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Lin CW, Chan KA, Chen YY, Huang WI, Chao PH, Liang HY, Chen WW, Hsiao FY. Risks of maternal cardiopulmonary events associated with ritodrine for tocolysis: A national database linkage study in 1 831 564 pregnant women. Int J Gynaecol Obstet 2024; 167:295-305. [PMID: 38666326 DOI: 10.1002/ijgo.15549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/06/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE Real-world data on cardiopulmonary events among pregnant women receiving β-agonist therapy are scarce. In the present study, we aimed to examine the absolute and relative risks of maternal cardiopulmonary events associated with the use of β-agonist ritodrine during pregnancy. METHODS By linking Taiwan's National Birth Certificate Application Database with National Health Insurance data, 1 831 564 pregnancies at ≥20 weeks' gestation were identified. Age-standardized incidence rates of cardiopulmonary events among pregnant women exposed to ritodrine were estimated. Nested case-control analyses were conducted to evaluate the relative risk of pulmonary edema, heart failure, and arrhythmia associated with prior ritodrine use. Cases and controls were matched using risk set sampling, and adjusted odds ratios were estimated using conditional logistic regression models. RESULTS A total of 189 cases of pulmonary edema, 126 cases of heart failure, and 162 cases of arrhythmia were identified (corresponding age-standardized incidence rates: 20.90, 8.35, and 16.63 per 100 000 among pregnant women only exposed to oral ritodrine; 91.28, 36.01, and 14.61 per 100 000 among those ever exposed to intravenous ritodrine). Exposure to oral ritodrine was associated with a lower increased risk of pulmonary edema (aOR 1.76; 95% CI: 1.12-2.76) and arrhythmia (2.21; 1.47-3.32) whereas exposure to ritodrine injection was associated with a significantly higher risk of pulmonary edema (10.56; 6.39-17.45), arrhythmia (4.15; 1.99-8.64), and heart failure (5.58; 2.27-13.74). CONCLUSIONS Pregnant women receiving intravenous ritodrine therapy had higher cardiopulmonary risks and should be intensively monitored. While the relative risk associated with oral ritodrine is not pronounced, it should be used judiciously among pregnant women as well.
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Affiliation(s)
- Chih-Wan Lin
- Taiwan Drug Relief Foundation, Taipei, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Yi-Yung Chen
- Division of High-risk Pregnancy, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei-I Huang
- Taiwan Drug Relief Foundation, Taipei, Taiwan
| | - Pi-Hui Chao
- Taiwan Drug Relief Foundation, Taipei, Taiwan
| | | | | | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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Ayub A, Zamir A, Imran I, Saeed H, Majeed A, Aziz M, Alqahtani F, Rasool MF. Clinical pharmacokinetics and pharmacodynamics of nicardipine; a systematic review. Expert Opin Drug Metab Toxicol 2024:1-15. [PMID: 39252195 DOI: 10.1080/17425255.2024.2402481] [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: 05/19/2024] [Revised: 08/29/2024] [Accepted: 09/05/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Nicardipine is a type of calcium channel blocker that is commonly used in the treatment of angina pectoris, hypertension, and related cardiovascular disorders. This systematic review assesses the reported pharmacokinetic (PK) and associated pharmacodynamic (PD) parameters of nicardipine in humans. AREAS COVERED An exhaustive literature search using four internet databases was conducted up to 5 October 2023, which yielded 871 papers, of which 32 fulfilled the eligibility requirements by including human PK and related PD data. The area under the plasma concentration vs. time curve from zero to infinity (AUC0-∞) and maximum plasma concentration (Cmax) of nicardipine rise proportionately with increasing dosage. One study revealed that AUC0-∞ of nicardipine was increased by 5-fold in hepatic cirrhosis patients compared to the control subjects. Moreover, related PD data in renal-impaired hypertensive patients revealed that a notable reduction in blood pressure was associated with nicardipine administration. EXPERT OPINION This review covers comprehensive data on clinical PK, drug-drug interaction studies, effects of dosage form on ADME, and associated PD parameters of nicardipine using all relevant published studies. The present study will also aid in the development and evaluation of PK models for suggesting model-informed dosing regimens. PROSPERO NUMBER CRD42024533051.
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Affiliation(s)
- Ammara Ayub
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, Allama Iqbal Campus, University of Punjab, Lahore, Pakistan
| | - Abdul Majeed
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Majid Aziz
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Mijušković A, Wray S, Arrowsmith S. A hydrogen sulphide-releasing non-steroidal anti-inflammatory, ATB-346, significantly attenuates human myometrial contractions. Pharmacol Rep 2024:10.1007/s43440-024-00643-z. [PMID: 39231921 DOI: 10.1007/s43440-024-00643-z] [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: 03/26/2024] [Revised: 08/09/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Spontaneous preterm birth is the leading cause of perinatal morbidity and mortality. Tocolytics are drugs used to inhibit uterine contractions in cases of imminent preterm birth, however, few are effective in stopping labour once initiated and all have side effects. Combination approaches involving drugs that target multiple signalling pathways that regulate contractions may increase efficacy, reduce dosage and improve tolerability. Both non-steroidal anti-inflammatory drugs (NSAIDs) and hydrogen sulphide (H2S)-releasing compounds can reduce myometrial contractions. In a novel approach we evaluated the tocolytic properties of ATB-346-a H2S-releasing derivative of the NSAID naproxen, shown clinically to reduce pain and inflammation in arthritis. METHODS Using organ baths, paired strips of human myometrium were exposed to increasing concentrations of ATB-346, or equimolar concentrations (10µM and 30µM) of the parent drug, naproxen, or the H2S-releasing moiety, 4-hydroxy-thiobenzamide (TBZ), alone. The ability of ATB-346 versus the individual components of ATB-346 to decrease ex vivo spontaneous contractions was investigated, and the potency was compared to a known H2S donor, Na2S. RESULTS Acute application of Na2S produced a concentration-dependent decrease in force amplitude and force integral (area under the curve) of contraction. ATB-346 produced a more profound decrease in contraction compared to equimolar concentrations of naproxen or TZB alone and was more potent than the equivalent concentration of Na2S. CONCLUSIONS ATB-346 exhibits potent tocolytic properties in human myometrium. These exciting results call for further exploration of ATB-346, with a view to repurposing this or similar drugs as novel therapies for delaying preterm labour.
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Affiliation(s)
- Ana Mijušković
- Harris-Wellbeing Research Centre, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Physiology, Institute for Biological Research 'Siniša Stanković', University of Belgrade, Belgrade, Serbia
| | - Susan Wray
- Harris-Wellbeing Research Centre, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sarah Arrowsmith
- Harris-Wellbeing Research Centre, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK.
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Khattab NW, Razzouk R, Tanios B, Nahouli L, Bou Khalil P, El Khoury N. Pulmonary Edema Following Nifedipine Use in Pregnancy: A Case Report. Cureus 2024; 16:e68467. [PMID: 39224493 PMCID: PMC11368172 DOI: 10.7759/cureus.68467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2024] [Indexed: 09/04/2024] Open
Abstract
Calcium channel blockers are generally considered safe for use during pregnancy. They have several indications, including second-line therapy for lowering blood pressure and tocolytic therapy. We present the case of a 24-year-old woman, G1P0, with a twin gestation at 22 weeks, who presented with acute respiratory distress. Her symptoms occurred shortly after starting nifedipine as tocolytic therapy. Investigations revealed signs of volume overload and pulmonary edema. Extensive cardiac and infectious workups were normal. Obstetrical ultrasound did not show any signs of ovarian hyperstimulation syndrome. Based on these findings, she was diagnosed with acute pulmonary edema following tocolytic therapy with oral nifedipine. Nifedipine was stopped, and intravenous furosemide was started, resulting in rapid clinical improvement. We are reporting this case to raise awareness of this rare but life-threatening adverse event associated with nifedipine use in pregnant patients.
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Affiliation(s)
- Nour W Khattab
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, LBN
| | - Ranim Razzouk
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, LBN
| | - Bassem Tanios
- Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut Medical Center, Beirut, LBN
| | - Lara Nahouli
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, LBN
| | - Pierre Bou Khalil
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, American University of Beirut Medical Center, Beirut, LBN
| | - Nabil El Khoury
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, LBN
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van der Windt L, Klumper J, van Limburg Stirum EVJ, van 't Hooft J, van Wely M, van Wassenaer-Leemhuis AG, Pajkrt E, Oudijk MA. Atosiban versus placebo in the treatment of threatened preterm birth between 30 and 34 weeks gestation: study protocol of the 4-year APOSTEL 8 follow-up. BMJ Open 2024; 14:e083600. [PMID: 39025819 PMCID: PMC11261668 DOI: 10.1136/bmjopen-2023-083600] [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] [Received: 12/22/2023] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Currently, the majority of women worldwide with threatened preterm birth are treated with tocolytics. Although tocolytics can effectively delay birth for 48 hours, no tocolytic drug has convincingly been shown to improve neonatal outcomes and effects on long-term child development are unknown. The aim of this follow-up study of a placebo controlled randomised trial is to investigate the long-term effects of atosiban administration in case of threatened preterm birth on child's neurodevelopment and behaviour development, overall health and mortality. METHODS AND ANALYSIS This protocol concerns a follow-up study of the multicentre randomised double-blind placebo controlled APOSTEL 8 trial (NL61439.018.17, EudraCT-number 2017-001007-72). In this trial, women with threatened preterm birth (between 30 and 34 weeks of gestation) defined as uterine contractions with (1) a cervical length of <15 mm or (2) a cervical length of 15-30 mm and a positive fibronectin test or (3) in centres where cervical length measurement is not part of the local protocol: a positive fibronectin test or Actim-Partus test or (4) ruptured membranes, are randomised to atosiban or placebo for 48 hours. The primary outcome is a composite of perinatal mortality and severe neonatal morbidity. Children born to mothers who participated in the APOSTEL 8 study (n=760) will be eligible for follow-up at 4 years of corrected age and assessed using four parent-reported questionnaires. Primary outcomes are neurodevelopment and behaviour problems. Secondary outcomes are on child growth and general health. All outcomes will be compared between the atosiban and placebo group with OR and corresponding 95% CI. Analyses will be performed using the intention-to-treat approach. ETHICS AND DISSEMINATION The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (Dutch WMO-law) did not apply to our study (W21_386 # 21.431). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results.
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Affiliation(s)
- Larissa van der Windt
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Job Klumper
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Emilie V J van Limburg Stirum
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Janneke van 't Hooft
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Obstetrics and Gynaecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development research institute, Amsterdam, Netherlands
- Obstetrics, Amsterdam UMC Locatie De Boelelaan, Amsterdam, The Netherlands
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van Winden T, Roos C, Mol BW, Pajkrt E, Oudijk MA. A historical narrative review through the field of tocolysis in threatened preterm birth. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100313. [PMID: 38736527 PMCID: PMC11087965 DOI: 10.1016/j.eurox.2024.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Preterm birth presents a significant challenge in clinical obstetrics, requiring effective strategies to reduce associated mortality and morbidity risks. Tocolytic drugs, aimed at inhibiting uterine contractions, are a key aspect of addressing this challenge. Despite extensive research over many years, determining the most effective tocolytic agents remains a complex task, prompting better understanding of the underlying mechanisms of spontaneous preterm birth and recording meaningful outcome measures. This paper provides a comprehensive review of various obsolete and current tocolytic drug regimens that were instituted over the past century, examining both historical contexts and contemporary challenges in their development and adoption. The examination of historical debates and advancements highlights the complexity of introducing new therapies. While the search for effective tocolytics continues, questions arise regarding their actual benefits in obstetric care and the necessity for ongoing exploration. The presence of methodological limitations in current research emphasizes the importance of well-designed randomized controlled trials with robust endpoints and extended follow-up periods.In response to these complexities, the consideration of shifting towards prevention strategies aimed at addressing the root causes of preterm labor becomes more and more evident. This potential shift may offer a more effective approach than relying solely on tocolytics to delay labor initiation.Ultimately, effectively managing threatened preterm birth necessitates ongoing investigation, innovation, and a willingness to reassess strategies in pursuit of optimal outcomes for mothers, neonates, and long-term child health.
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Affiliation(s)
- Tijn van Winden
- Amsterdam UMC, location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health Research Institute, Boelelaan 1117, Amsterdam, the Netherlands
| | - Carolien Roos
- Amsterdam UMC, location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - E. Pajkrt
- Amsterdam UMC, location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Martijn A. Oudijk
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, the Netherlands
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Cui H, Li H, Yin Z. Emergency cervical cerclage in delayed-interval delivery of twin pregnancies: a scoping review. BMC Pregnancy Childbirth 2024; 24:323. [PMID: 38671355 PMCID: PMC11046782 DOI: 10.1186/s12884-024-06515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The protocol for delayed-interval delivery of the second twin in twin pregnancies has not been standardized. Cervical cerclage is often performed, but its use is debated. To conduct a scoping review on cervical cerclage for prolonging the intertwin delivery interval and improving second twin survival and maternal outcomes after preterm delivery or spontaneous abortion of the first twin in twin pregnancies. METHODS Seven Chinese and English language databases were searched from inception to March 1, 2023, including PubMed, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP Chinese Science Journal Database, and Sinomed. Relevant observational studies that assessed the effectiveness of the use of cervical cerclage in delayed-interval delivery of twins were screened and selected, and raw data were extracted, and descriptive statistics and chi-square analysis were performed. RESULTS A total of 102 articles were retrieved. After screening and exclusion of duplicate and irrelevant articles, 22 articles meeting the inclusion criteria were obtained. Studies in which cerclage was performed reported longer intertwin delivery intervals than those that did not perform cerclage, and the difference was statistically significant. The cerclage group also tended to have lower rates of chorioamnionitis and maternal complications, but the difference between the two groups was not statistically significant. CONCLUSION After excluding patients with contraindications, emergency cervical cerclage can be considered in cases of spontaneous abortion of the first twin in twin pregnancies to prolong the gestation and improve the prognosis of the remaining fetus until it becomes viable and increases its birth weight.
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Affiliation(s)
- Hong Cui
- Department of Gynaecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Huan Li
- Department of Gynaecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Zhihua Yin
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, People's Republic of China.
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Zamani M, Alimi R, Arabi SM, Moradi M, Azmoude E. Comparison of the efficacy of nifedipine with ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:318. [PMID: 38664622 PMCID: PMC11044545 DOI: 10.1186/s12884-024-06497-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Some studies have compared the efficacy of nifedipine with that of other tocolytic drugs in the treatment of preterm labor, but the reported results are conflicting. OBJECTIVE To compare the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor. METHODS In this systematic review and meta-analysis, PubMed/MEDLINE, Scopus, Clarivate Analytics Web of Science, and Google Scholar were searched until April 3,2024 using predefined keywords. Randomized controlled trials (RCTs) and clinical trials that compared the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor were included. Two authors independently reviewed the articles, assessed their quality and extracted the data. The quality of the included RCTs based on the Cochrane Risk of Bias Tool 1 for clinical trial studies. The risk difference (RD) with the associated 95% confidence interval (CI) was calculated. A forest plot diagram was used to show the comparative point estimates of nifedipine and other tocolytic drugs on the prevention of preterm labor and their associated 95% confidence intervals based on the duration of pregnancy prolongation. Study heterogeneity was evaluated by the I2 index, and publication bias was evaluated by Egger's test. RESULTS Forty studies enrolling 4336 women were included. According to our meta-analysis, there was a significant difference in the prolongation of preterm labor within the first 48 h between the nifedipine group and the nitroglycerine group (RD, -0.04; 95% CI, -0.08 to -0.00; I2: 32.3%). Additionally, there were significant differences between nifedipine and ritodrine (RD, 0.11; 95% CI, 0.02 to 0.21; I2, 51.2%) for more than one week RD, 0.10; 95% CI, 0.03 to 0.19; I2, 33.2%) and for 34 weeks and more. The difference between nifedipine and magnesium sulfate was not significant in any of the four time points. CONCLUSIONS Considering the superiority of nifedipine over ritodrine and nitroglycerine and its similar efficacy to magnesium sulfate for tocolysis, it seems that the side effects of these options determine the first drug line.
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Affiliation(s)
- Maryam Zamani
- Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Rasoul Alimi
- Department of Epidemiology and Biostatistics, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Seyyed Mostafa Arabi
- Department of Nutrition, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Maryam Moradi
- Global and Women's Health, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Elham Azmoude
- Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran.
- Neyshabur University of Medical Sciences, Bagcheh Ban town, Neyshabur, Iran.
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Carter D, Better M, Abbasi S, Zulfiqar F, Shapiro R, Ensign LM. Nanomedicine for Maternal and Fetal Health. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2303682. [PMID: 37817368 PMCID: PMC11004090 DOI: 10.1002/smll.202303682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/25/2023] [Indexed: 10/12/2023]
Abstract
Conception, pregnancy, and childbirth are complex processes that affect both mother and fetus. Thus, it is perhaps not surprising that in the United States alone, roughly 11% of women struggle with infertility and 16% of pregnancies involve some sort of complication. This presents a clear need to develop safe and effective treatment options, though the development of therapeutics for use in women's health and particularly in pregnancy is relatively limited. Physiological and biological changes during the menstrual cycle and pregnancy impact biodistribution, pharmacokinetics, and efficacy, further complicating the process of administration and delivery of therapeutics. In addition to the complex pharmacodynamics, there is also the challenge of overcoming physiological barriers that impact various routes of local and systemic administration, including the blood-follicle barrier and the placenta. Nanomedicine presents a unique opportunity to target and sustain drug delivery to the reproductive tract and other relevant organs in the mother and fetus, as well as improve the safety profile and minimize side effects. Nanomedicine-based approaches have the potential to improve the management and treatment of infertility, obstetric complications, and fetal conditions.
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Affiliation(s)
- Davell Carter
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Marina Better
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Saed Abbasi
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fareeha Zulfiqar
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Shapiro
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Laura M. Ensign
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
- Departments of Gynecology and Obstetrics, Biomedical Engineering, Oncology, and Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sveiven M, Gassman A, Rosenberg J, Chan M, Boniface J, O’Donoghue AJ, Laurent LC, Hall DA. A dual-binding magnetic immunoassay to predict spontaneous preterm birth. Front Bioeng Biotechnol 2023; 11:1256267. [PMID: 37790251 PMCID: PMC10542577 DOI: 10.3389/fbioe.2023.1256267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Complications posed by preterm birth (delivery before 37 weeks of pregnancy) are a leading cause of newborn morbidity and mortality. The previous discovery and validation of an algorithm that includes maternal serum protein biomarkers, sex hormone-binding globulin (SHBG), and insulin-like growth factor-binding protein 4 (IBP4), with clinical factors to predict preterm birth represents an opportunity for the development of a widely accessible point-of-care assay to guide clinical management. Toward this end, we developed SHBG and IBP4 quantification assays for maternal serum using giant magnetoresistive (GMR) sensors and a self-normalizing dual-binding magnetic immunoassay. The assays have a picomolar limit of detections (LOD) with a relatively broad dynamic range that covers the physiological level of the analytes as they change throughout gestation. Measurement of serum from pregnant donors using the GMR assays was highly concordant with those obtained using a clinical mass spectrometry (MS)-based assay for the same protein markers. The MS assay requires capitally intense equipment and highly trained operators with a few days turnaround time, whereas the GMR assays can be performed in minutes on small, inexpensive instruments with minimal personnel training and microfluidic automation. The potential for high sensitivity, accuracy, and speed of the GMR assays, along with low equipment and personnel requirements, make them good candidates for developing point-of-care tests. Rapid turnaround risk assessment for preterm birth would enable patient testing and counseling at the same clinic visit, thereby increasing the timeliness of recommended interventions.
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Affiliation(s)
- Michael Sveiven
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Andrew Gassman
- Sera Prognostics, Inc., Salt Lake City, UT, United States
| | - Joshua Rosenberg
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Chan
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Jay Boniface
- Sera Prognostics, Inc., Salt Lake City, UT, United States
| | - Anthony J. O’Donoghue
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Louise C. Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Drew A. Hall
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
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11
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Daskalakis G, Psarris A, Koutras A, Fasoulakis Z, Prokopakis I, Varthaliti A, Karasmani C, Ntounis T, Domali E, Theodora M, Antsaklis P, Pappa KI, Papapanagiotou A. Maternal Infection and Preterm Birth: From Molecular Basis to Clinical Implications. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050907. [PMID: 37238455 DOI: 10.3390/children10050907] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
As the leading cause of neonatal morbidity and mortality, preterm birth is recognized as a major public health concern around the world. The purpose of this review is to analyze the connection between infections and premature birth. Spontaneous preterm birth is commonly associated with intrauterine infection/inflammation. The overproduction of prostaglandins caused by the inflammation associated with an infection could lead to uterine contractions, contributing to preterm delivery. Many pathogens, particularly Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Actinomyces, Candida spp., and Streptococcus spp. have been related with premature delivery, chorioamnionitis, and sepsis of the neonate. Further research regarding the prevention of preterm delivery is required in order to develop effective preventive methods with the aim of reducing neonatal morbidity.
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Affiliation(s)
- George Daskalakis
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Alexandros Psarris
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Antonios Koutras
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Zacharias Fasoulakis
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Ioannis Prokopakis
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Antonia Varthaliti
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Christina Karasmani
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Thomas Ntounis
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Marianna Theodora
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Panos Antsaklis
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Kalliopi I Pappa
- First Department of Obstetrics and Gynecology, 'Alexandra' Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Angeliki Papapanagiotou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
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12
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Li Y, Chu R, Li Y, Zhang M, Ma Y. Delayed interval delivery in a quadruplet pregnancy: a case report and literature review. BMC Pregnancy Childbirth 2023; 23:353. [PMID: 37189021 DOI: 10.1186/s12884-023-05647-w] [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: 10/21/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND As the rate of multiple pregnancies increases, delayed interval delivery (DID) is increasingly being implemented to improve perinatal outcomes. But there are no international guidelines for DID in multiple pregnancies. We report a case of DID in a quadruplet pregnancy and review the relevant literature to summarize the management of DID in multiple pregnancies. CASE PRESENTATION A 22-year-old woman, 22 2/7 weeks' gestation, with quadruplets, was admitted to the hospital for a first cervical cerclage due to cervical dilation. Twenty-five days later, it was found that the cervix was dilated again, so after removing the cervical cerclage, the first quadruplet was delivered vaginally (25 6/7 weeks), and a second cervical cerclage was performed. Four days later, due to re-dilation of the cervix, after removal of the cervical cerclage, the second quadruplet was delivered vaginally (26 3/7 weeks), followed by a third cervical cerclage. Six days later, the pregnancy was terminated by cesarean section due to fetal distress, and the third and fourth quadruplets were delivered (27 2/7 weeks). The patient had no postoperative complications, and all four infants were treated in the neonatal intensive care unit and discharged successfully. CONCLUSION This case emphasizes that comprehensive management of delayed interval delivery can improve perinatal outcomes in multiple pregnancies, including anti-infection, tocolytic therapy, practice to promote fetal lung, and cervical cerclage.
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Affiliation(s)
- Yanan Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Yarong Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Meiling Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Yuyan Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China.
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13
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Berger R, Abele H, Bahlmann F, Doubek K, Felderhoff-Müser U, Fluhr H, Garnier Y, Grylka-Baeschlin S, Hayward A, Helmer H, Herting E, Hoopmann M, Hösli I, Hoyme U, Kunze M, Kuon RH, Kyvernitakis I, Lütje W, Mader S, Maul H, Mendling W, Mitschdörfer B, Nothacker M, Olbertz D, Ramsell A, Rath W, Roll C, Schlembach D, Schleußner E, Schütz F, Seifert-Klauss V, Stubert J, Surbek D. Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, September 2022) - Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and on the Management of Preterm Premature Rupture of Membranes. Geburtshilfe Frauenheilkd 2023; 83:569-601. [PMID: 37169014 PMCID: PMC10166648 DOI: 10.1055/a-2044-0345] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/22/2023] [Indexed: 05/13/2023] Open
Abstract
Aim The revision of this guideline was coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of the guideline is to improve the prediction, prevention and management of preterm birth based on evidence from the current literature, the experience of members of the guidelines commission, and the viewpoint of self-help organizations. Methods The members of the contributing professional societies and organizations developed recommendations and statements based on international literature. The recommendations and statements were presented and adopted using a formal process (structured consensus conferences with neutral moderation, written Delphi vote). Recommendations Part 2 of this short version of the guideline presents statements and recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.
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Affiliation(s)
- Richard Berger
- Frauenklinik, Marienhaus Klinikum Neuwied, Neuwied, Germany
| | - Harald Abele
- Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Franz Bahlmann
- Frauenklinik, Bürgerhospital Frankfurt, Frankfurt am Main, Germany
| | | | - Ursula Felderhoff-Müser
- Klinik für Kinderheilkunde I/Perinatalzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Herbert Fluhr
- Frauenklinik, Universitätsklinikum Graz, Graz, Austria
| | - Yves Garnier
- Frauenklinik, Klinikum Osnabrück, Osnabrück, Germany
| | - Susanne Grylka-Baeschlin
- Zürcher Hochschule für angewandte Wissenschaften, Institut für Hebammenwissenschaft und reproduktive Gesundheit, Zürich, Switzerland
| | | | - Hanns Helmer
- Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Markus Hoopmann
- Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Irene Hösli
- Frauenklinik, Universitätsspital Basel, Basel, Switzerland
| | - Udo Hoyme
- Frauenklinik, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Mirjam Kunze
- Frauenklinik, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Ruben-H. Kuon
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Wolf Lütje
- Frauenklinik, Evangelisches Amalie Sieveking-Krankenhaus Hamburg, Hamburg, Germany
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, München, Germany
| | - Holger Maul
- Frauenklinik, Asklepios Kliniken Hamburg, Hamburg, Germany
| | - Werner Mendling
- Frauenklinik, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Berlin
| | - Dirk Olbertz
- Klinik für Neonatologie, Klinikum Südstadt Rostock, Rostock, Germany
| | | | - Werner Rath
- Emeritus, Universitätsklinikum Aachen, Aachen, Germany
| | - Claudia Roll
- Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Datteln, Germany
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Klinikum Neukölln/Berlin Vivantes Netzwerk für Gesundheit, Berlin, Germany
| | | | - Florian Schütz
- Frauenklinik, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | | | | | - Daniel Surbek
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Universität Bern, Bern, Switzerland
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14
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Goyal N, Agrawal M, Dewani D, Reddy Eleti M. A Comparative Study of the Effectiveness of Transdermal Nitroglycerine Patches and Oral Nifedipine in Prolongation of Pregnancy in Women With Preterm Labour. Cureus 2023; 15:e39106. [PMID: 37332464 PMCID: PMC10270707 DOI: 10.7759/cureus.39106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Backgrounds A significant contributor to newborn morbidity and mortality is preterm birth. Several techniques have been employed to identify patients at risk of premature labour. However, these predictors are not always effective because of their multifactorial aetiology. Preterm labour can be suppressed largely through tocolysis. This study compared the effectiveness and safety of transdermal nitroglycerine and oral nifedipine in preventing premature labour. Methods This study was done at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, from December 2020 to November 2022, on 130 women presenting with preterm labour pains between 28 and 37 weeks of gestational age. All the women selected were randomized into two equal groups by using the envelope method. Sixty-five women were given a nitroglycerine patch (Group A), and the rest (65 women) were given an oral nifedipine tablet (group B). The variables studied were mean days of prolongation of pregnancy, treatment outcome, steroid coverage, along with feto-maternal outcomes among both groups. Results The percentage of women whose pregnancy was prolonged for at least 48 hours in the nitroglycerine group was 75.3%, and in the nifedipine group it was 93.8%. Failure to achieve tocolysis, defined as delivery within 48 hours, was seen significantly more in the nitroglycerine group (24.6%) than in the nifedipine group (6.1%). The overall foetal outcomes were comparable in both groups. Conclusion Oral nifedipine was found to be superior to transdermal nifedipine patches in terms of efficacy and safety in the management of preterm labour, with a better side effect profile.
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Affiliation(s)
- Nidhi Goyal
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manjusha Agrawal
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepika Dewani
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manila Reddy Eleti
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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15
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Arman BM, Binder NK, de Alwis N, Beard S, Debruin DA, Hayes A, Tong S, Kaitu'u-Lino TJ, Hannan NJ. Assessment of the tocolytic nifedipine in preclinical primary models of preterm birth. Sci Rep 2023; 13:5646. [PMID: 37024530 PMCID: PMC10079980 DOI: 10.1038/s41598-023-31077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Spontaneous preterm birth is the leading cause of perinatal morbidity and mortality. Tocolytics are drugs used in cases of imminent preterm birth to inhibit uterine contractions. Nifedipine is a calcium channel blocking agent used to delay threatened spontaneous preterm birth, however, has limited efficacy and lacks preclinical data regarding mechanisms of action. It is unknown if nifedipine affects the pro-inflammatory environment associated with preterm labour pathophysiology and we hypothesise nifedipine only targets myometrial contraction rather than also mitigating inflammation. We assessed anti-inflammatory and anti-contractile effects of nifedipine on human myometrium using in vitro and ex vivo techniques, and a mouse model of preterm birth. We show that nifedipine treatment inhibited contractions in myometrial in vitro contraction assays (P = 0.004 vs. vehicle control) and potently blocked spontaneous and oxytocin-induced contractions in ex vivo myometrial tissue in muscle myography studies (P = 0.01 vs. baseline). Nifedipine treatment did not reduce gene expression or protein secretion of pro-inflammatory cytokines in either cultured myometrial cells or ex vivo tissues. Although nifedipine could delay preterm birth in some mice, this was not consistent in all dams and was overall not statistically significant. Our data suggests nifedipine does not modulate preterm birth via inflammatory pathways in the myometrium, and this may account for its limited clinical efficacy.
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Affiliation(s)
- Bridget M Arman
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Australia
| | - Natalie K Binder
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Australia
| | - Natasha de Alwis
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Australia
| | - Sally Beard
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Australia
| | - Danielle A Debruin
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, 3000, Australia
- Australian Institute for Musculoskeletal Science, Victoria University, St AlbansVictoria, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Victoria, 3021, Australia
| | - Alan Hayes
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, 3000, Australia
- Australian Institute for Musculoskeletal Science, Victoria University, St AlbansVictoria, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Victoria, 3021, Australia
| | - Stephen Tong
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Australia
| | | | - Natalie J Hannan
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia.
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Australia.
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16
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Taylor J, Sharp A, Rannard SP, Arrowsmith S, McDonald TO. Nanomedicine strategies to improve therapeutic agents for the prevention and treatment of preterm birth and future directions. NANOSCALE ADVANCES 2023; 5:1870-1889. [PMID: 36998665 PMCID: PMC10044983 DOI: 10.1039/d2na00834c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 06/19/2023]
Abstract
The World Health Organisation (WHO) estimates 15 million babies worldwide are born preterm each year, with 1 million infant mortalities and long-term morbidity in survivors. Whilst the past 40 years have provided some understanding in the causes of preterm birth, along with development of a range of therapeutic options, notably prophylactic use of progesterone or uterine contraction suppressants (tocolytics), the number of preterm births continues to rise. Existing therapeutics used to control uterine contractions are restricted in their clinical use due to pharmacological drawbacks such as poor potency, transfer of drugs to the fetus across the placenta and maternal side effects from activity in other maternal systems. This review focuses on addressing the urgent need for the development of alternative therapeutic systems with improved efficacy and safety for the treatment of preterm birth. We discuss the application of nanomedicine as a viable opportunity to engineer pre-existing tocolytic agents and progestogens into nanoformulations, to improve their efficacy and address current drawbacks to their use. We review different nanomedicines including liposomes, lipid-based carriers, polymers and nanosuspensions highlighting where possible, where these technologies have already been exploited e.g. liposomes, and their significance in improving the properties of pre-existing therapeutic agents within the field of obstetrics. We also highlight where active pharmaceutical agents (APIs) with tocolytic properties have been used for other clinical indications and how these could inform the design of future therapeutics or be repurposed to diversify their application such as for use in preterm birth. Finally we outline and discuss the future challenges.
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Affiliation(s)
- Jessica Taylor
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
| | - Andrew Sharp
- Harris-Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, Liverpool Women's Hospital, University of Liverpool Crown Street Liverpool L8 7SS UK
| | - Steve P Rannard
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool Liverpool L7 3NY UK
| | - Sarah Arrowsmith
- Department of Life Sciences, Manchester Metropolitan University Chester Street Manchester M1 5GD UK
| | - Tom O McDonald
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
- Department of Materials, Henry Royce Institute, The University of Manchester Manchester M13 9PL UK
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17
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Mulamreddy R, Hou X, Chemtob S, Lubell WD. Synthesis of 5- and 7-hydroxy indolizidin-2-one prostaglandin-F 2α modulators and activity on myometrial contractility towards development of agents for delaying preterm birth. J Pept Sci 2023; 29:e3455. [PMID: 36184819 DOI: 10.1002/psc.3455] [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: 06/01/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
In pursuit of more effective-labor delaying tocolytic agents, the prostaglandin F2α (PGF2α) receptor (FP) modulator PDC113.824 [(6S)-2] represents a potent lead for developing therapy to treat preterm birth. Derivatives of FP modulator (6S)-2 were synthesized, possessing respectively 5- and 7-hydroxyl groups on the indolizidin-2-one amino acid (I2 aa) residue. The effects of the alcohol substituents were examined in a PGF2α-induced myometrial contraction assay. Based on knowledge of dihedral angle values of model I2 aa peptides from X-ray analyses, the results of the study indicate respectively encouraging and limited potential for creating improved tocolytic agents by modifications at the 5- and 7-positions.
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Affiliation(s)
| | - Xin Hou
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Sylvain Chemtob
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Québec, Canada
| | - William D Lubell
- Département de Chimie, Université de Montréal, Montréal, Québec, Canada
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18
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Phung J, Wang C, Reeders J, Zakar T, Paul JW, Tyagi S, Pennell CE, Smith R. Preterm labor with and without chorioamnionitis is associated with activation of myometrial inflammatory networks: a comprehensive transcriptomic analysis. Am J Obstet Gynecol 2023; 228:330.e1-330.e18. [PMID: 36002050 DOI: 10.1016/j.ajog.2022.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The onset of preterm labor is associated with inflammation. Previous studies suggested that this is distinct from the inflammation observed during term labor. Our previous work on 44 genes differentially expressed in myometria in term labor demonstrated a different pattern of gene expression from that observed in preterm laboring and nonlaboring myometria. We found increased expression of inflammatory genes in preterm labor associated with chorioamnionitis, but in the absence of chorioamnionitis observed no difference in gene expression in preterm myometria regardless of laboring status, suggesting that preterm labor is associated with different myometrial genes or signals originating from outside the myometrium. Given that a small subset of genes were assessed, this study aimed to use RNA sequencing and bioinformatics to assess the myometrial transcriptome during preterm labor in the presence and absence of chorioamnionitis. OBJECTIVE This study aimed to comprehensively determine protein-coding transcriptomic differences between preterm nonlaboring and preterm laboring myometria with and without chorioamnionitis. STUDY DESIGN Myometria were collected at cesarean delivery from preterm patients not in labor (n=16) and preterm patients in labor with chorioamnionitis (n=8) or without chorioamnionitis (n=6). Extracted RNA from myometrial tissue was prepared and sequenced using Illumina NovaSeq. Gene expression was quantified by mapping the sequence reads to the human reference genome (hg38). Differential gene expression analysis, gene set enrichment analysis, and weighted gene coexpression network analysis were used to comprehensively interrogate transcriptomic differences and their associated biology. RESULTS Differential gene expression analysis comparing preterm patients in labor with chorioamnionitis with preterm patients not in labor identified 931 differentially expressed genes, whereas comparing preterm patients in labor without chorioamnionitis with preterm patients not in labor identified no statistically significant gene expression changes. In contrast, gene set enrichment analysis and weighted gene coexpression network analysis demonstrated that preterm labor with and without chorioamnionitis was associated with enrichment of pathways involved in activation of the innate immune system and inflammation, and activation of G protein-coupled receptors. Key genes identified included chemotactic CYP4F3, CXCL8, DOCK2, and IRF1 in preterm labor with chorioamnionitis and CYP4F3, FCAR, CHUK, and IL13RA2 in preterm labor without chorioamnionitis. There was marked overlap in the pathways enriched in both preterm labor subtypes. CONCLUSION Differential gene expression analysis demonstrated that myometria from preterm patients in labor without chorioamnionitis and preterm patients not in labor were transcriptionally similar, whereas the presence of chorioamnionitis was associated with marked gene changes. In contrast, comprehensive bioinformatic analysis indicated that preterm labor with or without chorioamnionitis was associated with innate immune activation. All causes of preterm labor were associated with activation of the innate immune system, but this was more marked in the presence of chorioamnionitis. These data suggest that anti-inflammatory therapy may be relevant in managing preterm labor of all etiologies.
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Affiliation(s)
- Jason Phung
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, Australia; Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia.
| | - Carol Wang
- Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Jocelyn Reeders
- Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
| | - Tamas Zakar
- Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Jonathan W Paul
- Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Sonika Tyagi
- Central Clinical School, Monash University, Clayton, Australia
| | - Craig E Pennell
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, Australia; Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
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19
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Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2023; 120:3-23. [PMID: 36863329 PMCID: PMC10064400 DOI: 10.1159/000528914] [Citation(s) in RCA: 133] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023]
Abstract
Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).
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Affiliation(s)
- David G. Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
| | - Virgilio P. Carnielli
- Department of Neonatology, University Polytechnic Della Marche, University Hospital Ancona, Ancona, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mikko Hallman
- Department of Children and Adolescents, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria
| | - Eren Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Arjan te Pas
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Charles C. Roehr
- Faculty of Health Sciences, University of Bristol, UK and National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Christian P. Speer
- Department of Pediatrics, University Children's Hospital, Wuerzburg, Germany
| | - Maximo Vento
- Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gerry H.A. Visser
- Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - Henry L. Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, UK
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Sun L, Tang M, Peng M, Xu P, Wang Y. Ritodrine-induced rhabdomyolysis and psychiatric symptoms: a case report and literature review. BMC Pregnancy Childbirth 2023; 23:11. [PMID: 36611175 PMCID: PMC9824990 DOI: 10.1186/s12884-022-05299-2] [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: 03/10/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ritodrine hydrochloride, a β2-adrenergic agonist, has been widely used in Asia and Europe to treat preterm labor in pregnant women. It has some typical side effects, such as palpitations, pulmonary edema, and hypokalemia. Here, we report a case of rhabdomyolysis and psychiatric symptoms might be associated with intravenous ritodrine. CASE PRESENTATION A 32-year-old Chinese primigravida woman who was pregnant with twins by in vitro fertilization-embryo transfer was diagnosed with placenta previa and threatened abortion at 21 gestational weeks (GW). The patient was then treated with ritodrine hydrochloride. The initial dose of ritodrine was 150 μg/min, gradually increasing to 360 μg/min at 235/7 GW and 400 μg/min at 271/7 GW. Magnesium sulfate was added to the ritodrine regimen at 215/7 GW in dosage of 1-2 g/h. Psychiatric symptoms appeared at 245/7, 265/7, and 273/7 GW, manifesting as depression, anxiety, and suicidal tendencies. Severe muscle pain in her limbs and general weakness appeared after six weeks of ritodrine administration, which might have been a sign of rhabdomyolysis resulting from ritodrine administration. After ceasing the administration of ritodrine, the muscle pain and relevant data from laboratory tests on the patient were significantly improved, and her mood was stable. It is worth noting that this is the first time to report psychiatric symptoms may associated with the administration of ritodrine. In addition, we reviewed and analyzed six reported cases of rhabdomyolysis caused by ritodrine. CONCLUSION Our results suggest that we should pay more attention to the risk of rhabdomyolysis and psychiatric symptoms induced by intravenous ritodrine hydrochloride, especially in patients with a history of neuromuscular disorder, or concomitant use of magnesium sulfate.
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Affiliation(s)
- Li Sun
- grid.452708.c0000 0004 1803 0208Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, 410011 China ,grid.216417.70000 0001 0379 7164Institute of Clinical Pharmacy, Central South University, Changsha, 410011 China ,Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008 China
| | - Mimi Tang
- grid.216417.70000 0001 0379 7164Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008 China
| | - Mei Peng
- grid.452708.c0000 0004 1803 0208Department of obstetrics, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Ping Xu
- grid.452708.c0000 0004 1803 0208Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, 410011 China ,grid.216417.70000 0001 0379 7164Institute of Clinical Pharmacy, Central South University, Changsha, 410011 China
| | - Ying Wang
- grid.452708.c0000 0004 1803 0208Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, 410011 China ,grid.216417.70000 0001 0379 7164Institute of Clinical Pharmacy, Central South University, Changsha, 410011 China
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De Bie FR, Basurto D, Kumar S, Deprest J, Russo FM. Sildenafil during the 2nd and 3rd Trimester of Pregnancy: Trials and Tribulations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11207. [PMID: 36141480 PMCID: PMC9517616 DOI: 10.3390/ijerph191811207] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Sildenafil, a phosphodiesterase 5 inhibitor with a vasodilatory and anti-remodeling effect, has been investigated concerning various conditions during pregnancy. Per indication, we herein review the rationale and the most relevant experimental and clinical studies, including systematic reviews and meta-analyses, when available. Indications for using sildenafil during the second and third trimester of pregnancy include maternal pulmonary hypertension, preeclampsia, preterm labor, fetal growth restriction, oligohydramnios, fetal distress, and congenital diaphragmatic hernia. For most indications, the rationale for administering prenatal sildenafil is based on limited, equivocal data from in vitro studies and rodent disease models. Clinical studies report mild maternal side effects and suggest good fetal tolerance and safety depending on the underlying pathology.
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Affiliation(s)
| | - David Basurto
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Sailesh Kumar
- Mater Research Institute and School of Medicine, University of Queensland, Brisbane, QLD 4343, Australia
| | - Jan Deprest
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, 3000 Leuven, Belgium
| | - Francesca Maria Russo
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, UZ Leuven, 3000 Leuven, Belgium
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22
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Pavlidis I, Stock SJ. Preterm Birth Therapies to Target Inflammation. J Clin Pharmacol 2022; 62 Suppl 1:S79-S93. [PMID: 36106783 PMCID: PMC9545799 DOI: 10.1002/jcph.2107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022]
Abstract
Preterm birth (PTB; defined as delivery before 37 weeks of pregnancy) is the leading cause of morbidity and mortality in infants and children aged <5 years, conferring potentially devastating short- and long-term complications. Despite extensive research in the field, there is currently a paucity of medications available for PTB prevention and treatment. Over the past few decades, inflammation in gestational tissues has emerged at the forefront of PTB pathophysiology. Even in the absence of infection, inflammation alone can prematurely activate the main components of parturition resulting in uterine contractions, cervical ripening and dilatation, membrane rupture, and subsequent PTB. Mechanistic studies have identified critical elements of the complex inflammatory molecular pathways involved in PTB. Here, we discuss therapeutic options that target such key mediators with an aim to prevent, postpone, or treat PTB. We provide an overview of more traditional therapies that are currently used or being tested in humans, and we highlight recent advances in preclinical studies introducing novel approaches with therapeutic potential. We conclude that urgent collaborative action is required to address the unmet need of developing effective strategies to tackle the challenge of PTB and its complications.
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Affiliation(s)
- Ioannis Pavlidis
- University of Warwick Biomedical Research Unit in Reproductive HealthCoventryUK
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23
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Wilson A, Hodgetts-Morton VA, Marson EJ, Markland AD, Larkai E, Papadopoulou A, Coomarasamy A, Tobias A, Chou D, Oladapo OT, Price MJ, Morris K, Gallos ID. Tocolytics for delaying preterm birth: a network meta-analysis (0924). Cochrane Database Syst Rev 2022; 8:CD014978. [PMID: 35947046 PMCID: PMC9364967 DOI: 10.1002/14651858.cd014978.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Preterm birth is the leading cause of death in newborns and children. Tocolytic drugs aim to delay preterm birth by suppressing uterine contractions to allow time for administration of corticosteroids for fetal lung maturation, magnesium sulphate for neuroprotection, and transport to a facility with appropriate neonatal care facilities. However, there is still uncertainty about their effectiveness and safety. OBJECTIVES To estimate relative effectiveness and safety profiles for different classes of tocolytic drugs for delaying preterm birth, and provide rankings of the available drugs. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov (21 April 2021) and reference lists of retrieved studies. SELECTION CRITERIA We included all randomised controlled trials assessing effectiveness or adverse effects of tocolytic drugs for delaying preterm birth. We excluded quasi- and non-randomised trials. We evaluated all studies against predefined criteria to judge their trustworthiness. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed the trials for inclusion and risk of bias, and extracted data. We performed pairwise and network meta-analyses, to determine the relative effects and rankings of all available tocolytics. We used GRADE to rate the certainty of the network meta-analysis effect estimates for each tocolytic versus placebo or no treatment. MAIN RESULTS This network meta-analysis includes 122 trials (13,697 women) involving six tocolytic classes, combinations of tocolytics, and placebo or no treatment. Most trials included women with threatened preterm birth, singleton pregnancy, from 24 to 34 weeks of gestation. We judged 25 (20%) studies to be at low risk of bias. Overall, certainty in the evidence varied. Relative effects from network meta-analysis suggested that all tocolytics are probably effective in delaying preterm birth compared with placebo or no tocolytic treatment. Betamimetics are possibly effective in delaying preterm birth by 48 hours (risk ratio (RR) 1.12, 95% confidence interval (CI) 1.05 to 1.20; low-certainty evidence), and 7 days (RR 1.14, 95% CI 1.03 to 1.25; low-certainty evidence). COX inhibitors are possibly effective in delaying preterm birth by 48 hours (RR 1.11, 95% CI 1.01 to 1.23; low-certainty evidence). Calcium channel blockers are possibly effective in delaying preterm birth by 48 hours (RR 1.16, 95% CI 1.07 to 1.24; low-certainty evidence), probably effective in delaying preterm birth by 7 days (RR 1.15, 95% CI 1.04 to 1.27; moderate-certainty evidence), and prolong pregnancy by 5 days (0.1 more to 9.2 more; high-certainty evidence). Magnesium sulphate is probably effective in delaying preterm birth by 48 hours (RR 1.12, 95% CI 1.02 to 1.23; moderate-certainty evidence). Oxytocin receptor antagonists are probably effective in delaying preterm birth by 48 hours (RR 1.13, 95% CI 1.05 to 1.22; moderate-certainty evidence), are effective in delaying preterm birth by 7 days (RR 1.18, 95% CI 1.07 to 1.30; high-certainty evidence), and possibly prolong pregnancy by 10 days (95% CI 2.3 more to 16.7 more). Nitric oxide donors are probably effective in delaying preterm birth by 48 hours (RR 1.17, 95% CI 1.05 to 1.31; moderate-certainty evidence), and 7 days (RR 1.18, 95% CI 1.02 to 1.37; moderate-certainty evidence). Combinations of tocolytics are probably effective in delaying preterm birth by 48 hours (RR 1.17, 95% CI 1.07 to 1.27; moderate-certainty evidence), and 7 days (RR 1.19, 95% CI 1.05 to 1.34; moderate-certainty evidence). Nitric oxide donors ranked highest for delaying preterm birth by 48 hours and 7 days, and delay in birth (continuous outcome), followed by calcium channel blockers, oxytocin receptor antagonists and combinations of tocolytics. Betamimetics (RR 14.4, 95% CI 6.11 to 34.1; moderate-certainty evidence), calcium channel blockers (RR 2.96, 95% CI 1.23 to 7.11; moderate-certainty evidence), magnesium sulphate (RR 3.90, 95% CI 1.09 to 13.93; moderate-certainty evidence) and combinations of tocolytics (RR 6.87, 95% CI 2.08 to 22.7; low-certainty evidence) are probably more likely to result in cessation of treatment. Calcium channel blockers possibly reduce the risk of neurodevelopmental morbidity (RR 0.51, 95% CI 0.30 to 0.85; low-certainty evidence), and respiratory morbidity (RR 0.68, 95% CI 0.53 to 0.88; low-certainty evidence), and result in fewer neonates with birthweight less than 2000 g (RR 0.49, 95% CI 0.28 to 0.87; low-certainty evidence). Nitric oxide donors possibly result in neonates with higher birthweight (mean difference (MD) 425.53 g more, 95% CI 224.32 more to 626.74 more; low-certainty evidence), fewer neonates with birthweight less than 2500 g (RR 0.40, 95% CI 0.24 to 0.69; low-certainty evidence), and more advanced gestational age (MD 1.35 weeks more, 95% CI 0.37 more to 2.32 more; low-certainty evidence). Combinations of tocolytics possibly result in fewer neonates with birthweight less than 2500 g (RR 0.74, 95% CI 0.59 to 0.93; low-certainty evidence). In terms of maternal adverse effects, betamimetics probably cause dyspnoea (RR 12.09, 95% CI 4.66 to 31.39; moderate-certainty evidence), palpitations (RR 7.39, 95% CI 3.83 to 14.24; moderate-certainty evidence), vomiting (RR 1.91, 95% CI 1.25 to 2.91; moderate-certainty evidence), possibly headache (RR 1.91, 95% CI 1.07 to 3.42; low-certainty evidence) and tachycardia (RR 3.01, 95% CI 1.17 to 7.71; low-certainty evidence) compared with placebo or no treatment. COX inhibitors possibly cause vomiting (RR 2.54, 95% CI 1.18 to 5.48; low-certainty evidence). Calcium channel blockers (RR 2.59, 95% CI 1.39 to 4.83; low-certainty evidence), and nitric oxide donors probably cause headache (RR 4.20, 95% CI 2.13 to 8.25; moderate-certainty evidence). AUTHORS' CONCLUSIONS Compared with placebo or no tocolytic treatment, all tocolytic drug classes that we assessed (betamimetics, calcium channel blockers, magnesium sulphate, oxytocin receptor antagonists, nitric oxide donors) and their combinations were probably or possibly effective in delaying preterm birth for 48 hours, and 7 days. Tocolytic drugs were associated with a range of adverse effects (from minor to potentially severe) compared with placebo or no tocolytic treatment, although betamimetics and combination tocolytics were more likely to result in cessation of treatment. The effects of tocolytic use on neonatal outcomes such as neonatal and perinatal mortality, and on safety outcomes such as maternal and neonatal infection were uncertain.
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Affiliation(s)
- Amie Wilson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ella J Marson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Eva Larkai
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - Argyro Papadopoulou
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - Aurelio Tobias
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Malcolm J Price
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katie Morris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ioannis D Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
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Young Park J, Hong S, Hye Jo J, Hye Shin I, Young Kim G, Sun Ko H, Yang Park I. The effect of tocolytics in women with preterm labor after 34 weeks of gestation: A propensity score-matched study. Eur J Obstet Gynecol Reprod Biol 2022; 277:1-6. [DOI: 10.1016/j.ejogrb.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
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Assessing the Potency of the Novel Tocolytics 2-APB, Glycyl-H-1152, and HC-067047 in Pregnant Human Myometrium. Reprod Sci 2022; 30:203-220. [PMID: 35715551 PMCID: PMC9810572 DOI: 10.1007/s43032-022-01000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/02/2022] [Indexed: 01/07/2023]
Abstract
The intracellular signaling pathways that regulate myometrial contractions can be targeted by drugs for tocolysis. The agents, 2-APB, glycyl-H-1152, and HC-067047, have been identified as inhibitors of uterine contractility and may have tocolytic potential. However, the contraction-blocking potency of these novel tocolytics was yet to be comprehensively assessed and compared to agents that have seen greater scrutiny, such as the phosphodiesterase inhibitors, aminophylline and rolipram, or the clinically used tocolytics, nifedipine and indomethacin. We determined the IC50 concentrations (inhibit 50% of baseline contractility) for 2-APB, glycyl-H-1152, HC-067047, aminophylline, rolipram, nifedipine, and indomethacin against spontaneous ex vivo contractions in pregnant human myometrium, and then compared their tocolytic potency. Myometrial strips obtained from term, not-in-labor women, were treated with cumulative concentrations of the contraction-blocking agents. Comprehensive dose-response curves were generated. The IC50 concentrations were 53 µM for 2-APB, 18.2 µM for glycyl-H-1152, 48 µM for HC-067047, 318.5 µM for aminophylline, 4.3 µM for rolipram, 10 nM for nifedipine, and 59.5 µM for indomethacin. A single treatment with each drug at the determined IC50 concentration was confirmed to reduce contraction performance (AUC) by approximately 50%. Of the three novel tocolytics examined, glycyl-H-1152 was the most potent inhibitor. However, of all the drugs examined, the overall order of contraction-blocking potency in decreasing order was nifedipine > rolipram > glycyl-H-1152 > HC-067047 > 2-APB > indomethacin > aminophylline. These data provide greater insight into the contraction-blocking properties of some novel tocolytics, with glycyl-H-1152, in particular, emerging as a potential novel tocolytic for preventing preterm birth.
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Jang EJ, Kim YJ, Hwang HS, Yee J, Gwak HS. Associations of GNAS and RGS Gene Polymorphisms with the Risk of Ritodrine-Induced Adverse Events in Korean Women with Preterm Labor: A Cohort Study. Pharmaceutics 2022; 14:pharmaceutics14061220. [PMID: 35745791 PMCID: PMC9227008 DOI: 10.3390/pharmaceutics14061220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Ritodrine, a β2-adrenergic receptor agonist, is among most commonly prescribed tocolytic agents. This study aimed to evaluate the associations of single nucleotide polymorphisms in GNAS, RGS2, and RGS5 with the risk of ritodrine-induced adverse events (AEs) and develop a risk scoring system to identify high-risk patients. This is the prospective cohort study conducted at the Ewha Woman’s University Mokdong Hospital between January 2010 and October 2016. Pregnant women were included if they were treated with ritodrine for preterm labor with regular uterine contractions (at least 3 every 10 min) and cervical dilation. A total of 6, 3, and 5 single nucleotide polymorphisms (SNPs) of GNAS, RGS2, and RGS5 genes were genotyped and compared in patients with and without ritodrine-induced AEs. A total of 163 patients were included in this study. After adjusting confounders, GNAS rs3730168 (per-allele odds ratio (OR): 2.1; 95% confidence interval (95% CI): 1.0–4.3) and RGS2 rs1152746 (per-allele OR: 2.6, 95% CI: 1.1–6.5) were significantly associated with ritodrine-induced AEs. According to the constructed risk scoring models, patients with 0, 1, 2, 3, 4, and 5 points showed 0%, 13%, 19%, 31%, 46%, and 100% risks of AEs. This study suggested that GNAS and RGS2 polymorphisms could affect the risk of AEs in patients treated with ritodrine.
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Affiliation(s)
- Eun-Jeong Jang
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
| | - Young-Ju Kim
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul 07985, Korea;
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea;
| | - Jeong Yee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- Correspondence: (J.Y.); (H.-S.G.); Tel.: +82-2-3277-3052 (J.Y.); +82-2-3277-4376 (H.-S.G.); Fax: +82-2-3277-3051 (J.Y. & H.-S.G.)
| | - Hye-Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- Correspondence: (J.Y.); (H.-S.G.); Tel.: +82-2-3277-3052 (J.Y.); +82-2-3277-4376 (H.-S.G.); Fax: +82-2-3277-3051 (J.Y. & H.-S.G.)
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27
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Campbell F, Salam S, Sutton A, Jayasooriya SM, Mitchell C, Amabebe E, Balen J, Gillespie BM, Parris K, Soma-Pillay P, Chauke L, Narice B, Anumba DO. Interventions for the prevention of spontaneous preterm birth: a scoping review of systematic reviews. BMJ Open 2022; 12:e052576. [PMID: 35568487 PMCID: PMC9109033 DOI: 10.1136/bmjopen-2021-052576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/04/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Globally, 11% of babies are born preterm each year. Preterm birth (PTB) is a leading cause of neonatal death and under-five mortality and morbidity, with lifelong sequelae in those who survive. PTB disproportionately impacts low/middle-income countries (LMICs) where the burden is highest. OBJECTIVES This scoping review sought to the evidence for interventions that reduce the risk of PTB, focusing on the evidence from LMICs and describing how context is considered in evidence synthesis. DESIGN We conducted a scoping review, to describe this wide topic area. We searched five electronic databases (2009-2020) and contacted experts to identify relevant systematic reviews of interventions to reduce the risk of PTB. We included published systematic reviews that examined the effectiveness of interventions and their effect on reducing the risk of PTB. Data were extracted and is described narratively. RESULTS 139 published systematic reviews were included in the review. Interventions were categorised as primary or secondary. The interventions where the results showed a greater effect size and consistency across review findings included treatment of syphilis and vaginal candidiasis, vitamin D supplementation and cervical cerclage. Included in the 139 reviews were 1372 unique primary source studies. 28% primary studies were undertaken in LMIC contexts and only 4.5% undertaken in a low-income country (LIC) Only 10.8% of the reviews sought to explore the impact of context on findings, and 19.4% reviews did not report the settings or the primary studies. CONCLUSION This scoping review highlights the lack of research evidence derived from contexts where the burden of PTB globally is greatest. The lack of rigour in addressing contextual applicability within systematic review methods is also highlighted. This presents a risk of inappropriate and unsafe recommendations for practice within these contexts. It also highlights a need for primary research, developing and testing interventions in LIC settings.
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Affiliation(s)
| | - Shumona Salam
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | | | | | - Caroline Mitchell
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Emmanuel Amabebe
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Julie Balen
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Bronwen M Gillespie
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Kerry Parris
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Lawrence Chauke
- Department of Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg, South Africa
| | - Brenda Narice
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Dilichukwu O Anumba
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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Murata T, Kyozuka H, Yasuda S, Fukuda T, Tanaka T, Fujimori K. Effects of maternal ritodrine hydrochloride administration on the heart rate of preterm fetal sheep with intraamniotic inflammation. PLoS One 2022; 17:e0265872. [PMID: 35358222 PMCID: PMC8970407 DOI: 10.1371/journal.pone.0265872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Ritodrine hydrochloride is used for pregnancy prolongation and intrauterine fetal resuscitation. However, its clinical significance in intraamniotic inflammation during preterm labor and intrauterine fetal distress is unclear. We investigated the effects of maternal ritodrine hydrochloride administration (MRA; 200 μg/min for 2 h, followed by 800 μg/min for 2 h after 24 h) on fetal physiological parameters. For this purpose, we used chronically instrumented pregnant sheep at 113–119 d (term = 145 d) of gestation without (Group 1, n = 5) and with (Group 2, n = 5) intraamniotic inflammation induced by lipopolysaccharide injection into the amniotic cavity. The changes in fetal heart rate (FHR) and short-term variability (STV) and long-term variability (LTV) in FHR, fetal blood pressure, and fetal arterial blood gas (FABG) values were measured before and at 1 and 2 h after initiating MRA. Before MRA, all parameters were similar between Groups 1 and 2; however, there was significantly higher STV in Group 2 than in Group 1 before MRA at 800 μg/min, significantly higher partial arterial pressure of carbon dioxide in FABG in Group 2 than in Group 1 before MRA at 200 μg/min, and significantly lower blood glucose (BG) in Group 2 than in Group 1 before MRA at 800 μg/min. One hour after MRA, the FHR, STV, and LTV were significantly higher at 800 μg/min than those at the baseline in Group 1, as determined by the Friedman test; however, no significant difference was observed in Group 2. Additionally, the FABG pH significantly decreased 1 h after MRA at 800 μg/min in Group 2, whereas FABG lactate and BG significantly increased 2 h after MRA at 800 μg/min in Groups 1 and 2. Thus, short-term MRA at 800 μg/min increased the FHR, STV, and LTV significantly; these values were further modified under intraamniotic inflammation.
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Affiliation(s)
- Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
- * E-mail:
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Teruyoshi Tanaka
- Department of Biomolecular Science, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Do obstetric units adhere to the evidence-based national guideline? A Germany-wide survey on the current practice of initial tocolysis. Eur J Obstet Gynecol Reprod Biol 2022; 270:133-138. [DOI: 10.1016/j.ejogrb.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 12/22/2022]
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Preterm labor is a distinct process from term labor following computational analysis of human myometrium. Am J Obstet Gynecol 2022; 226:106.e1-106.e16. [PMID: 34245680 DOI: 10.1016/j.ajog.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/09/2021] [Accepted: 07/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The onset of the term human parturition involves myometrial gene expression changes to transform the uterus from a quiescent to a contractile phenotype. It is uncertain whether the same changes occur in the uterus during preterm labor. OBJECTIVE This study aimed to compare the myometrial gene expression between term and preterm labor and to determine whether the presence of acute clinical chorioamnionitis or twin gestation affects these signatures. STUDY DESIGN Myometrial specimens were collected during cesarean delivery from the following 7 different groups of patients: term not in labor (n=31), term labor (n=13), preterm not in labor (n=21), preterm labor with acute clinical chorioamnionitis (n=6), preterm labor with no acute clinical chorioamnionitis (n=9), twin preterm not in labor (n=8), and twin preterm labor with no acute clinical chorioamnionitis (n=5). RNA was extracted, reverse transcribed and quantitative polymerase chain reactions were performed on 44 candidate genes (with evidence for differential expression in human term labor) using the Fluidigm platform. Computational analysis was performed using 2-class unpaired Wilcoxon tests and principal component analysis. RESULTS Computational analysis revealed that gene expression in the preterm myometrium, irrespective of whether in labor or not in labor, clustered tightly and is clearly different from the term labor and term not-in-labor groups. This was true for both singleton and twin pregnancies. Principal component analysis showed that 57% of the variation was explained by 3 principal components. These 44 genes interact in themes of prostaglandin activity and inflammatory signaling known to be important during term labor, but are not a full representation of the myometrium transcriptional activity. CONCLUSION The myometrial contractions associated with preterm labor are associated with a pattern of gene expression that is distinct from term labor. Therefore, preterm labor may be initiated by a different myometrial process or processes outside the myometrium.
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Wen YH, Wang IT, Lin FJ, Hsu HY, Wu CH. Association between the prolonged use of magnesium sulfate for tocolysis and fracture risk among infants. Medicine (Baltimore) 2021; 100:e28310. [PMID: 34941123 PMCID: PMC8701460 DOI: 10.1097/md.0000000000028310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/23/2021] [Indexed: 01/05/2023] Open
Abstract
In 2013, the U.S. Food and Drug Administration issued a safety warning that cautioned against using magnesium sulfate (MgSO4) injections for more than 5 to 7 days to stop preterm delivery due to the bone problems subsequently observed in infants. However, the warning was mainly based on case reports, and further investigation is necessary to determine whether prolonged MgSO4 use increased infant fractures.To evaluate whether prolonged MgSO4 use for tocolysis increased the risk of subsequent fractures among infants.A retrospective population-based cohort study was conducted with a new-user study design using the National Health Insurance Database in Taiwan. We included pregnant women aged between 12 and 55 years old who delivered a live-born singleton. The enrollment period was from January 1, 2012 to December 31, 2014. The exposure group was defined as pregnant women who received MgSO4 injection for >5 days during pregnancy, while those not receiving any tocolytics were the reference group. The outcome was any bone fracture among the infants during the 2-year follow-up period. Propensity score matching and Cox proportional hazards regression models were used to estimate the hazard of fractures. We further studied the effect of MgSO4 treatment with varied dosages and durations of treatment in the sensitivity analyses.Among the 4092 pregnant women in the database, 693 (16.9%) of them were included in the exposure group. The hazard ratio of infant fractures among prolonged MgSO4 users was not significantly different from that of tocolytic nonusers in adjusted models (adjusted hazard ratio (aHR) = 1.48; 95% confidence interval (CI) = 0.59-3.71). A similar lack of significance was found in the sensitivity analyses (aHR = 1.45; 95% CI = 0.40-5.28 for larger treatment dosage; aHR = 2.52; 95% CI = 0.49-12.98 for longer treatment duration).Prolonged MgSO4 tocolysis use did not increase the risk of infant fractures. Our findings reconfirmed the safety of MgSO4 as a tocolytic treatment.
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Affiliation(s)
- Yung-Hsiang Wen
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - I-Te Wang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsing-Yu Hsu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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32
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Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, Welton NJ, Baxter H, Kessler D, Churchill R, Lewis G. Pharmacological and Psychotherapeutic Interventions for Management of Obsessive-compulsive Disorder in Adults: A Systematic Review and Network Meta-analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:457-467. [PMID: 35747299 DOI: 10.1176/appi.focus.19402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reprinted under Creative Commons CC-BY license.
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Affiliation(s)
- Petros Skapinakis
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Deborah M Caldwell
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - William Hollingworth
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Peter Bryden
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Naomi A Fineberg
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Paul Salkovskis
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Nicky J Welton
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Helen Baxter
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - David Kessler
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Rachel Churchill
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK (P Skapinakis, Prof G Lewis); Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece (P Skapinakis); School of Social and Community Medicine, University of Bristol, Bristol, UK (D M Caldwell, Prof W Hollingworth, P Bryden, N J Welton, H Baxter, D Kessler); Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK, and Highly Specialised Obsessive-Compulsive Disorder and Body Dysmorphic Disorder Services, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK (N A Fineberg); Department of Psychology, University of Bath, Bath, UK (Prof P Salkovskis); and Centre for Reviews and Dissemination, University of York, York, UK (Prof R Churchill)
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Wendremaire M, Hadi T, Pezze M, Barrichon M, Lopez T, Neiers F, Sagot P, Garrido C, Lirussi F. Macrophage-induced reactive oxygen species promote myometrial contraction and labor-associated mechanisms†. Biol Reprod 2021; 102:1326-1339. [PMID: 32167534 DOI: 10.1093/biolre/ioaa032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/31/2019] [Accepted: 03/12/2020] [Indexed: 11/14/2022] Open
Abstract
At labor, the myometrium is infiltrated by a massive influx of macrophages that secrete high levels of pro-inflammatory cytokines inducing the expression of specific labor-associated markers. However, the interactions between myocytes and macrophages and the role of macrophages in the myometrium at labor remain to be elucidated. In this work, we studied the role of myometrium-infiltrated macrophages and their interaction with myocytes in lipopolysaccharide-induced preterm labor. A co-culture model of human primary myometrial cells and macrophages was developed and validated. Collagen lattices were used to evaluate myocyte contraction. Differentiation steps were assessed by (i) phalloidin and vinculin staining for cytoskeleton reorganization, (ii) gap junction protein alpha 1 expression and scrape loading/dye transfer with Lucifer Yellow for gap junction intercellular communication, and (iii) calcium imaging for cell excitability. We demonstrated that macrophages favored lipopolysaccharide-induced contraction and early differentiation of myometrial cells. Transwell assays showed that previous activation of macrophages by lipopolysaccharide was essential for this differentiation and that macrophage/myocyte interactions involved macrophage release of reactive oxygen species (ROS). The effects of macrophage-released ROS in myometrial cell transactivation were mimicked by H2O2, suggesting that superoxide anion is a major intermediate messenger in macrophage/myocyte crosstalk during labor. These novel findings provide the foundation for innovative approaches to managing preterm labor, specifically the use of antioxidants to inhibit the initial stages of labor before the contractile phenotype has been acquired. In addition, the co-culture model developed by our team could be used in future research to decipher pathophysiological signaling pathways or screen/develop new tocolytics.
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Affiliation(s)
- Maeva Wendremaire
- Institut National de la Santéc et de la Recherche Médicale, Lipides Nutrition Cancer, Dijon, France.,Université de Bourgogne Franche-Comté, Lipides Nutrition Cancer, Dijon, France.,Laboratoire de Pharmacologie-Toxicologie, CHU Dijon-Bourgogne, Dijon, France
| | - Tarik Hadi
- Institut National de la Santéc et de la Recherche Médicale, Lipides Nutrition Cancer, Dijon, France.,Université de Bourgogne Franche-Comté, Lipides Nutrition Cancer, Dijon, France.,Department of Cardiac Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Maria Pezze
- Institut National de la Santéc et de la Recherche Médicale, Lipides Nutrition Cancer, Dijon, France.,Université de Bourgogne Franche-Comté, Lipides Nutrition Cancer, Dijon, France
| | - Marina Barrichon
- Institut National de la Santéc et de la Recherche Médicale, Lipides Nutrition Cancer, Dijon, France.,Université de Bourgogne Franche-Comté, Lipides Nutrition Cancer, Dijon, France
| | - Tatiana Lopez
- Institut National de la Santéc et de la Recherche Médicale, Lipides Nutrition Cancer, Dijon, France.,Université de Bourgogne Franche-Comté, Lipides Nutrition Cancer, Dijon, France
| | - Fabrice Neiers
- Centre des Sciences du Goût et de l'Alimentation, INRA, CNRS, Université de Bourgogne Franche-Comté, Dijon, France
| | - Paul Sagot
- Service de Gynécologie-Obstétrique, CHU Dijon-Bourgogne, Dijon, France
| | - Carmen Garrido
- Institut National de la Santéc et de la Recherche Médicale, Lipides Nutrition Cancer, Dijon, France.,Université de Bourgogne Franche-Comté, Lipides Nutrition Cancer, Dijon, France.,Centre Georges François Leclerc, Dijon, France
| | - Frédéric Lirussi
- Institut National de la Santéc et de la Recherche Médicale, Lipides Nutrition Cancer, Dijon, France.,Université de Bourgogne Franche-Comté, Lipides Nutrition Cancer, Dijon, France.,Laboratoire de Pharmacologie-Toxicologie, CHU Dijon-Bourgogne, Dijon, France
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Marchand G, Blumrick R, Ruuska AD, Ware K, Masoud AT, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Ulibarri H, Sainz K. Novel oxytocin receptor antagonists for tocolysis: a systematic review and meta-analysis of the available data on the efficacy, safety, and tolerability of retosiban. Curr Med Res Opin 2021; 37:1677-1688. [PMID: 34134590 DOI: 10.1080/03007995.2021.1944076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the efficacy, safety, and tolerability of retosiban-a novel tocolytic unavailable in the US-in the management of preterm labor. METHODS We searched ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS, Web of Science, and the Cochrane Library for relevant clinical trials using the terms "retosiban" and "preterm labor" through 09/2020. We included all published randomized clinical trials (three) that compared retosiban to placebo for preterm labor, excluding conferences, books, reviews, posters, case reports, and animal studies. We analyzed homogeneous data under the fixed-effects model and heterogeneous data under the random-effects model. RESULTS We included all randomized clinical trials addressing this topic, which ultimately resulted in three trials with a total of 116 patients. There were no significant differences between retosiban and placebo in births at term (RR = 0.41, p = .02), births ≤7 days from the first study treatment (RR = 0.59, p = .23), or administration of rescue tocolytic (RR = 0.36, p = .07); the maternal adverse events of headache, anemia, constipation, or urinary tract infection (p > .05); or neonatal outcomes of Apgar score at 1 min (p = .88) or 5 min (p = .69), weight (p = .23), head circumference (p = .55), malnutrition (p = .27), hyperbilirubinemia (RR = 0.56, p = .21), jaundice (RR = 1.21, p = .84), respiratory distress (RR = 0.53, p = .49), or tachypnea (RR = 0.40, p = .42). CONCLUSION With the limited high quality evidence available, retosiban demonstrates no clear benefit over placebo in the management of preterm labor. Nevertheless, its favorable safety profile, oral bioavailability, and novel mechanism of action and the limited number of studies available for review warrant further analysis.
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Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Alexandra D Ruuska
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Kelly Ware
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- International University of Health Sciences, Basseterre, St. Kitts
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Moylan HEC, Nguyen-Ngo C, Lim R, Lappas M. The short-chain fatty acids butyrate and propionate protect against inflammation-induced activation of mediators involved in active labor: implications for preterm birth. Mol Hum Reprod 2021; 26:452-468. [PMID: 32236411 DOI: 10.1093/molehr/gaaa025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/01/2020] [Indexed: 12/12/2022] Open
Abstract
Spontaneous preterm birth is a global health issue affecting up to 20% of pregnancies and leaves a legacy of neurodevelopmental complications. Inflammation has been implicated in a significant proportion of preterm births, where pro-inflammatory insults trigger production of additional pro-inflammatory and pro-labor mediators. Thus, novel therapeutics that can target inflammation may be a novel avenue for preventing preterm birth and improving adverse fetal outcomes. Short-chain fatty acids (SCFAs), such as butyrate and propionate, are dietary metabolites produced by bacterial fermentation of fiber in the gut. SCFAs are known to possess anti-inflammatory properties and have been found to function through G-coupled-receptors and histone deacetylases. Therefore, this study aimed to investigate the effect of SCFAs on pro-inflammatory and pro-labor mediators in an in vitro model of preterm birth. Primary human cells isolated from myometrium and fetal membranes (decidua, amnion mesenchymal and amnion epithelial cells) were stimulated with the pro-inflammatory cytokines tumor necrosis factor alpha (TNF) or interleukin 1B (IL1B). The SCFAs butyrate and propionate suppressed inflammation-induced expression of pro-inflammatory cytokines and chemokines, adhesion molecules, the uterotonic prostaglandin PGF2alpha and enzymes involved in remodeling of myometrium and degradation of the fetal membranes. Notably, propionate and butyrate also suppressed inflammation-induced prostaglandin signaling and myometrial cell contraction. These effects appear to be mediated through suppression of nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) activation. These results suggest that the SCFAs may be able to prevent myometrial contractions and rupture of membranes. Further in vivo studies are warranted to identify the efficacy of SCFAs as a novel anti-inflammatory therapeutic to prevent inflammation-induced spontaneous preterm birth.
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Affiliation(s)
- Hope Eveline Carter Moylan
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Caitlyn Nguyen-Ngo
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Ratana Lim
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia.,Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia.,Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Kalansuriya DM, Lim R, Lappas M. In vitro selenium supplementation suppresses key mediators involved in myometrial activation and rupture of fetal membranes. Metallomics 2021; 12:935-951. [PMID: 32373896 DOI: 10.1039/d0mt00063a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spontaneous preterm birth, which can affect up to 20% of all pregnancies, is the greatest contributor to perinatal morbidity and mortality. Infection is the leading pathological cause of spontaneous preterm birth. Infection activates the maternal immune system, resulting in the upregulation of pro-inflammatory and pro-labor mediators that activate myometrial contractions and rupture of fetal membranes. Anti-inflammatory agents therefore have the potential for the prevention of spontaneous preterm birth. Selenium, an essential micronutrient, has been shown to be a potent anti-inflammatory regulator. Notably, clinical and epidemiological studies have suggested a link between selenium and preterm birth. Thus, the aim of this study was to assess the effect of selenite (an inorganic form of selenium) on the expression of pro-inflammatory and pro-labor mediators in human gestational tissues. Human fetal membranes and myometrium were pre-incubated with or without selenite before incubation with the bacterial product lipopolysaccharide (LPS) to stimulate inflammation associated with preterm birth. Selenite blocked LPS-induced expression of pro-inflammatory cytokines and chemokines and enzymes involved in remodelling of myometrium and degradation of fetal membranes. Of note, selenite also suppressed myometrial activation induced by inflammation as evidenced by a decrease in LPS-induced prostaglandin signalling and myometrial cell contractility. These effects of selenite were mediated by the MAPK protein ERK as selenite blunted LPS induced activation of ERK. In conclusion, selenite suppresses key mediators involved in inflammation induced activation of mediators involved in active labor in human fetal membranes and myometrium. These findings support recent clinical studies demonstrating selenium supplementation is associated with decreased incidence of spontaneous preterm birth.
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Affiliation(s)
- Dineli Matheesha Kalansuriya
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Level 4/163 Studley Road, Heidelberg, 3084, Victoria, Australia.
| | - Ratana Lim
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Level 4/163 Studley Road, Heidelberg, 3084, Victoria, Australia. and Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Level 4/163 Studley Road, Heidelberg, 3084, Victoria, Australia. and Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Saade GR, Shennan A, Beach KJ, Hadar E, Parilla BV, Snidow J, Powell M, Montague TH, Liu F, Komatsu Y, McKain L, Thornton S. Randomized Trials of Retosiban Versus Placebo or Atosiban in Spontaneous Preterm Labor. Am J Perinatol 2021; 38:e309-e317. [PMID: 32380566 DOI: 10.1055/s-0040-1710034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to assess the efficacy and safety of retosiban in spontaneous preterm labor (sPTL). STUDY DESIGN Two multicenter, randomized, and double-blind trials compared retosiban with placebo and retosiban with atosiban in women with a singleton pregnancy and intact membranes in sPTL at 24 to 336/7 weeks' gestation. Coprimary endpoints in the placebo-controlled trial were time to delivery (TTD) or treatment failure (whichever occurred first) and neonatal composite morbidity and mortality. The primary endpoint of the atosiban comparator trial was TTD. RESULTS The trials were terminated early because of slow recruitment. The placebo-controlled trial enrolled 23 participants (February 2016-July 2017; 2.6% of target);the atosiban-comparator trial enrolled 97 (March 2015-August 2017; 29% of target). Baseline participant characteristics were similar between treatments. In the placebo-controlled trial, mean gestational ages at randomization were 30.8 (retosiban, n = 10) and 30.5 weeks (placebo, n = 13), and mean times to delivery/treatment failure were 18.9 days (retosiban) and 11.1 days (placebo). Two and four neonates in the retosiban and placebo groups, respectively, had ≥1 component of the neonatal composite endpoint. In the atosiban-comparator trial, mean gestational age at randomization was 31.5 weeks (for both retosiban, n = 47, and atosiban, n = 50), and adjusted mean TTDs were 32.51 days (retosiban) and 33.71 days (atosiban; p > 0.05). Adverse events were no more common with retosiban than placebo or atosiban. CONCLUSION Despite considerable efforts to conduct two adequate and well-controlled studies in patients with sPTL, both studies were unable to recruit effectively and consequently terminated prematurely. Key factors negatively affecting participation were patient and physician resistance to use of a placebo comparator, lack of investigator consensus on diagnostic criteria and acceptance of protocol procedures, and ethics committee decisions. Meaningful cooperation between pharmaceutical companies, regulatory authorities, and the obstetric community is essential for future development of drugs to treat sPTL.
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Affiliation(s)
- George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, UK
| | - Kathleen J Beach
- Department of Maternal and Fetal Medicine, GSK, Research Triangle Park, North Carolina
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barbara V Parilla
- Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Jerry Snidow
- Alternative Discovery and Development, GSK, Research Triangle Park, North Carolina
| | - Marcy Powell
- Central Safety Department, GSK, Research Triangle Park, North Carolina
| | - Timothy H Montague
- Clinical Statistics, Quantitative Sciences, GSK, Collegeville, Pennsylvania
| | - Feng Liu
- Clinical Statistics, Quantitative Sciences, GSK, Collegeville, Pennsylvania
| | - Yosuke Komatsu
- Maternal and Neonatal Health Unit, Alternative Discovery & Development, R&D, GSK, Research Triangle Park, North Carolina
| | - Laura McKain
- Pharmacovigilance, PPD, Wilmington, North Carolina
| | - Steven Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Coler BS, Shynlova O, Boros-Rausch A, Lye S, McCartney S, Leimert KB, Xu W, Chemtob S, Olson D, Li M, Huebner E, Curtin A, Kachikis A, Savitsky L, Paul JW, Smith R, Adams Waldorf KM. Landscape of Preterm Birth Therapeutics and a Path Forward. J Clin Med 2021; 10:2912. [PMID: 34209869 PMCID: PMC8268657 DOI: 10.3390/jcm10132912] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Preterm birth (PTB) remains the leading cause of infant morbidity and mortality. Despite 50 years of research, therapeutic options are limited and many lack clear efficacy. Tocolytic agents are drugs that briefly delay PTB, typically to allow antenatal corticosteroid administration for accelerating fetal lung maturity or to transfer patients to high-level care facilities. Globally, there is an unmet need for better tocolytic agents, particularly in low- and middle-income countries. Although most tocolytics, such as betamimetics and indomethacin, suppress downstream mediators of the parturition pathway, newer therapeutics are being designed to selectively target inflammatory checkpoints with the goal of providing broader and more effective tocolysis. However, the relatively small market for new PTB therapeutics and formidable regulatory hurdles have led to minimal pharmaceutical interest and a stagnant drug pipeline. In this review, we present the current landscape of PTB therapeutics, assessing the history of drug development, mechanisms of action, adverse effects, and the updated literature on drug efficacy. We also review the regulatory hurdles and other obstacles impairing novel tocolytic development. Ultimately, we present possible steps to expedite drug development and meet the growing need for effective preterm birth therapeutics.
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Affiliation(s)
- Brahm Seymour Coler
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Oksana Shynlova
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada; (O.S.); (A.B.-R.); (S.L.)
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Adam Boros-Rausch
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada; (O.S.); (A.B.-R.); (S.L.)
| | - Stephen Lye
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada; (O.S.); (A.B.-R.); (S.L.)
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Stephen McCartney
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
| | - Kelycia B. Leimert
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R7, Canada; (K.B.L.); (W.X.); (D.O.)
| | - Wendy Xu
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R7, Canada; (K.B.L.); (W.X.); (D.O.)
| | - Sylvain Chemtob
- Departments of Pediatrics, Université de Montréal, Montréal, QC H3T 1J4, Canada;
| | - David Olson
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T6G 2R7, Canada; (K.B.L.); (W.X.); (D.O.)
- Departments of Pediatrics and Physiology, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Miranda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
- Department of Biological Sciencies, Columbia University, New York, NY 10027, USA
| | - Emily Huebner
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
| | - Anna Curtin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
| | - Leah Savitsky
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
| | - Jonathan W. Paul
- Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (J.W.P.); (R.S.)
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (J.W.P.); (R.S.)
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Kristina M. Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA; (B.S.C.); (S.M.); (M.L.); (E.H.); (A.C.); (A.K.); (L.S.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
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Ibrahim MH, Elfaki T, Elhassan EM, Abdelrahiem SK, Adam I. The effectiveness of nifedipine/indomethacin combination therapy and nifedipine monotherapy for postponing preterm birth (25-34 weeks of gestation) in Sudanese women: a randomized clinical trial study protocol. BMC Pregnancy Childbirth 2021; 21:457. [PMID: 34187394 PMCID: PMC8244195 DOI: 10.1186/s12884-021-03951-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm birth is the most common cause of neonatal morbidity and mortality. Tocolytics are considered a standard treatment for women with threatened preterm delivery to allow time for maternal steroid administration and transfer to referral centers with neonatal intensive care units. However, there is controversy about the best tocolytic therapy to be considered as the first choice. The aim of this study is to compare the tocolytic effectiveness and tolerability of combination therapy with nifedipine and indomethacin versus nifedipine monotherapy among Sudanese women with preterm labor (PTL) as well as to compare the possible neonatal outcomes associated with each drug. METHODS/DESIGN This is a randomized controlled clinical trial to be conducted in the Medani Maternity Hospital, Sudan. Women aged 18-40 years that are diagnosed with preterm labor and have a gestational age between 25 and 34 weeks will be eligible to participate in this trial. The diagnosis of threatened PTL is defined as persistent uterine contractions "(four contractions every 20 min or eight contractions every 60 min)" with cervical changes "(cervical effacement ≤80% or cervical dilatation >two cm)". Patients will be eligible regardless of the presentation of the fetus. It will be randomly decided whether participants receive nifedipine/indomethacin combination therapy or nifedipine monotherapy. The primary outcome is the number of women who do not deliver and do not need alternative tocolytic drug (terbutaline). The secondary outcome is an estimated association with neonatal morbidity and mortality. The sample size will be 117 subjects in each arm of the study, according to a type I error of 0.05 and a study power of 80%. DISCUSSION We expect higher effectiveness of the combination indomethacin/nifedipine tocolytic therapy compared with nifedipine monotherapy. We plan to suggest this combination therapy as the best option for postponing PTL. TRIAL REGISTRATION Clinical trial registration: PACTR202004681537890 , date of registration: March 8, 2020.
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Affiliation(s)
- Mohammed H Ibrahim
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah City, Qassim Region, 51911, Saudi Arabia
| | - Tahani Elfaki
- Department of Obstetrics and Gynecology, University of Gezira, Medani, Sudan.
| | - Elhassan M Elhassan
- Department of Obstetrics and Gynecology, University of Gezira, Medani, Sudan
| | - Somia K Abdelrahiem
- Department of Obstetrics and Gynecology, University of Gezira, Medani, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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40
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Khader N, Shchuka VM, Shynlova O, Mitchell JA. Transcriptional control of parturition: insights from gene regulation studies in the myometrium. Mol Hum Reprod 2021; 27:gaab024. [PMID: 33823545 PMCID: PMC8126590 DOI: 10.1093/molehr/gaab024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/09/2021] [Indexed: 12/19/2022] Open
Abstract
The onset of labour is a culmination of a series of highly coordinated and preparatory physiological events that take place throughout the gestational period. In order to produce the associated contractions needed for foetal delivery, smooth muscle cells in the muscular layer of the uterus (i.e. myometrium) undergo a transition from quiescent to contractile phenotypes. Here, we present the current understanding of the roles transcription factors play in critical labour-associated gene expression changes as part of the molecular mechanistic basis for this transition. Consideration is given to both transcription factors that have been well-studied in a myometrial context, i.e. activator protein 1, progesterone receptors, oestrogen receptors, and nuclear factor kappa B, as well as additional transcription factors whose gestational event-driving contributions have been demonstrated more recently. These transcription factors may form pregnancy- and labour-associated transcriptional regulatory networks in the myometrium to modulate the timing of labour onset. A more thorough understanding of the transcription factor-mediated, labour-promoting regulatory pathways holds promise for the development of new therapeutic treatments that can be used for the prevention of preterm labour in at-risk women.
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Affiliation(s)
- Nawrah Khader
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Virlana M Shchuka
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Oksana Shynlova
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, ON, Canada
| | - Jennifer A Mitchell
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
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The Antenatal and Postnatal Consequences of Antenatal Exposure to Prolonged Low Dose Indomethacin. J Clin Med 2021; 10:jcm10091851. [PMID: 33923146 PMCID: PMC8122978 DOI: 10.3390/jcm10091851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022] Open
Abstract
Despite its many clinical applications, indomethacin is seldom used in pregnancy, principally because of concerns regarding the potential for constriction of the arterial duct. The aim of this study was to document adverse antenatal effects and postnatal outcomes after in utero exposure to low-dose indomethacin. We studied a retrospective cohort of pregnancies between 2005 and 2016 at the John Radcliffe Hospital, Oxford, UK, in which mothers at extremely high risk of preterm birth were treated as prophylaxis with indomethacin 25 mg, 12 hourly, before 29 weeks. Antenatal effects on the arterial duct and postnatal outcomes were analysed. Overall, 198 fetuses had in utero follow-up, and 13 (6.6%) had ductal constriction, all within 9 days of starting treatment. No ductal constriction was seen in pregnancies when therapy was started before 20 weeks, and all effects were reversed after cessation of therapy. An analysis of postnatal complications was possible in 181 neonates. There were eight (4.4%) neonatal deaths, all but one associated with extreme preterm birth. Seven (5%) patent ductus arteriosus cases occurred in the 140 neonates delivered after 28 weeks who were alive at discharge. Postnatal complications were not more common in neonates in whom antenatal ductal constriction had been demonstrated. In conclusion, fetuses exposed to prolonged low dose indomethacin have a low incidence of in utero complications; these complications can be diagnosed with ultrasound and are reversible. Adverse postnatal events are related to gestation at birth and do not appear more common.
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Malik M, Roh M, England SK. Uterine contractions in rodent models and humans. Acta Physiol (Oxf) 2021; 231:e13607. [PMID: 33337577 PMCID: PMC8047897 DOI: 10.1111/apha.13607] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/18/2022]
Abstract
Aberrant uterine contractions can lead to preterm birth and other labour complications and are a significant cause of maternal morbidity and mortality. To investigate the mechanisms underlying dysfunctional uterine contractions, researchers have used experimentally tractable small animal models. However, biological differences between humans and rodents change how researchers select their animal model and interpret their results. Here, we provide a general review of studies of uterine excitation and contractions in mice, rats, guinea pigs, and humans, in an effort to introduce new researchers to the field and help in the design and interpretation of experiments in rodent models.
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Affiliation(s)
- Manasi Malik
- Center for Reproductive Health SciencesDepartment of Obstetrics and GynecologyWashington University School of MedicineSt. LouisMOUSA
| | - Michelle Roh
- Center for Reproductive Health SciencesDepartment of Obstetrics and GynecologyWashington University School of MedicineSt. LouisMOUSA
| | - Sarah K. England
- Center for Reproductive Health SciencesDepartment of Obstetrics and GynecologyWashington University School of MedicineSt. LouisMOUSA
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Hyuga S, Parry RC, Danielsson J, Vink J, Fu XW, Wu A, Dan W, Yim PD, Gallos G. Anoctamin 1 antagonism potentiates conventional tocolytic-mediated relaxation of pregnant human uterine smooth muscle. J Physiol Sci 2021; 71:7. [PMID: 33618673 PMCID: PMC9352361 DOI: 10.1186/s12576-021-00792-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/07/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Currently available tocolytic agents are not effective treatment for preterm labor beyond 48 h. A major reason is the development of maternal side effects which preclude the maintenance of an effective steady-state drug concentration. One strategy that can mitigate these side effects is utilizing synergistic drug combinations to reduce the drug concentrations necessary to elicit a clinical effect. We have previously shown that three anoctamin 1 (ANO1) antagonists mediate potent relaxation of precontracted human uterine smooth muscle (USM). In this study, we aimed to determine whether a combination of sub-relaxatory doses of tocolytic drugs in current clinical use [the L-type voltage-gated calcium channel (VGCC) blocker, nifedipine (NIF); and the β2-adrenergic (β2AR) agonist, terbutaline (TRB)] will potentiate USM relaxation with two ANO1 antagonists [benzbromarone (BB) and MONNA (MN)]. OBJECTIVE This study sought to examine the synergistic potency and mechanistic basis of two ANO1 antagonists with currently available tocolytic drugs. Functional endpoints assessed included relaxation of pre-contracting pregnant human USM tissue, inhibition of intracellular calcium release, and reduction of spontaneous transient inward current (STIC) recordings in human uterine smooth muscle cells. METHODS Human myometrial strips and primary human USM cells were used in organ bath and calcium flux experiments with different combinations of sub-threshold doses of ANO1 antagonists and terbutaline or nifedipine to determine if ANO1 antagonists potentiate tocolytic drugs. RESULTS The combination of sub-threshold doses of two ANO1 antagonists and current tocolytic drugs demonstrate a significant degree of synergy to relax human pregnant USM compared to the effects achieved when these drugs are administered individually. CONCLUSION A combination of sub-threshold doses of VGCC blocker and β2AR agonist with ANO1 antagonists potentiates relaxation of oxytocin-induced contractility and calcium flux in human USM ex vivo. Our findings may serve as a foundation for novel tocolytic drug combinations.
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Affiliation(s)
- Shunsuke Hyuga
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA
| | - Robert C Parry
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA
| | - Jennifer Danielsson
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA
| | - Joy Vink
- Department of Obstetrics & Gynecology, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Xiao Wen Fu
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA
| | - Amy Wu
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA
| | - William Dan
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA
| | - Peter D Yim
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA
| | - George Gallos
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W. 168th St. P&S Box 46, New York, NY, 10032, USA.
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Jaju PB. Effectiveness and Safety of Isoxsuprine Hydrochloride as Tocolytic Agent in Arresting Active/Threatened Preterm Labor and Its Role in Maintenance Tocolysis: A Prospective, Open-Label Study. Am J Perinatol 2021; 38:291-295. [PMID: 31550735 DOI: 10.1055/s-0039-1696720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the study is to obtain insights on the short and long-term safety and effectiveness of isoxsuprine hydrochloride as a tocolytic agent in the management of PTL. STUDY DESIGN In this prospective, single-center, noncomparative study, patients (with preterm labor at gestational age of 24-37 weeks) were administered intravenous (IV) infusion of 40-mg isoxsuprine hydrochloride until uterine quiescence, followed by intramuscular (IM) injection of isoxsuprine hydrochloride 10 mg/4-hourly for first 24 hours and maintained with retard 40-mg sustained release capsule (two times a day) till the time of delivery or 37 completed weeks of pregnancy. RESULTS All patients (n = 50) achieved successful tocolysis in 24 hours and 48 hours postadministration of isoxsuprine hydrochloride (IV/IM/oral). Mean (±SD) gestation age at the time of delivery was 39.8 ± 2.1 weeks, with latency period of 58.5 ± 18.7 days. Pregnancy outcomes were normal in all the patients and no congenital anomaly/fetal infection was reported. Mean (±SD) fetal birth weight was 2.7 ± 0.3 kg; mean (±SD) Apgar score at 1 and 5 minutes were 7.5 ± 0.6 and 9.2 ± 0.4, respectively. Maternal tachycardia and vomiting (8.0% each) were the commonly reported adverse drug reactions, which were resolved with dose adjustment. CONCLUSION Isoxsuprine was found to be an effective and well-tolerated tocolytic agent in arresting PTL, in turn resulting in the overall improvement in maternal and perinatal outcomes.
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Affiliation(s)
- Purushottam B Jaju
- Department of Obstetrics and Gynecology, B.M. Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, India
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D'Souza R, Ashraf R, Rowe H, Zipursky J, Clarfield L, Maxwell C, Arzola C, Lapinsky S, Paquette K, Murthy S, Cheng MP, Malhamé I. Pregnancy and COVID-19: pharmacologic considerations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:195-203. [PMID: 32959455 PMCID: PMC7537532 DOI: 10.1002/uog.23116] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
In this review, we summarize evidence regarding the use of routine and investigational pharmacologic interventions for pregnant and lactating patients with coronavirus disease 2019 (COVID-19). Antenatal corticosteroids may be used routinely for fetal lung maturation between 24 and 34 weeks' gestation, but decisions in those with critical illness and those < 24 or > 34 weeks' gestation should be made on a case-by-case basis. Magnesium sulfate may be used for seizure prophylaxis and fetal neuroprotection, albeit cautiously in those with hypoxia and renal compromise. There are no contraindications to using low-dose aspirin to prevent placenta-mediated pregnancy complications when indicated. An algorithm for thromboprophylaxis in pregnant patients with COVID-19 is presented, which considers disease severity, timing of delivery in relation to disease onset, inpatient vs outpatient status, underlying comorbidities and contraindications to the use of anticoagulation. Nitrous oxide may be administered for labor analgesia while using appropriate personal protective equipment. Intravenous remifentanil patient-controlled analgesia should be used with caution in patients with respiratory depression. Liberal use of neuraxial labor analgesia may reduce the need for emergency general anesthesia which results in aerosolization. Short courses of non-steroidal anti-inflammatory drugs can be administered for postpartum analgesia, but opioids should be used with caution due to the risk of respiratory depression. For mechanically ventilated pregnant patients, neuromuscular blockade should be used for the shortest duration possible and reversal agents should be available on hand if delivery is imminent. To date, dexamethasone is the only proven and recommended experimental treatment for pregnant patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen. Although hydroxycholoroquine, lopinavir/ritonavir and remdesivir may be used during pregnancy and lactation within the context of clinical trials, data from non-pregnant populations have not shown benefit. The role of monoclonal antibodies (tocilizumab), immunomodulators (tacrolimus), interferon, inhaled nitric oxide and convalescent plasma in pregnancy and lactation needs further evaluation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R. D'Souza
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
- Lunenfeld‐Tanenbaum Research InstituteTorontoCanada
| | - R. Ashraf
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
| | - H. Rowe
- Neonatal and Pediatric PharmacySurrey Memorial Hospital, Fraser HealthSurreyCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
| | - J. Zipursky
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
- Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
| | - L. Clarfield
- Faculty of MedicineUniversity of TorontoTorontoCanada
| | - C. Maxwell
- Division of Maternal‐Fetal Medicine, Department of Obstetrics & GynaecologyMount Sinai Hospital, University of TorontoTorontoCanada
| | - C. Arzola
- Department of Anesthesiology and Pain MedicineMount Sinai Hospital, University of TorontoTorontoCanada
| | - S. Lapinsky
- Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
| | - K. Paquette
- Division of NeonatologyMontreal Children's HospitalMontrealCanada
- Department of PediatricsMcGill UniversityMontrealCanada
- Research Institute of the McGill University Health CentreMontrealCanada
| | - S. Murthy
- Division of Critical Care, Department of PaediatricsUniversity of British ColumbiaVancouverCanada
- BC Children's Hospital and Sunny Hill Health CentreVancouverBCCanada
| | - M. P. Cheng
- Research Institute of the McGill University Health CentreMontrealCanada
- Divisions of Infectious Diseases and Medical Microbiology, Department of Medicine, McGill University Health CentreMcGill UniversityMontrealCanada
- McGill Interdisciplinary Initiative in Infection and ImmunityMontrealCanada
| | - I. Malhamé
- Research Institute of the McGill University Health CentreMontrealCanada
- Division of General Internal Medicine, Department of Medicine, McGill University Health CentreMcGill UniversityMontrealCanada
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Morgan AS, Waheed S, Gajree S, Marlow N, David AL. Maternal and infant morbidity following birth before 27 weeks of gestation: a single centre study. Sci Rep 2021; 11:288. [PMID: 33431902 PMCID: PMC7801674 DOI: 10.1038/s41598-020-79445-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
Delivery at extreme preterm gestational ages (GA) [Formula: see text] weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks' GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes.
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Affiliation(s)
- Andrei S Morgan
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Hôpital Tenon, Rue de la Chine, 75020, Paris, France.,SAMU 93-SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Saadia Waheed
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Shivani Gajree
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Neil Marlow
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Anna L David
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK. .,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.
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van Winden TMS, Roos C, Nijman TAJ, Kleinrouweler CE, Olaru A, Mol BW, McAuliffe FM, Pajkrt E, Oudijk MA. Tocolysis compared with no tocolysis in women with threatened preterm birth and ruptured membranes: A propensity score analysis. Eur J Obstet Gynecol Reprod Biol 2020; 255:67-73. [PMID: 33096392 DOI: 10.1016/j.ejogrb.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION In women with preterm ruptured membranes and contractions, the administration of tocolysis is controversial. This study compares tocolysis with no tocolysis in women with threatened preterm birth and ruptured membranes. OBJECTIVE To compare tocolysis with no tocolysis in women with threatened preterm birth and ruptured membranes. STUDY DESIGN Data from the APOSTEL III RCT was combined with data from the National Maternity Hospital, Dublin. In the APOSTEL III trial, women with threatened preterm birth were randomized to atosiban or nifedipine. Patient data from Ireland were obtained from a cohort of women with threatened preterm birth with ruptured membranes. The Irish women received no tocolytic treatment. Only women with ruptured membranes and contractions were selected. We studied women with singleton or twin pregnancies and a gestational age between 25+0 and 33+6 weeks. Propensity score matching was performed to create comparable groups. Primary outcome was a composite adverse neonatal outcome. Secondary outcomes were individual components of the primary outcome, as well as neonatal intensive care unit (NICU) admission, gestational age at delivery, prolongation of pregnancy and mode of delivery. RESULTS 153 women from the Apostel III trial were compared with 51 eligible women of the Irish cohort. We could match 46 women who received tocolysis and 46 women who received no tocolysis. All women had ruptured membranes. Maternal age, BMI, parity and gestational age at study entry were comparable between the groups after matching. There were no statistically significant differences in neonatal composite outcome (9.6 % in the tocolysis group versus 18 % in the control group, OR 0.46, 95 % CI 0.13-1.63). We found a lower incidence of NICU admission in the tocolysis group (63 %) than in the control group (94 %; OR 0.11, 95 % CI 0.03-0.41), which could be explained by differences in national admission policies. There were no statistically significant differences between tocolysis and no tocolysis in any of the other outcomes including sepsis, gestational age at delivery and time to delivery. CONCLUSION In this propensity score analysis of women with threatened preterm birth and ruptured membranes, tocolytic therapy did not alter composite adverse neonatal outcome or time to delivery.
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Affiliation(s)
- T M S van Winden
- Amsterdam UMC, University of Amsterdam, Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - C Roos
- Amsterdam UMC, University of Amsterdam, Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - T A J Nijman
- Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, the Netherlands
| | - C E Kleinrouweler
- Amsterdam UMC, University of Amsterdam, Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Adriana Olaru
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Ireland
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Ireland
| | - E Pajkrt
- Amsterdam UMC, University of Amsterdam, Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - M A Oudijk
- Amsterdam UMC, University of Amsterdam, Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
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Varley-Campbell J, Mújica-Mota R, Coelho H, Ocean N, Barnish M, Packman D, Dodman S, Cooper C, Snowsill T, Kay T, Liversedge N, Parr M, Knight L, Hyde C, Shennan A, Hoyle M. Three biomarker tests to help diagnose preterm labour: a systematic review and economic evaluation. Health Technol Assess 2020; 23:1-226. [PMID: 30917097 DOI: 10.3310/hta23130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Preterm birth may result in short- and long-term health problems for the child. Accurate diagnoses of preterm births could prevent unnecessary (or ensure appropriate) admissions into hospitals or transfers to specialist units. OBJECTIVES The purpose of this report is to assess the test accuracy, clinical effectiveness and cost-effectiveness of the diagnostic tests PartoSure™ (Parsagen Diagnostics Inc., Boston, MA, USA), Actim® Partus (Medix Biochemica, Espoo, Finland) and the Rapid Fetal Fibronectin (fFN)® 10Q Cassette Kit (Hologic, Inc., Marlborough, MA, USA) at thresholds ≠50 ng/ml [quantitative fFN (qfFN)] for women presenting with signs and symptoms of preterm labour relative to fFN at 50 ng/ml. METHODS Systematic reviews of the published literature were conducted for diagnostic test accuracy (DTA) studies of PartoSure, Actim Partus and qfFN for predicting preterm birth, the clinical effectiveness following treatment decisions informed by test results and economic evaluations of the tests. A model-based economic evaluation was also conducted to extrapolate long-term outcomes from the results of the diagnostic tests. The model followed the structure of the model that informed the 2015 National Institute for Health and Care Excellence guidelines on preterm labour diagnosis and treatment, but with antenatal steroids use, as opposed to tocolysis, driving health outcomes. RESULTS Twenty studies were identified evaluating DTA against the reference standard of delivery within 7 days and seven studies were identified evaluating DTA against the reference standard of delivery within 48 hours. Two studies assessed two of the index tests within the same population. One study demonstrated that depending on the threshold used, qfFN was more or less accurate than Actim Partus, whereas the other indicated little difference between PartoSure and Actim Partus. No study assessing qfFN and PartoSure in the same population was identified. The test accuracy results from the other included studies revealed a high level of uncertainty, primarily attributable to substantial methodological, clinical and statistical heterogeneity between studies. No study compared all three tests simultaneously. No clinical effectiveness studies evaluating any of the three biomarker tests were identified. One partial economic evaluation was identified for predicting preterm birth. It assessed the number needed to treat to prevent a respiratory distress syndrome case with a 'treat-all' strategy, relative to testing with qualitative fFN. Because of the lack of data, our de novo model involved the assumption that management of pregnant women fully adhered to the results of the tests. In the base-case analysis for a woman at 30 weeks' gestation, Actim Partus had lower health-care costs and fewer quality-adjusted life-years (QALYs) than qfFN at 50 ng/ml, reducing costs at a rate of £56,030 per QALY lost compared with qfFN at 50 ng/ml. PartoSure is less costly than Actim Partus while being equally effective, but this is based on diagnostic accuracy data from a small study. Treatment with qfFN at 200 ng/ml and 500 ng/ml resulted in lower cost savings per QALY lost relative to fFN at 50 ng/ml than treatment with Actim Partus. In contrast, qfFN at 10 ng/ml increased QALYs, by 0.002, and had a cost per QALY gained of £140,267 relative to fFN at 50 ng/ml. Similar qualitative results were obtained for women presenting at different gestational ages. CONCLUSION There is a high degree of uncertainty surrounding the test accuracy and cost-effectiveness results. We are aware of four ongoing UK trials, two of which plan to enrol > 1000 participants. The results of these trials may significantly alter the findings presented here. STUDY REGISTRATION The study is registered as PROSPERO CRD42017072696. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rubén Mújica-Mota
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Neel Ocean
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Max Barnish
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - David Packman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sophie Dodman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK.,Health Economics Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tracey Kay
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Michelle Parr
- Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Lisa Knight
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
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49
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Yim PD, Hyuga S, Wu AD, Dan W, Vink JY, Gallos G. Activation of an Endogenous Opsin 3 Light Receptor Mediates Photo-Relaxation of Pre-Contracting Late Gestation Human Uterine Smooth Muscle Ex Vivo. Reprod Sci 2020; 27:1791-1801. [PMID: 32166706 PMCID: PMC9352362 DOI: 10.1007/s43032-020-00180-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
Abstract
Spontaneous preterm birth (sPTB) remains a worldwide healthcare challenge. Preterm labor (PTL) is thought to be the largest reversible cause of sPTB, but current tocolytic therapies are ineffective and associated with systemic side effects from chronic use. Therefore, identifying novel mechanisms that promote human uterine smooth muscle (hUSM) relaxation is essential to improving clinical management of PTL. Here, we aimed to determine if an extraocular opsin receptor (OPN 3,4,5) system is expressed in pregnant hUSM and to characterize how photo-mediated relaxation of pre-contracting hUSM may be facilitated by external application of light. Translational studies were performed with hUSM from healthy late gestation patients (n = 8) and non-pregnant, similarly aged patients undergoing hysterectomy (n = 4). First, RT-PCR screened for mRNA coding for components of the classical extraocular light receptors (OPN 3,4,5). We found a restricted repertoire of opsin receptors (OPN3) expressed in pregnant hUSM tissue. Immunohistochemistry was performed to confirm protein expression. Pre-contracting late gestation hUSM strips were studied in functional organ bath studies to determine if photo-mediated relaxation is intensity or wavelength dependent. Functional organ bath studies revealed acute photo-mediated relaxation occurring in an intensity- and wavelength-dependent manner. Finally, coimmunoprecipitation of OPN3 with Gs following light activation suggests that a component of photo-relaxation occurs via G protein-coupled receptor machinery. This is the first report of light-mediated relaxation of pre-contracted human myometrium. Activation of endogenous light receptors on human myometrium may become a novel, non-invasive tocolytic strategy.
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Affiliation(s)
- Peter D Yim
- Vagelos College of Physicians and Surgeons, Department of Anesthesiology, Columbia University, 622 168th Street, P&S Box 46, New York, NY, USA.
| | - Shunsuke Hyuga
- Vagelos College of Physicians and Surgeons, Department of Anesthesiology, Columbia University, 622 168th Street, P&S Box 46, New York, NY, USA
| | - Amy D Wu
- Vagelos College of Physicians and Surgeons, Department of Anesthesiology, Columbia University, 622 168th Street, P&S Box 46, New York, NY, USA
| | - William Dan
- Vagelos College of Physicians and Surgeons, Department of Anesthesiology, Columbia University, 622 168th Street, P&S Box 46, New York, NY, USA
| | - Joy Y Vink
- Vagelos College of Physicians and Surgeons, Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - George Gallos
- Vagelos College of Physicians and Surgeons, Department of Anesthesiology, Columbia University, 622 168th Street, P&S Box 46, New York, NY, USA
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50
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Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic is causing a necessary, rapid adjustment within the field of obstetrics. Corticosteroid use is a mainstay of therapy for those women delivering prematurely. Unfortunately, corticosteroid use has been associated with worse outcomes in COVID-19 positive patients. Given this information, it is necessary that obstetricians adjust practice to carefully weigh the fetal benefits with maternal risks. Therefore, our institution has examined the risks and benefits and altered our corticosteroid recommendations. KEY POINTS: · Corticosteroid use is an important part of prematurity treatment because it provides benefit to the fetus.. · Corticosteroid use may be related with increased morbidity and mortality in novel coronavirus disease 2019 (COVID-19).. · Therefore, during the COVID-19 pandemic, an alteration in current corticosteroid practices is necessary to uniquely weigh the maternal risks and fetal benefits..
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Affiliation(s)
- Jennifer Jury McIntosh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin,Address for correspondence Jennifer J. McIntosh, DO, MS Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin9200 W Wisconsin Avenue, Milwaukee, WI 53226
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