutic options in order to allow effective targeted interventions.
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Affiliation(s)
- Niralee Babooa
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Wen-Jing Shi
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Chao Chen
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China.
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Dede H, Takmaz O, Ozbasli E, Dede S, Gungor M. Higher Level of Oxidative Stress Markers in Small for Gestational Age Newborns Delivered by Cesarean Section at Term. Fetal Pediatr Pathol 2017; 36:232-239. [PMID: 28368675 DOI: 10.1080/15513815.2017.1303860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The aim of our study was to determine lipid peroxidation products and antioxidant enzyme activity in umbilical cord blood of small for gestational age (SGA) neonates. MATERIALS AND METHODS Umbilical cord arterial blood samples were collected from 21-term singleton SGA newborn infants and 21 age- and sex-matched appropriate for gestational age (AGA) term neonates prospectively born by elective cesarean section for determination of malondialdehyde (MDA) as a marker of lipid peroxidation and superoxide dismutase (SOD) for antioxidant activity. RESULTS MDA levels were increased (5.20 vs. 3.52 nmol/mL; p < 0.001), while levels of SOD (6.24 vs. 8.99 U/mL; p < 0.01) were decreased in SGA neonates when compared with AGA newborn infants. CONCLUSIONS Elevated MDA levels and decreased SOD activity in umbilical cord blood may show the possibility of insufficient protective mechanisms against increased oxidative stress in SGA neonates born by cesarean section.
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Affiliation(s)
- Hulya Dede
- a Department of Obstetrics and Gynecology , Acibadem University Maslak Hospital , Istanbul , Turkey
| | - Ozguc Takmaz
- a Department of Obstetrics and Gynecology , Acibadem University Maslak Hospital , Istanbul , Turkey
| | - Esra Ozbasli
- a Department of Obstetrics and Gynecology , Acibadem University Maslak Hospital , Istanbul , Turkey
| | - Suat Dede
- a Department of Obstetrics and Gynecology , Acibadem University Maslak Hospital , Istanbul , Turkey
| | - Mete Gungor
- a Department of Obstetrics and Gynecology , Acibadem University Maslak Hospital , Istanbul , Turkey
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Bagci S, Mensinga D, Katzer D, Merz WM, Reutter H, Müller A. An examination of the factors affecting intestinal wall integrity in newborns at birth. J Matern Fetal Neonatal Med 2017; 31:294-299. [PMID: 28110600 DOI: 10.1080/14767058.2017.1285883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND An understanding of the factors that influence intestinal wall integrity during the transition from fetal to neonatal life is important to elucidate and minimize potential contributions to the development of intestinal pathologies in vulnerable newborns. OBJECTIVE To assess the factors affecting intestinal wall integrity of late preterm and term newborns at birth. METHODS The concentrations of serum intestinal fatty acid-binding protein (I-FABP) as biomarker of intestinal wall injury, superoxide dismutase (SOD), and glutathione peroxidase (Gpx) as parameters of oxidative stress, and blood gas analyses were measured in the arterial cord blood of 80 newborns, delivered by spontaneous vaginal delivery (labor group) or elective cesarean delivery (non-labor group). RESULTS Compared with the non-labor group, I-FABP, SOD, and Gpx levels were significantly higher in the labor group. I-FABP concentration was inversely correlated with pH and BE and positively correlated with SOD and Gpx concentrations, second stage of labor duration, and active pushing time. CONCLUSIONS This study demonstrates that oxidative stress at birth and prolonged second stage of labor may lead to the intestinal injury, which is reflected in increased serum concentration of I-FABP.
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Affiliation(s)
- Soyhan Bagci
- a Neonatology and Pediatric Intensive Care , Children's Hospital, University of Bonn , Bonn , Germany
| | - Daniel Mensinga
- a Neonatology and Pediatric Intensive Care , Children's Hospital, University of Bonn , Bonn , Germany
| | - David Katzer
- a Neonatology and Pediatric Intensive Care , Children's Hospital, University of Bonn , Bonn , Germany
| | - Waltraut M Merz
- b Department of Obstetrics and Prenatal Medicine , University of Bonn , Bonn , Germany
| | - Heiko Reutter
- a Neonatology and Pediatric Intensive Care , Children's Hospital, University of Bonn , Bonn , Germany.,c Institute of Human Genetics , University of Bonn , Bonn , Germany
| | - Andreas Müller
- a Neonatology and Pediatric Intensive Care , Children's Hospital, University of Bonn , Bonn , Germany
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11
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Ramy N, Al Sharany W, Mohamed MA, Madani H, Saleh E, Aly H. Lipid peroxides in the serum of asphyxiated neonates. J Perinatol 2016; 36:849-52. [PMID: 27309626 DOI: 10.1038/jp.2016.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Lipid peroxides (LPOs) are released when free radicals react with unsaturated fatty acids in cell membranes during hypoxic ischemic insult in neonates. We aimed to assess LPO concentrations in the serum of asphyxiated and non-asphyxiated neonates and examine their correlation with the severity of asphyxia. STUDY DESIGN This prospective cross-sectional study was conducted on a group of asphyxiated neonates and controls. Serum LPO concentrations was measured by enzyme-linked immunosorbent assay at 4-6 h of life in all subjects. Encephalopathy was classified according to Sarnat's stages into mild, moderate and severe at 12-24 h of life. LPO was compared between groups and was correlated with severity of encephalopathy and mortality. RESULTS A total of 90 infants were enrolled; of them 45 had asphyxia. Serum LPO (nmol ml(-1)) was significantly greater in the asphyxia group (6.9±3.01 vs 1.78±1.09, P<0.001). It correlated positively with severity of encephalopathy (P<0.001) and negatively with Apgar score at 5 min (r=-0.532, P<0.001) and with initial blood gases pH (r=-0.664, P<0.001). LPO measured greater concentrations in infants who died compared with asphyxiated survivors (11.64±1.31 vs 6.18±2.48, P=0.0004). CONCLUSION LPO was increased and correlated with severity of asphyxia as well as with mortality. Further studies are warranted to examine whether it is only a marker for outcome or a contributor in the pathogenesis of hypoxic-ischemic brain injury.
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Affiliation(s)
- N Ramy
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - W Al Sharany
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - M A Mohamed
- Division of Newborn Services, The George Washington University Hospital and Children's National Medical Center, Washington, DC, USA
| | - H Madani
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt
| | - E Saleh
- Department of Pediatrics, Matareya Hospital, Cairo, Egypt
| | - H Aly
- Division of Newborn Services, The George Washington University Hospital and Children's National Medical Center, Washington, DC, USA
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Katzer D, Mueller A, Welzing L, Reutter H, Reinsberg J, Bartmann P, Bagci S. Antioxidative status and oxidative stress in the fetal circulation at birth: the effects of time of delivery and presence of labor. Early Hum Dev 2015; 91:119-24. [PMID: 25594499 DOI: 10.1016/j.earlhumdev.2014.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 12/18/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are important physiological changes in the maternal, placental, and fetal compartments during pregnancy and labor. Increased oxidative stress has been demonstrated during labor. Melatonin has been reported to serve as an indirect antioxidant via the stimulation and induction of antioxidant enzymes as superoxide dismutase (SOD) and glutathione peroxidase (Gpx) in several tissues. AIM : To assess whether the melatonin status, presence of labor at the time of birth and the time of delivery influence the extracellular antioxidative enzymes and DNA oxidative stress in newborns. METHODS The extracellular antioxidative status and oxidative stress were analyzed by measuring the concentrations of the SOD3, Gpx3 and 8-hydroxydeoxyguanosine (8-OHdG) in the cord blood of 135 newborns. Newborns delivered during the day and at night and newborns delivered by spontaneous vaginal delivery (labor group) or elective caesarean section delivery (no labor group) were studied. OUTCOME MEASURES The concentration of melatonin, SOD3, Gpx3 and 8-OHdG. RESULTS Independent of the time of delivery, we found significantly higher melatonin, SOD3 and Gpx3 but lower 8-OHdG concentrations in the labor group than in the no labor group. We did not observe a correlation between the concentration of melatonin and SOD3, Gpx3 or 8-OHdG, or a day-night difference in SOD3, Gpx3 or 8-OHdG. CONCLUSION Our findings suggest that oxidative stress during labor leads to an elevation of melatonin, SOD3 and Gpx3 in the fetal circulation, protecting the newborn from serious impairment, which is reflected by lower 8-OHdG levels. The melatonin status at the time of birth does not influence the extracellular SOD3 or Gpx3 concentrations.
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Affiliation(s)
- David Katzer
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Lars Welzing
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany; Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Jochen Reinsberg
- Department of Gynecological Endocrinology, University of Bonn, Bonn, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Soyhan Bagci
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany.
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Mutinati M, Pantaleo M, Roncetti M, Piccinno M, Rizzo A, Sciorsci RL. Oxidative stress in neonatology: a review. Reprod Domest Anim 2013; 49:7-16. [PMID: 24112309 DOI: 10.1111/rda.12230] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/30/2013] [Indexed: 11/30/2022]
Abstract
Free radicals are highly reactive oxidizing agents containing one or more unpaired electrons. Both in human and veterinary neonathology, it is generally accepted that oxidative stress functions as an important catalysator of neonatal disease. Soon after birth, many sudden physiological and environmental conditions make the newborn vulnerable for the negative effects of oxidative stress, which potentially can impair neonatal vitality. As a clinician, it is important to have in depth knowledge about factors affecting maternal/neonatal oxidative status and the cascades of events that enrol when the neonate is subjected to oxidative stress. This report aims at providing clinicians with an up-to-date review about oxidative stress in neonates across animal species. It will be emphasized which handlings and treatments that are applied during neonatal care or resuscitation can actually impose oxidative stress upon the neonate. Views and opinions about maternal and/or neonatal antioxydative therapy will be shared.
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Affiliation(s)
- M Mutinati
- Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari "Aldo Moro", Valenzano (BA), Italy
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Cocelli LP, Cekmen M, Balat O, Dikensoy E, Aksoy F, Tahtaci N. Nitric oxide and malondialdehyde levels in different delivery methods. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/016911107x268783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Yalcin S, Aydoğan H, Yuce HH, Kucuk A, Karahan MA, Vural M, Camuzcuoğlu A, Aksoy N. Effects of sevoflurane and desflurane on oxidative stress during general anesthesia for elective cesarean section. Wien Klin Wochenschr 2013; 125:467-73. [PMID: 23860695 DOI: 10.1007/s00508-013-0397-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 06/16/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anesthetic agents might considerably influence maternal-fetal oxidative stress and antioxidants during cesarean section (CS). The aim of this study was to investigate the effects of desflurane and sevoflurane on oxidative stress parameters both in mothers and newborns undergoing elective CS. MATERIALS AND METHODS Eighty ASA physical status I-II, term parturients undergoing elective CS under general anesthesia were randomized to desflurane (Group D) and sevoflurane (Group S) groups. Blood samples were collected from mothers before operation and postoperatively and umbilical artery samples were obtained at delivery. Total oxidant status (TOS), total antioxidant capacity (TAC) status, lipid hydroperoxide (LOOH), and free sulfhydryl (-SH) levels were measured and oxidative stress index was calculated. Secondary outcomes included maternal hemodynamics. RESULTS Preoperative LOOH, TOS, OSI, TAC, and -SH levels were similar among groups. Postoperative maternal serum LOOH, TOS, and OSI levels were significantly increased in Group D compared to Group S (p = 0.003, p = 0.005, p = 0.04; respectively). Postoperative umbilical artery LOOH, TOS, OSI levels were also significantly increased in Group D compared to Group S (p = 0.04, p = 0.02, p = 0.01; respectively). Postoperative TOS (p = 0.001, < 0.001 respectively) and OSI (p = 0.003, < 0.001 respectively) levels in both Group D and Group S were statistically significantly decreased compared to preoperative levels. Postoperative LOOH and -SH levels in Group S (p = 0.04, 0.029 respectively) were statistically significantly decreased compared to preoperative levels. There were no significant differences in TAC and -SH levels among groups (p = nonsignificant [n.s.]). Maternal perioperative mean blood pressure and heart rate were similar among groups (p = n.s.). CONCLUSION Oxidative stress indices might be modified with preferred anesthetic agent and sevoflurane showed more favorable effects than desflurane in view of oxidative stress.
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Affiliation(s)
- Saban Yalcin
- Department of Anesthesiology and Reanimation, Harran University Medical Faculty, Yeniğehir Yerleğkesi, 63300 Sanliurfa, Turkey.
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Watanabe K, Iwasaki A, Mori T, Kimura C, Matsushita H, Shinohara K, Wakatsuki A. Differences in levels of oxidative stress in mothers and neonate: the impact of mode of delivery. J Matern Fetal Neonatal Med 2013; 26:1649-52. [DOI: 10.3109/14767058.2013.794209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Does mode of delivery affect neonate oxidative stress in parturition? Review of literature. Arch Gynecol Obstet 2012; 287:403-6. [PMID: 23143408 DOI: 10.1007/s00404-012-2619-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 10/30/2012] [Indexed: 01/28/2023]
Abstract
PURPOSE The production of reactive oxygen substances plays an important regulatory role in many physiologic reproductive processes. Excessive production may lead to oxidative stress (OS), and bring about pregnancy disorders. Growing evidence indicates that OS plays a major role in the pathophysiology of complications such as early pregnancy loss, placental insufficiency, preeclampsia, fetal growth restriction, and neonatal complications. Whether parturition induces oxidative stress is in dispute. In this review, we elaborate the influence of mode of delivery (vaginal delivery or cesarean delivery) on oxidative stress of neonates. METHODS A review of old and recent literature was done. The studies were divided according to the impact of mode of delivery on oxidative stress in the newborn. RESULTS There is a divergence in the oxidative stress production according to the mode of delivery. CONCLUSIONS In view of neonatal oxidative stress measures, no major difference was found between uncomplicated vaginal delivery and elective cesarean section.
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Rao G, Kamath U, Raghothama C, Pradeep KS, Rao P. Maternal and fetal indicators of oxidative stress in various obstetric complications. Indian J Clin Biochem 2012; 18:80-6. [PMID: 23105396 DOI: 10.1007/bf02867371] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study demonstrates the incidence of increased lipid peroxidation and protein oxidation in both maternal and fetal erythrocytes as markers of oxygen radical activity in different complications of pregnancy. In fetuses born after premature rupture of membranes, lipid peroxidation was significantly elevated as indicated by increased malondialdehyde levels (p<0.05) as compared to controls. Proteolytic activity in the erythrocytes of mothers in this group was also significantly high (p<0.01). In patients delivered by lower segment cesarian section, lipid peroxidation and proteolytic activity in maternal erythrocytes were significantly high (p<0.05 and p<0.001 respectively). In patients with prolonged second stage of labour, lipid peroxidation and proteolytic activity in maternal erythrocytes was significantly higher than in controls (p<0.001 and p<0.05 respectively). In this group, endogenous protein damage due to oxidative stress was significantly high both in the mother and the fetus (p<0.001 and p<0.05 respectively).
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Affiliation(s)
- Guruprasad Rao
- Department of Biochemistry, International Centre for Health Sciences and Kasturba Medical College, 576 119 Manipal, Karnataka India
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Chen JX, O’Mara PW, Poole SD, Brown N, Ehinger NJ, Slaughter JC, Paria BC, Aschner JL, Reese J. Isoprostanes as physiological mediators of transition to newborn life: novel mechanisms regulating patency of the term and preterm ductus arteriosus. Pediatr Res 2012; 72:122-8. [PMID: 22565502 PMCID: PMC3586272 DOI: 10.1038/pr.2012.58] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased oxygen tension at birth regulates physiologic events that are essential to postnatal survival, but the accompanying oxidative stress may also generate isoprostanes. We hypothesized that isoprostanes regulate ductus arteriosus (DA) function during postnatal vascular transition. METHODS Isoprostanes were measured by gas chromatography-mass spectrometry. DA tone was assessed by pressure myography. Gene expression was measured by quantitative PCR. RESULTS Oxygen exposure was associated with increased 8-iso-prostaglandin (PG)F2α in newborn mouse lungs. Both 8-iso-PGE2 and 8-iso-PGF2α induced concentration-dependent constriction of the isolated term DA, which was reversed by the thromboxane A2 (TxA2) receptor antagonist SQ29548. SQ29548 pretreatment unmasked an isoprostane-induced DA dilation mediated by the EP4 PG receptor. Exposure of the preterm DA to 8-iso-PGE2 caused unexpected DA relaxation that was reversed by EP4 antagonism. In contrast, exposure to 8-iso-PGF2α caused preterm DA constriction via TxA2 receptor activation. Further investigation revealed the predominance of the TxA2 receptor at term, whereas the EP4 receptor was expressed and functionally active from mid-gestation onward. CONCLUSION This study identifies a novel physiological role for isoprostanes during postnatal vascular transition and provide evidence that oxidative stress may act on membrane lipids to produce vasoactive mediators that stimulate physiological DA closure at birth or induce pathological patency of the preterm DA.
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Affiliation(s)
- Jian-Xiong Chen
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Patrick W. O’Mara
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Stanley D. Poole
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Naoko Brown
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Noah J. Ehinger
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - James C. Slaughter
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Bibhash C. Paria
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Judy L. Aschner
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Jeff Reese
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee;,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee
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Negi R, Pande D, Kumar A, Khanna RS, Khanna HD. Evaluation of biomarkers of oxidative stress and antioxidant capacity in the cord blood of preterm low birth weight neonates. J Matern Fetal Neonatal Med 2011; 25:1338-41. [PMID: 22046974 DOI: 10.3109/14767058.2011.633672] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of the study is to investigate the association between oxidative stress markers and enzymatic / non-enzymatic antioxidants (marker of the resistance in body to oxidative damage) in the cord blood of preterm low birth weight (LBW) neonates. METHODS Malondialdehyde (MDA), carbonyl proteins, total antioxidant capacity and Vitamin A, E and C levels in the cord blood were determined by spectrophotometry. RESULTS Increased lipid peroxidation, protein oxidation with decreased values of vitamin A, E, C and total antioxidant capacity were observed in the preterm LBW newborns. Observations of negative correlation between MDA and protein carbonyl with antioxidants vitamin A, E and C and total antioxidant status points towards the existence of oxidative stress in the preterm LBW newborns. CONCLUSIONS Poor fetal growth affects the development of antioxidant defenses of preterm LBW babies, predisposing them to higher oxidative stress, which in turn may partly account for increased morbidity and mortality in these infants. The presence of an association between oxidative stress biomarkers and enzymatic /non-enzymatic antioxidants in the cord blood of preterm LBW neonates suggest that increased oxidative stress may be the result of changes in the levels of certain enzymatic and non-enzymatic antioxidants due to the cause or the effect of oxidative damage occurring at the molecular level.
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Affiliation(s)
- Reena Negi
- Department of Biophysics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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21
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Heazell AEP, Riches J, Hopkins L, Myers JE. Fetal blood sampling in early labour: is there an increased risk of operative delivery and fetal morbidity? BJOG 2011; 118:849-55. [DOI: 10.1111/j.1471-0528.2011.02922.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Mutlu B, Aksoy N, Cakir H, Celik H, Erel O. The effects of the mode of delivery on oxidative-antioxidative balance. J Matern Fetal Neonatal Med 2011; 24:1367-70. [PMID: 21247235 DOI: 10.3109/14767058.2010.548883] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of the mode of delivery on the oxidant and antioxidant systems in mothers and infants and to demonstrate which mode leads more oxidative stress. METHODS The participants were divided into two groups according to the mode of their labour and delivery: group 1 (n = 33) women with normal labour and delivery and group 2 (n = 33) with scheduled caesarean section (C/S) and delivery. The maternal, cord, and infant blood samples in both groups were collected. The serum total antioxidant capacity (TAC) and the total oxidant status (TOS) were evaluated by using an automated colorimetric measurement method. RESULTS The parameters indicating oxidative stress (TOS, oxidative stress index, and lipid hydroperoxide) in maternal, cord, and newborn blood samples were higher in patients delivering with C/S than those normal spontaneous vaginal deliveries (NSVD) patient group, while it was vice versa for TAC. CONCLUSIONS It may be concluded that both the mothers and neonates in C/S group are exposed to higher oxidative stress as compared with those in NSVD group and the antioxidant mechanisms are insufficient to cope with this stress during C/S. This result indicates that the normal delivery through the physiological route is healthier for the bodies of mothers and infants.
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Affiliation(s)
- Birgul Mutlu
- Medical Faculty, Cukurova University, Adana, Turkey.
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23
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Khaw KS, Ngan Kee WD, Chu CY, Ng FF, Tam WH, Critchley LAH, Rogers MS, Wang CC. Effects of different inspired oxygen fractions on lipid peroxidation during general anaesthesia for elective Caesarean section. Br J Anaesth 2010; 105:355-60. [PMID: 20576633 DOI: 10.1093/bja/aeq154] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During general anaesthesia (GA) for Caesarean section (CS), fetal oxygenation is increased by administering an inspired oxygen fraction (Fi(o(2))) of 1.0. However, it is unclear whether such high Fi(o(2)) will increase oxygen free radical activity. METHODS We randomized 39 ASA I-II parturients undergoing elective CS under GA to receive 30% (Gp 30), 50% (Gp 50), or 100% (Gp 100) oxygen with nitrous oxide and sevoflurane adjusted to provide equivalent minimum alveolar concentration. Baseline maternal arterial blood before preoxygenation and maternal arterial, umbilical arterial and venous blood at delivery were sampled for assays of the by-product of lipid peroxidation, isoprostane, and for measurement of blood gases and oxygen content. RESULTS Maternal and umbilical isoprostane concentrations were similar among the three groups at delivery, despite significantly increased maternal and fetal oxygenation in Gp 100. However, paired comparisons of maternal delivery vs baseline concentration of isoprostane showed an increase at delivery for all groups [Gp 30: mean 342 (sd 210) vs 154 (65) pg ml(-1), P=0.016; Gp 50: 284 (129) vs 156 (79) pg ml(-1), P=0.009; Gp 100: 332 (126) vs 158 (68) pg ml(-1), P<0.001]. The magnitude of increase was similar in all three groups and independent of the Fi(o(2)) or duration after induction. CONCLUSIONS GA for CS is associated with a marked increase in free radical activity in the mother and baby. The mechanism is unclear but it is independent of the inspired oxygen in the anaesthetic mixture. Therefore, when 100% oxygen is administered with sevoflurane for GA, fetal oxygenation can be increased, without inducing an increase in lipid peroxidation.
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Affiliation(s)
- K S Khaw
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Rook D, Te Braake FWJ, Schierbeek H, Longini M, Buonocore G, Van Goudoever JB. Glutathione synthesis rates in early postnatal life. Pediatr Res 2010; 67:407-11. [PMID: 20057337 DOI: 10.1203/pdr.0b013e3181d22cf6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Preterm infants have diminished antioxidant defenses. Glutathione (GSH), the main intracellular antioxidant, increases upon amino acid (AA) administration in preterm infants, without an accompanying rise of the fractional synthesis rate of GSH (FSRGSH) This study investigated the mechanism behind this increased GSH concentration by determining GSH synthesis in the first days after birth using stable isotope techniques in very low-birth-weight (VLBW) infants receiving i.v. AAs. Advanced oxidized protein products (AOPPs) were determined to quantify oxidative stress. Eighteen infants (birth weight 989 +/- 241 g, gestational age of 27/7 +/- 1/7 weeks) were studied either on postnatal day 1 or 2 (7 or 31 h postnatally, respectively). Concentration of GSH increased with postnatal age (1.45 +/- 0.48 mM versus 1.99 +/- 0.40 mM, p = 0.019). FSRGSH was not significantly different, but the absolute synthesis rate of GSH (ASRGSH) tended to be higher in the infants studied on day 2 [8.1 +/- 2.7 mg/(kg . d) versus 10.6 +/- 2.4 mg/(kg . d), p = 0.054]. AOPP concentrations were not different between groups. In conclusion, GSH concentration in VLBW infants increases significantly after birth. A concomitant increased synthesis rate was not found, suggesting that GSH consumption decreases upon AA administration.
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Affiliation(s)
- Denise Rook
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, 3015 GJ Rotterdam, The Netherlands
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25
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Lipid peroxidation and biochemical parameters in maternal pre-delivery and post-delivery plasma. Biologia (Bratisl) 2010. [DOI: 10.2478/s11756-009-0223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vakilian K, Ranjbar A, Zarganjfard A, Mortazavi M, Vosough-Ghanbari S, Mashaiee S, Abdollahi M. On the relation of oxidative stress in delivery mode in pregnant women; a toxicological concern. Toxicol Mech Methods 2009; 19:94-9. [PMID: 19778252 DOI: 10.1080/15376510802232134] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The objective was to investigate the effect two modes of labor (vaginal delivery and elective cesarean section) on thiobarbituric reactive substances (TBARS) as markers of lipid peroxidation, total antioxidant power (ferric reducing ability, TAP), and total thiol molecules (TTM) in blood of mothers and their newborns. One hundred and twenty women with normal pregnancy and normal blood biochemical parameters were divided into groups of vaginal delivery (VD) and elective cesarean surgery (ECS). Blood samples were obtained firstly in the time 37-40 weeks of pregnancy and secondly during labor phase for VD or during ECS. Blood samples from umbilical cord arterial of newborns were also obtained at birth after separation of cord. Plasma levels of TBARS, TAP, and TTM were determined. There was no significant differences between VD and ECS mothers before labor in plasma levels of TBARS, TTM, and TAP. Mothers in the VD group showed a significant increase in TBARS (p < 0.05) after delivery. And TTM level showed a significant increase in ECS group (p < 0.05) as compared to pre-delivery levels. Comparing oxidative stress variables between VD and ECS groups after labor, plasma levels of TBARS, and TTM significantly increased (p < 0.05) in VD mothers. TAP was not significantly different between VD and ECS groups. Newborn of VD mothers showed a significant increase in TBARS (p < 0.05), and TAP (p < 0.05) as compared to newborn of ECS. TTM was not significantly different between two groups of newborns. The results indicate that mothers in VD and their newborns are in more oxidative stress than those who underwent ECS for delivery. Linking oxidative stress to severe neonatal diseases, it may be reasonable to assess whether antioxidant supplementation during pregnancy may reduce the frequency of neonatal diseases.
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Affiliation(s)
- Katayun Vakilian
- School of Paramedical Sciences, Arak University of Medical Sciences, Arak, Iran
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27
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Khan RN, Matharoo-Ball B, Shaw RW. Antioxidant enzyme expression, lipid peroxidation, and protein oxidation in human myometrium with parturition. Reprod Sci 2009; 17:78-84. [PMID: 19801538 DOI: 10.1177/1933719109348027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oxygen levels fluctuate considerably during human labor leading to hypoxia and reoxygenation of the uteroplacental unit and in some cases may compromise the progression of labor. Our aim was to assess the possible contribution of oxidative stress to the onset of labor. Thiobarbituric acid was used as a marker of lipid peroxidation along with Western blotting using anti-dinitrophenylhydrazine (DNPH) to assess protein carbonylation in myometrial samples obtained before and after the onset of term and preterm labor. Levels of key antioxidative enzymes were also compared. Higher levels of lipid peroxidation were observed in myometrial samples obtained during term or preterm labor. Reduced levels of glutathione peroxidase (GSHPx) were also encountered in these 2 groups. Conversely, protein carbonyl content was higher in laboring term and preterm myometrial samples. Levels of catalase (CAT) and superoxide dismutase (SOD) were unaltered across all 4 groups. Lipids in the laboring myometrium are susceptible to oxidative injury possibly due to diminished protection as a result of lower GSHPx activity. The reason for enhanced protein carbonylation suggests differential mechanisms governing protein turnover in the pregnant compared with the parturient uterus. Localized, oxidant damage of human myometrium may be a causal factor in difficult deliveries.
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Affiliation(s)
- Raheela N Khan
- Academic Division of Obstetrics and Gynaecology, University of Nottingham, The Medical School Academic Division of Obstetrics and Gynaecology, Derby City General Hospital, University of Nottingham, Derby DE22 3DT, United Kingdom.
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28
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Onan A, Kurdoglu M, Sancak B, Bukan N, Yildirim M. Lipid peroxidation in nuchal cord cases: implication for fetal distress. J Matern Fetal Neonatal Med 2009; 22:254-8. [PMID: 19089774 DOI: 10.1080/14767050802556034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine whether nuchal cord affects fetal lipid peroxidation and cord arterial blood gases, and thus to determine whether lipid peroxidation can show intrapartum distress. METHODS Pregnant women giving birth to a baby with nuchal cord (n = 32) formed the study group and others without this condition made up the control group (n = 36). The maternal malondialdehyde levels (MDA) before and after delivery as well as fetal umbilical cord MDA and arterial blood gases were measured in both the groups. RESULTS Mean cord MDA level was higher in the study group (p < 0.02) and was significantly higher than maternal MDA level after birth within the same group (p = 0.007). Cord blood gases as well as neonatal and labour characteristics showed no difference, except for variable decelerations, which were 2.2 times more common in the study group. Correlations between maternal MDA levels before and after delivery, umbilical cord MDA and arterial blood gases were non-significant in the nuchal cord group. CONCLUSIONS During delivery, nuchal cord increases lipid peroxidation without causing significant fetal acidemia. Level of lipid peroxidation may be a more sensitive indicator of intrapartum distress than results of acid-base studies.
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Affiliation(s)
- Anil Onan
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
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29
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Lipid peroxidation and biochemical parameters in umbilical cord blood of well-adapted term newborns. Biologia (Bratisl) 2009. [DOI: 10.2478/s11756-009-0055-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Khaw KS, Wang CC, Ngan Kee WD, Tam WH, Ng FF, Critchley LAH, Rogers MS. Supplementary oxygen for emergency Caesarean section under regional anaesthesia. Br J Anaesth 2008; 102:90-6. [PMID: 19011261 DOI: 10.1093/bja/aen321] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Controversy still exists if the administration of supplementary oxygen to patients having emergency Caesarean section (CS) under regional anaesthesia is beneficial or potentially harmful. Therefore, in a prospective double-blinded study, we randomized patients having emergency CS under regional anaesthesia to receive either air or 60% oxygen until delivery and compared the effects on fetal oxygenation and lipid-peroxidation in the mother and baby. METHODS We recruited 131 women having emergency CS under regional anaesthesia. Either 21% (air group) or 60% oxygen (oxygen group) was administered using a Venturi-type facemask until delivery. We compared the oxygen exposure duration, umbilical arterial (UA) and venous (UV) blood gases and oxygen content, and plasma concentration of 8-isoprostane. Subanalysis was performed according to whether or not fetal compromise was considered present. RESULTS Data from 125 patients were analysed. For the oxygen group vs the air group, there were greater values for UA PO(2) [mean 2.2 (SD 0.5) vs 1.9 (0.6) kPa, P=0.01], UA O(2) content [6.6 (2.5) vs 4.9 (2.8) ml dl(-1), P=0.006], UV PO(2) [3.8 (0.8) vs 3.2 (0.8) kPa, P<0.0001], and UV O(2) content [12.9 (3.5) vs 10.4 (3.8) ml dl(-1), P=0.001]. There was no difference between the groups in maternal, UA, or UV 8-isoprostane concentration. Apgar scores and UA pH were similar between the groups. Similar changes were observed regardless of whether fetal compromise was considered present (n=37) or not (n=88). CONCLUSIONS Breathing 60% oxygen during emergency CS under regional anaesthesia increased fetal oxygenation with no associated increase in lipid-peroxidation in the mother or fetus.
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Affiliation(s)
- K S Khaw
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
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Cord blood ischemia-modified albumin levels in normal and intrauterine growth restricted pregnancies. Mediators Inflamm 2008; 2008:523081. [PMID: 18483569 PMCID: PMC2375971 DOI: 10.1155/2008/523081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Revised: 02/25/2008] [Accepted: 04/07/2008] [Indexed: 11/17/2022] Open
Abstract
Ischemia-modified albumin (IMA) is a sensitive biomarker of cardiac
ischemia. Intrauterine growth restriction (IUGR) may imply fetal hypoxia,
resulting in blood flow centralization in favour of vital organs (brain, heart,
adrenals—“brain sparing effect”). Based on the latter, we
hypothesized that cord blood IMA levels should not differ between IUGR and
appropriate-for-gestational-age (AGA) full-term pregnancies. IMA was measured
in blood samples from doubly-clamped umbilical cords of 110 AGA and 57
asymmetric IUGR pregnancies. No significant differences in IMA levels
were documented between AGA and IUGR groups. IMA levels were elevated in
cases of elective cesarean section (P = .035), and offspring of
multigravidas (P = .021). In conclusion, “brain
sparing effect” is possibly responsible for the lack of differences in
cord blood IMA levels at term, between IUGR and AGA groups. Furthermore, higher
oxidative stress could account for the elevated IMA levels in cases of elective
cesarean section, and offspring of multigravidas.
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Advantages of human umbilical vein scaffolds derived from cesarean section vs. vaginal delivery for vascular tissue engineering. Biomaterials 2008; 29:1075-84. [DOI: 10.1016/j.biomaterials.2007.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 11/06/2007] [Indexed: 11/20/2022]
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Kumar A, Panigrahi I, Basu S, Dash D. Urinary malondialdehyde levels in newborns following delivery room resuscitation. Neonatology 2008; 94:96-9. [PMID: 18277056 DOI: 10.1159/000116633] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 11/19/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delivery room resuscitation (DRR) is a common emergency in newborns, particularly in resource-poor settings where intrapartum monitoring is not readily available. It may give rise to oxidative stress in neonates due to reoxygenation and reperfusion of previously hypoxic and ischemic tissues. Urinary malondialdehyde (MDA), being non-invasive, may serve as a marker of oxidative stress in these infants. OBJECTIVE We assessed oxidative stress in term newborns requiring DRR by measuring MDA levels in urine and serum samples collected at 12-24 h of age. METHODS The study population consisted of 41 cases and 63 healthy age-matched control infants. The inclusion criterion was a need for positive pressure ventilation at birth for >1 min. MDA levels were measured colorimetrically by thiobarbituric acid reaction. RESULTS Urinary and serum MDA levels were found to be significantly higher in cases than in controls. Of the neonates given DRR, urinary and serum MDA values were elevated in those infants who passed meconium in utero, developed hypoxic ischemic encephalopathy or expired than in those who did not have these complications, but the difference was not significant. We found a significant correlation between urinary and serum MDA levels in infants given DRR. CONCLUSION Newborns requiring DRR are subjected to significant oxidative stress which can be easily assessed by measuring urinary MDA levels.
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Affiliation(s)
- Ashok Kumar
- Division of Neonatology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Koklu E, Akcakus M, Narin F, Saraymen R. The relationship between birth weight, oxidative stress and bone mineral status in newborn infants. J Paediatr Child Health 2007; 43:667-72. [PMID: 17854450 DOI: 10.1111/j.1440-1754.2007.01184.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It was shown that oxygen-derived free radicals, and particularly the superoxide anion, are intermediaries in the formation and activation of osteoclasts. Many antioxidant defence systems depend on micronutrients or are micronutrients themselves. Oxidative stress might be related to bone indices in newborn infants. AIM To assess the relationship between oxidative status and bone indices in small-for-gestational-age (SGA), large-for-gestational-age (LGA) and appropriate-for-gestational-age (AGA) babies born to healthy mothers. METHODS Umbilical cord venous blood samples were obtained at the delivery from 100 term newborn infants to measure plasma malondialdhyde, superoxide dismutase (SOD) and myeloperoxidase concentrations. Forty of the newborn infants had birth weights AGA, 30 were SGA and 30 LGA. Data were acquired using the whole body dual-energy X-ray absorptiometry scanner in the first 24 h after birth. RESULTS Plasma malondialdhyde and SOD concentrations of the mothers and their newborn infants were positively correlated; however, plasma myeloperoxidase concentrations were not. SOD concentrations of SGA infants were significantly higher than those of AGA and LGA infants. Whole body bone mineral density and content were lower in SGA but higher in LGA babies than in AGA babies. Oxidative stress status of both infants and their mothers was not related to the bone indices. CONCLUSION Our study does not provide support for the hypothesis that oxidative status of the infants and mothers may play a major role in the regulation of bone metabolism in the developing skeleton.
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Affiliation(s)
- Esad Koklu
- Division of Neonatology, Department of Paediatrics, Department of Biochemistry School of Medicine, Erciyes University, 38039 Kayseri, Turkey.
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Khaw KS, Ngan Kee WD. Fetal effects of maternal supplementary oxygen during Caesarean section. Curr Opin Anaesthesiol 2007; 17:309-13. [PMID: 17021570 DOI: 10.1097/01.aco.0000137089.37484.5e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarises the current issues, knowledge and research on the effects of maternal supplementary oxygen therapy on the fetus during Caesarean section. This is a controversial subject since supplementary oxygen has the potential to confer both benefits and also harm to the fetus, depending on the circumstances. RECENT FINDINGS For elective Caesarean section, breathing room air under regional anaesthesia or 30% oxygen under general anaesthesia is not associated with either maternal or fetal hypoxia. A prolonged uterine-incision-to-delivery (U-D) interval of up to 310 s is not a major factor per se for development of fetal hypoxia or acidosis, and no benefits could be derived from breathing supplementary oxygen in this situation. Although it appears rational to provide supplementary oxygen in the presence of a hypoxic or compromised fetus, to achieve meaningful increases in fetal oxygenation, a very high inspired oxygen fraction (FiO2) is required. However, it still remains unclear whether this is beneficial for the fetus. The process of damage to the hypoxic fetus is one of oxidative stress mediated by free radicals generated during reperfusion (ischaemia-reperfusion injury). Independently, hyperoxia from breathing supplementary oxygen also induces formation of free radicals by direct mitochondrial electron transfer. Although hyperoxia could lessen the severity of fetal hypoxia, there is also a theoretical risk of an enhanced reperfusion injury. This issue has not been resolved in a clinical study, but an animal study reported enhanced formation of free radicals after an episode of fetal hypoxia in the group receiving supplementary oxygen. SUMMARY For elective Caesarean section, current evidence suggests that supplementary oxygen is unnecessary. For emergency Caesarean section, further data are required before a conclusion can be made for its beneficial and adverse effects. Improvement of fetal oxygenation should be the primary objective, and this is achievable in the short term by using a very high FiO2. Although there is also a possibility of an enhanced reperfusion injury, particularly in the preterm and non-labouring patients, further data are necessary before a conclusion can be made.
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Affiliation(s)
- Kim S Khaw
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
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Paamoni-Keren O, Silberstein T, Burg A, Raz I, Mazor M, Saphier O, Weintraub AY. Oxidative stress as determined by glutathione (GSH) concentrations in venous cord blood in elective cesarean delivery versus uncomplicated vaginal delivery. Arch Gynecol Obstet 2007; 276:43-6. [PMID: 17333227 DOI: 10.1007/s00404-006-0304-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether neonates are subject to oxidative stress by the labor process and the mode of delivery by measuring glutathione (GSH) concentrations in umbilical cord venous blood. STUDY DESIGN Forty-eight women with singleton term pregnancies were prospectively recruited and classified as follows: 26 women had a spontaneous uncomplicated vaginal delivery (VD), and 22 women had an elective cesarean delivery (CD). GSH concentration in umbilical venous blood samples was determined by a spectroscopic method. RESULTS Umbilical cord venous blood GSH levels were significantly lower in the elective CD group than in the VD group (2.2 and 2.7 mM, respectively, P = 0.0003). There was a significantly negative correlation between cord blood pO(2) and GSH levels; however, the negative correlation was significantly higher in the elective CD group (P < 0.05). CONCLUSION Neonates delivered by CD were exposed to a higher oxidative stress as determined by GSH levels compared to those who had an uncomplicated VD.
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Affiliation(s)
- Orit Paamoni-Keren
- Department of Obstetrics and Gynecology, Soroka University Medical center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Herse F, Dechend R, Harsem NK, Wallukat G, Janke J, Qadri F, Hering L, Muller DN, Luft FC, Staff AC. Dysregulation of the circulating and tissue-based renin-angiotensin system in preeclampsia. Hypertension 2007; 49:604-11. [PMID: 17261642 DOI: 10.1161/01.hyp.0000257797.49289.71] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The renin-angiotensin system (RAS) participates in preeclampsia; however, the relative contributions from the circulating RAS and the tissue-based, uteroplacental RAS are unknown. We hypothesized that the tissue-based uteroplacental RAS is dysregulated in preeclampsia. We performed microarray and gene expression studies and confirmed the findings on the protein level by immunohistochemistry in ureteroplacental units from 10 preeclamptic women and 10 women with uneventful pregnancies. All of the women were delivered by cesarean section. We also analyzed plasma renin activity and circulating agonistic angiotensin II type 1 (AT1) receptor autoantibodies. In preeclampsia, we found that the angiotensin II AT1 receptor gene was 5-fold upregulated in decidua (maternal origin). We also found AT1 autoantibodies in preeclamptic women and in their offspring by neonatal cardiomyocyte bioassay compared with women with normal pregnancies and their infants (mother: 17.5+/-2.2 versus 0.05+/-0.4; fetus: 14.5+/-1.8 versus 0.5+/-0.5 Deltabpm). Gene expressions for renin (35.0-fold), angiotensin-converting enzyme (2.9-fold), and angiotensinogen (8.9-fold) were higher in decidua than placenta (fetal origin) in both control and preeclamptic women, whereas the AT1 receptor was expressed 10-fold higher in placenta than in decidua in both groups. Our findings elucidate the ureteroplacental unit RAS in preeclamptic and normal pregnancies. We found that, in preeclampsia, the AT1 receptor expression is particularly high in decidua, combined with pregnancy-specific tissue RAS involving decidual angiotensin II production and AT1 autoantibodies. We also showed that AT1 autoantibodies cross the ureteroplacental barrier. These components could participate in the pathophysiology of preeclampsia.
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Affiliation(s)
- Florian Herse
- Medical Faculty of the Charité, Franz-Volhard Clinic, HELIOS Klinikum, Berlin, Germany
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Lurie S, Matas Z, Boaz M, Fux A, Golan A, Sadan O. Different degrees of fetal oxidative stress in elective and emergent cesarean section. Neonatology 2007; 92:111-5. [PMID: 17377411 DOI: 10.1159/000100965] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 11/15/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several studies have addressed the influence of labor and mode of delivery on oxidative stress. Still it is unclear whether oxidative stress is related to delivery itself or whether it reflects a pre-existing fetal oxidative status. OBJECTIVE To investigate whether the degree of fetal oxidative stress is different between distressed fetuses that were delivered by emergent cesarean section and non-distressed fetuses that were delivered by elective cesarean section. METHODS The protocol of this prospective study was approved by the Institutional Review Board Committee. Amniotic fluid and umbilical artery blood were prospectively collected from 21 parturients who were delivered by an emergent cesarean section for non-reassuring fetal heart rate pattern and from 21 parturients who were delivered by an elective cesarean section in a tertiary care center. Oxidative stress was evaluated in amniotic fluid, umbilical cord plasma and erythrocytes by determining malondialdehyde concentration and glutathione peroxidase (GPX) activity. RESULTS Malondialdehyde concentration was higher in amniotic fluid (mean +/- SEM) (2.2 +/- 0.7 nmol/l vs. 0.6 +/- 0.02 nmol/l, p < 0.05), in umbilical cord plasma (1.2 +/- 0.2 nmol/l vs. 0.7 +/- 0.3 nmol/l, p < 0.05) and in umbilical cord erythrocytes (159.6 +/- 48.6 nmol/g Hb vs. 85.8 +/- 5.2 nmol/g Hb, p < 0.05) in women delivering by emergent cesarean compared to those delivering by elective cesarean. GPX activity was enhanced in amniotic fluid (12.4 +/- 2.2 U/l vs. 5.1 +/- 0.6 U/l, p < 0.05) and GPX activity/hemoglobin ratio was higher in cord blood (22.0 +/- 0.8 U/g Hb vs. 18.7 +/- 0.9 U/g Hb, p < 0.05) in women delivering by emergent cesarean compared to those delivering by elective cesarean. CONCLUSION Distressed fetuses delivered by emergency cesarean exhibited increased malondialdehyde concentrations, an indicative parameter for oxidative damage, and enhanced GPX activity an antioxidant enzyme, in amniotic fluid and umbilical cord blood compared to non-distressed fetuses delivered by elective cesarean section. This is probably an indication of higher fetal oxidative stress.
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Affiliation(s)
- Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
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Zitnanová I, Sumegová K, Simko M, Maruniaková A, Chovanová Z, Chavko M, Duracková Z. Protein carbonyls as a biomarker of foetal-neonatal hypoxic stress. Clin Biochem 2006; 40:567-70. [PMID: 17321511 DOI: 10.1016/j.clinbiochem.2006.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 09/29/2006] [Accepted: 10/30/2006] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Investigation of the effect of hypoxic conditions during labour on the protein oxidative modifications and changes in plasma antioxidative capacity of newborns. DESIGN AND METHODS Oxidative damage to proteins was determined by high-performance liquid chromatography. Antioxidative status was monitored by Trolox equivalent antioxidant capacity method. In our study, 11 hypoxic and 19 normoxic newborns were involved. RESULTS In hypoxic newborns, we have found a significant increase in protein carbonyl levels (3.55+/-0.86 versus 3.24+/-0.69 mol carbonyls/mol proteins, p=0.045) and plasma antioxidant capacity (1.76+/-0.056 versus 1.68+/-0.097 mmol Trolox/L, p=0.004) when compared to normoxic children. Bilirubin levels were unchanged (p=0.87). CONCLUSION Our results show elevated levels of carbonyls in hypoxic neonates compared to normoxic children. The oxidative damage to proteins is not sufficiently prevented by increased antioxidant capacity detected in plasma of hypoxic newborns.
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Affiliation(s)
- Ingrid Zitnanová
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinkova 2, Bratislava, Slovak Republic
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Abstract
Preeclampsia is associated with oxidative stress in maternal circulation. The purpose of this study was to explore oxidative stress and antioxidants in the fetal circulation in preeclampsia. Women with preeclampsia (n = 19) or uncomplicated pregnancies (n = 33) delivered by cesarean section were included. Blood was sampled separately from the umbilical vein and artery. 8-Iso-prostaglandin F(2alpha) (8-isoprostane), a stable product of lipid peroxidation, is a reliable marker of oxidative stress. Concentration of total 8-isoprostane in cord plasma was analyzed by gas chromatography-mass spectrometry. Antioxidant status was evaluated measuring ferric reducing ability of plasma and vitamin E. There was no difference between preeclampsia and control groups regarding median plasma concentration of 8-isoprostane in umbilical vein (955 versus 780 pg/mL, p = 0.41) or in umbilical artery (233 versus 276 pg/mL, p = 0.65). Concentration of 8-isoprostane was much higher in plasma from the umbilical vein than artery, suggesting placenta as the source of 8-isoprostane. Median ferric reducing ability of plasma concentration was higher in preeclampsia than in controls, both in the umbilical vein and artery. Median vitamin E concentration in the umbilical vein was higher in preeclampsia, but no difference was found in the umbilical artery. In conclusion, no evidence of increased oxidative stress, evaluated by 8-isoprostane concentration, was found in fetal circulation in preeclampsia.
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Affiliation(s)
- Kristin Braekke
- Department of Pediatric Intensive Care, Ulleval University Hospital, 0407 Oslo, Norway.
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Dittrich R, Hoffmann I, Stahl P, Müller A, Beckmann MW, Pischetsrieder M. Concentrations of Nepsilon-carboxymethyllysine in human breast milk, infant formulas, and urine of infants. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2006; 54:6924-8. [PMID: 16939359 DOI: 10.1021/jf060905h] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Maillard products, such as Nepsilon-carboxymethyllysine (CML), are readily formed during the manufacturing of infant formulas. Little has been known, however, about the presence of CML in human breast milk and about the uptake of CML by infants. In this study, CML was measured in the serum and breast milk of 32 healthy mothers by ELISA. CML concentrations in breast milk (137 +/- 82.7 ng/mL) were significantly lower than in the serum (399 +/- 67.8 ng/mL, p < 0.001) and on average 35-fold lower than in infant formulas (4754 +/- 4299.5 ng/mL). CML was also measured in the urine of 21 infants, which were fed with breast milk or formulas. Although there was a tendency toward higher urinary CML excretion in infants fed with hypoallergenic formulas compared to breast-fed ones, the differences were not significant. Neonates that were delivered by vaginal birth had significantly higher concentrations of CML compared to those delivered by caesarean section (1306 +/- 653 vs 601 +/- 220 ng/mL, p = 0.012). It is concluded that CML passes from the serum into the breast milk, but the levels are by far lower than in infant formulas. In very young neonates (< or =3 days), the mode of delivery has a greater influence on urinary CML excretion than the nutrition.
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Affiliation(s)
- Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, University of Erlangen-Nuremberg, Universitaetsstrasse 21-23, D-91054 Erlangen, Germany
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Wang X, Sun Z, Qian L, Guo C, Yu W, Wang W, Lu KW, Taeusch HW, Sun B. Effects of Hyaluronan-Fortified Surfactant in Ventilated Premature Piglets with Respiratory Distress. Neonatology 2006; 89:15-24. [PMID: 16155382 DOI: 10.1159/000088194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 04/18/2005] [Indexed: 11/19/2022]
Abstract
We hypothesized that enriching surfactant with hyaluronan would restore lung function when tested in a premature animal model. Newborn piglets (85% gestation, term 112-114 days) were delivered by cesarean section, subjected to mechanical ventilation (tidal volume 6- 8 ml/kg) and randomly assigned to treatment with 50 or 100 mg/kg Curosurf (C50 and C100), 50 or 100 mg/kg Curosurf mixed with 2.5% HA (w/w, CH50 and CH100). A ventilated and not treated group (Cont) and a not treated and not ventilated group (Non) were included as controls. Six hours after treatment the lungs were removed and biochemical, biophysical, cytological and histological analyses were carried out. The CH100, CH50, C100 and C50 groups had variable but significantly improved alveolar phospholipid content, minimal surface tension, alveolar aeration and wet/dry lung weight ratios, but little histological evidence of lung injury. CH100, CH50 and C100 groups had the best effects in terms of oxygenation, lung compliance and histology and evidence of decreased inflammation (IL-8 and TNF-alpha mRNA expression). We conclude that HA added to 50 mg/kg Curosurf or use of 100 mg/kg Curosurf with or without HA provides the best effects in terms of lung function and reduction of inflammation.
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Affiliation(s)
- Xiaoning Wang
- Laboratory of Pediatric Respiratory and Intensive Care Medicine, Children's Hospital of Fudan University, Shanghai, PR China
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Abstract
BACKGROUND Oxidative stress may play an important role in the pathophysiology of preeclampsia. An increase in lipid peroxidation products and a decrease in antioxidant activity in preeclamptic women have been reported in many papers. The objective of this study was to evaluate oxidative stress in infants born to preeclamptic mothers. METHODS Malondialdehyde (MDA) and glutathione (GSH) levels and glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were measured in cord plasma of infants born to preeclamptic (n = 18) or normotensive (n = 9) mothers. RESULTS Gestational age was similar in both groups. The mean birth weight was significantly lower in the preeclamptic group (P = 0.007). Maternal age, primigravidity, antenatal steroid use, premature rupture of the membranes, clinical chorioamnionitis and adverse neonatal outcomes including sepsis, respiratory distress syndrome and neonatal mortality did not differ between groups. Cesarean delivery was significantly higher in the preeclamptic group. There was no significant difference in cord plasma levels of MDA and GSH, and activity of GPx between the preeclamptic and control groups. SOD was found to be increased in preeclamptic group (P = 0.03). CONCLUSIONS We concluded that although cord plasma MDA levels were similar in both the preeclamptic and control groups, increased SOD activity might be an indicator of increased oxidative stress in infants born to preeclamptic mothers.
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Affiliation(s)
- Ayhan Tastekin
- Division of Neonatology, Atatürk University Faculty of Medicine, Erzurum, Turkey.
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Rogers MS, Wang CC, Lau TK, Xiao X, Zhou XG, Fok TF, Chu KO, Pang CP. Relationship between Isoprostane Concentrations, Metabolic Acidosis, and Morbid Neonatal Outcome. Clin Chem 2005; 51:1271-4. [PMID: 15976110 DOI: 10.1373/clinchem.2004.047241] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael Scott Rogers
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Fogel I, Pinchuk I, Kupferminc MJ, Lichtenberg D, Fainaru O. Oxidative stress in the fetal circulation does not depend on mode of delivery. Am J Obstet Gynecol 2005; 193:241-6. [PMID: 16021086 DOI: 10.1016/j.ajog.2004.10.637] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We tested whether neonates are subject to oxidative stress by comparing the susceptibility of umbilical blood lipids with copper-induced peroxidation. STUDY DESIGN Umbilical arterial and venous blood samples were drawn from 32 pregnant women who delivered by elective cesarean section (CS) and from 32 pregnant women who delivered by spontaneous vaginal delivery (SVD) in a tertiary care center. Oxidative stress was evaluated by spectrophotometric monitoring of copper-induced peroxidation of serum samples. RESULTS The lag preceding lipid peroxidation in umbilical arterial blood was shorter than the lag in umbilical venous blood, irrespective of mode of delivery (14.0+/-1.8 vs 50.6+/-8.25 min, P=.0004 in SVD group; 17.7+/-1.6 vs 39.2+/-7.6 min, P=.006 in CS group). CONCLUSION Umbilical arterial lipids are more susceptible to peroxidation than umbilical venous lipids, indicating high oxidative stress in the fetal circulation irrespective of mode of delivery.
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Affiliation(s)
- Itay Fogel
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, and Department of Obstetrics and Gynecology, Lis Maternity Hospital, Israel
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Sajjad Y, Leonard M, Doyle M. Antioxidant levels in the cord blood of term fetus. J OBSTET GYNAECOL 2005; 20:468-71. [PMID: 15512628 DOI: 10.1080/014436100434613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare the differences in the total antioxidant levels in the cord blood after a normal vaginal delivery and after an elective caesarean section. This was a prospective study approved by the Wirral Hospital ethical research committee. The study was carried out in a district general hospital. We investigated 96 healthy pregnant women who had normal antenatal period with singleton pregnancies between 37 and 42 completed weeks of gestation. Sixty-five women had a spontaneous normal vaginal delivery and 31 underwent elective caesarean section. Umbilical cord blood was obtained immediately after delivery. Antioxidants such as glutathione peroxidase (GPX) and superoxide dismutase (SOD) were measured and compared between the normal vaginal delivery and elective ceasarean sections. The mean values for GPx in umbilical cord arterial blood (95; 86-103, n=74) was found to be significantly higher (P=0.0133) than that found in umbilical cord venous blood (84; 80-88, n=95). The arterial SOD values were found to be significantly higher (P=0.0337) in infants who had been delivered by caesarean section (1188; 1065-1311, n=22) than by vaginal delivery (1021;958-1083, n=39). The differences in the levels of GPX between the arterial and venous systems is not well documented but may be due to differences in the level of selenium, hydroperoxides or glutathione. In addition, why infants delivered by ceasarian section have a higher level of arterial SOD than those delivered by vaginal delivery remains unclear, but it may be a reflection of a relatively low level in infants subjected to the stress of labour.
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Abstract
We hypothesized that early infancy would be a time of oxidative stress due to the difficulty of adapting to ambient oxygen. Therefore, we measured levels of products of lipid peroxidation (F2-isoprostanes), antioxidant enzyme activity (catalase (CAT) and superoxide dismutase (SOD)), and ability to resist oxidative stress (ferric reducing ability of plasma (FRAP)) in full-term infants (38-42 wk) fed human milk from birth. Seventy-seven infants were followed at 1, 3.5, 6, and 12 mo of age. F2-isoprostanes in plasma declined significantly (p < 0.05) from 1 to 6 mo (160 +/- 43; 90 +/- 33; 41 +/- 27 pg/mL (mean +/- SD)). FRAP values (775 +/- 196, 723 +/- 133, 697 +/- 126, 669 +/- 145 microM) 1, 3.5, 6, and 12, respectively) declined (p = 0.06) from 1 to 3.5 mo and from 3.5 to 6 mo of age. RBC-SOD (2.7 +/- 2, 3.2 +/- 2.8, 2.1 +/- 1.8, 2.5 +/- 1.8 U, 1, 3.5, 6, 12 mo, respectively) declined from 3.5 to 6 mo. RBC-CAT (76 +/- 23, 94 +/- 28, 81 +/- 22, 85 +/- 31 U, 1, 3.5, 6, 12 mo, respectively) also declined between 3.5 and 6 mo, after a significant increase between 1 and 3.5 mo. These data suggest that the human infant is under oxidative stress early in infancy and further study may be warranted to assess the potential benefits of antioxidant supplementation for either the mother or the infant.
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Affiliation(s)
- James K Friel
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada R3T 2N2.
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Abstract
Free radicals derived from molecular oxygen and nitrogen are highly reactive metabolites called reactive oxygen species (ROS). Cells continuously produce free radicals and ROS as part of the metabolic process. They are involved in the various functions of the reproductive system. Antioxidants are enzymes or compounds that scavenge and reduce the presence of free radicals. Normally, a balance exists between concentrations of reactive oxygen species and antioxidant scavenging systems. The disruption of the delicate balance between pro- and antioxidants results in oxidative stress. Oxidative stress has been implicated in embryo fragmentation, DNA damage, apoptosis and poor pregnancy outcome. It has also been implicated in a large number of gynecologic diseases, such as endometriosis, pre-eclampsia and maternal diabetes. The use of antioxidants may be beneficial in combating the harmful effects of oxidative stress in many of these diseases. The present review outlines the importance of these species in the pathology of various gynecologic diseases. (Reprod Med Biol 2004; 3: 177 - 199).
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Affiliation(s)
- Rakesh K Sharma
- Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Glickman Urological Institute and Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ashok Agarwal
- Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Glickman Urological Institute and Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Mocatta TJ, Winterbourn CC, Inder TE, Darlow BA. The effect of gestational age and labour on markers of lipid and protein oxidation in cord plasma. Free Radic Res 2004; 38:185-91. [PMID: 15104212 DOI: 10.1080/10715760310001646048] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There are many potential sources of reactive oxidants around the time of birth and pre-term infants are considered to be particularly vulnerable to oxidative injury. To gain insight into these processes, we have measured biomarkers of lipid and protein oxidation in umbilical cord plasma and related concentrations to mode of delivery and gestational age. Protein carbonyls were measured by ELISA and malondialdehyde (MDA) by HPLC after reaction with thiobarbituric acid, for 54 pre-term (< or = 36 weeks gestational age) and 43 term infants. Protein carbonyls were significantly lower in pre-term (median for < 32 weeks gestational age 0.048nmol/mg protein) than in term infants (0.105 nmol/mg, p = 0.004), and were unrelated to mode of delivery. In contrast, MDA concentrations were higher in the very pre-term (<32 weeks gestation) group (2.47 compared with 1.83 microM for term infants, p < 0.0001). MDA concentrations were higher in infants who were born with labour compared with elective caesarean section. Pre-eclampsia in the mother was associated with higher cord blood MDA concentrations. The MDA results are consistent with other studies of this marker and could be interpreted as indicating increased oxidative stress associated with prematurity and labour. However, the lower protein carbonyls in pre-term infants would lead to an opposite interpretation. More information is needed on the source and fate of these and other biomarkers before drawing strong conclusions on how they reflect oxidative stress in this and other clinical situations.
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Affiliation(s)
- Tessa J Mocatta
- Department of Pathology, Christchurch School of Medicine and Health Sciences, P.O. Box 4345, Christchurch, New Zealand
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Luykx LM, Berger HM, Geerdink J, Kanhai HHH, Egberts J. Non-protein-bound iron and free radical damage in fetuses with rhesus haemolytic disease: influence of intrauterine transfusions. BJOG 2004; 111:303-10. [PMID: 15008763 DOI: 10.1111/j.1471-0528.2004.00072.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine iron-induced free radical damage in fetal rhesus haemolytic disease (RHD) before and after repeated intrauterine red blood cell transfusions and its relation to hydrops fetalis. DESIGN Prospective, observational study. SETTING Department of Obstetrics, Leiden University Medical Centre, the Netherlands. POPULATION Fifty anaemic fetuses, including 13 hydropic ones, 9 preterm and 12 term neonates and 8 female non-pregnant adults. METHODS Venous blood plasma samples were collected from 50 fetuses suffering from RHD preliminary to the first, and if appropriate, subsequent intrauterine red blood cell transfusions for determination of iron status including non-protein-bound iron (NPBI) and iron-binding primary antioxidant proteins, total plasma anti-oxidant capacity and its contributing secondary antioxidants (e.g. vitamin C, uric acid, sulphydryl groups and peroxidation products). Results were compared with values of healthy preterm and term neonates directly at birth and adult controls. Within the fetal haemolytic group, 13 hydropic fetuses were analysed as a separate group. MAIN OUTCOME MEASURES Non-protein-bound iron, antioxidants, total antioxidant capacity and peroxidation products. Sub analysis of the outcome measures of the hydropic fetuses. RESULTS RHD fetuses had at initial cordocentesis a significantly higher NPBI level and a significantly lower total plasma antioxidant capacity than control babies and adults. Their vitamin C tended to be more oxidised but lipid peroxidation had not increased, when compared with preterm babies. The repeated intrauterine red blood cell transfusions had a positive effect on the total antioxidant capacity of plasma and did not increase the concentration of NPBI. The hydropic fetuses, who had higher NPBI concentrations and lower plasma protein concentrations and total antioxidant capacity, did not show more peroxidation products in plasma than the non-hydropic fetuses. Fetuses without reversal of hydrops despite intrauterine transfusions showed decreasing levels of proteins with subsequent transfusions but peroxidation products remained constant. CONCLUSION Repeated intrauterine red blood cell transfusions do not lead to free radical damage in the fetus in utero. Iron-induced free radical activity does not appear to play a causative role in the proceeding of hydrops fetalis in RHD.
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Affiliation(s)
- L M Luykx
- Department of Obstetrics, Leiden University Medical Centre, The Netherlands
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