1
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Briana D, Malamitsi-Puchner A, Di Renzo GC. Using ultrasound instead of X-ray to diagnose neonatal lung disease: an important milestone in the development of neonatal medicine. J Matern Fetal Neonatal Med 2024; 37:2311097. [PMID: 38326279 DOI: 10.1080/14767058.2024.2311097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Despina Briana
- NICU, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Permanent International and European School of Perinatal and Reproductive Medicine, Florence, Italy
- Department of Obstetrics and Gynecology, The I. M. Sechenov First State University of Moscow, Moscow, Russia
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2
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Daskalakis G, Pergialiotis V, Domellöf M, Ehrhardt H, Di Renzo GC, Koç E, Malamitsi-Puchner A, Kacerovsky M, Modi N, Shennan A, Ayres-de-Campos D, Gliozheni E, Rull K, Braun T, Beke A, Kosińska-Kaczyńska K, Areia AL, Vladareanu S, Sršen TP, Schmitz T, Jacobsson B. European guidelines on perinatal care: corticosteroids for women at risk of preterm birth. J Matern Fetal Neonatal Med 2023; 36:2160628. [PMID: 36689999 DOI: 10.1080/14767058.2022.2160628] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
of recommendationsCorticosteroids should be administered to women at a gestational age between 24+0 and 33+6 weeks, when preterm birth is anticipated in the next seven days, as these have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality evidence; strong recommendation). In selected cases, extension of this period up to 34+6 weeks may be considered (Expert opinion). Optimal benefits are found in infants delivered within 7 days of corticosteroid administration. Even a single-dose administration should be given to women with imminent preterm birth, as this is likely to improve neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation).Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart) or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart, or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality evidence; Strong recommendation). Administration of two "all" doses is named a "course of corticosteroids".Administration between 22+0 and 23+6 weeks should be considered when preterm birth is anticipated in the next seven days and active newborn life-support is indicated, taking into account parental wishes. Clear survival benefit has been observed in these cases, but the impact on short-term neurological and respiratory function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality evidence; Weak recommendation).Administration between 34 + 0 and 34 + 6 weeks should only be offered to a few selected cases (Expert opinion). Administration between 35+0 and 36+6 weeks should be restricted to prospective randomized trials. Current evidence suggests that although corticosteroids reduce the incidence of transient tachypnea of the newborn, they do not affect the incidence of respiratory distress syndrome, and they increase neonatal hypoglycemia. Long-term safety data are lacking (Moderate quality evidence; Conditional recommendation).Administration in pregnancies beyond 37+0 weeks is not indicated, even for scheduled cesarean delivery, as current evidence does not suggest benefit and the long-term effects remain unknown (Low-quality evidence; Conditional recommendation).Administration should be given in twin pregnancies, with the same indication and doses as for singletons. However, existing evidence suggests that it should be reserved for pregnancies at high-risk of delivering within a 7-day interval (Low-quality evidence; Conditional recommendation). Maternal diabetes mellitus is not a contraindication to the use of antenatal corticosteroids (Moderate quality evidence; Strong recommendation).A single repeat course of corticosteroids can be considered in pregnancies at less than 34+0 weeks gestation, if the previous course was completed more than seven days earlier, and there is a renewed risk of imminent delivery (Low-quality evidence; Conditional recommendation).
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Affiliation(s)
- George Daskalakis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus-Liebig-University and Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Lung Research Center (DZL), Giessen, Germany
| | - Gian Carlo Di Renzo
- Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Esin Koç
- Department of Neonatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Králové, Hradec Kralove, Czech Republic
| | - Neena Modi
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK
| | - Diogo Ayres-de-Campos
- Medical School, Santa Maria University Hospital, Lisbon, Portugal.,European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Elko Gliozheni
- Department of Obstetrics and Gynaecology, Maternity Koco Gliozheni Hospital, Tirana, Albania
| | - Kristiina Rull
- Women's Clinic of Tartu University Hospital, Tartu, Estonia.,Department of Obstetrics and Gynaecology, University of Tartu, Tartu Estonia.,Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Thorsten Braun
- Department of Obstetrics and Division of 'Experimental Obstetrics', Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Katarzyna Kosińska-Kaczyńska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Ana Luisa Areia
- Obstetrics Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Centre of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Coimbra, Portugal
| | - Simona Vladareanu
- Neonatology Clinic, Department of Obstetrics and Gynecology, Faculty of General Medicine, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Tanja Premru Sršen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de gynécologie-obstétrique, hôpital Robert-Debré, Université Paris Cité, Paris, France
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
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3
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Malamitsi-Puchner A, Briana DD. Antenatal corticosteroids revisited-Novel approaches and future perspectives. Acta Paediatr 2023; 112:2465-2467. [PMID: 37399077 DOI: 10.1111/apa.16896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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4
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Malamitsi-Puchner A, Briana DD. Advanced parental age affects cardiometabolic risk in offspring. Acta Paediatr 2023; 112:2307-2311. [PMID: 37410550 DOI: 10.1111/apa.16902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/24/2023] [Accepted: 07/04/2023] [Indexed: 07/08/2023]
Abstract
Advanced age at conception usually refers to human mothers aged 35 years plus and fathers aged 40 years plus. Advanced parental age may be responsible for genetic and/or epigenetic alterations and may affect the health of offspring. Limited epidemiological and experimental studies have addressed the effect of advanced parental age on cardio-metabolic functions in human and rodent offspring. This mini review aimed to present the knowledge by focusing on adverse and favourable outcomes related to sex-specific risks and intergenerational inheritance. The outcomes identified by this review were mainly negative, but there were also some positive results.
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Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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5
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Malamitsi-Puchner A, Addati L, Eydal GB, Briana DD, Bustreo F, Di Renzo GC, O'Brien M, Hanson M, Modi N. Paid leave to support parenting-A neglected tool to improve societal well-being and prosperity. Acta Paediatr 2023; 112:2045-2049. [PMID: 37531082 DOI: 10.1111/apa.16929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/03/2023]
Abstract
Cohesive families and stimulating and caring environments promoting attachment to caregivers is fundamental for a child's physical and psychosocial growth and development. Parental care, supporting early years development, presupposes the presence and involvement of parents in children's daily life with activities that include breastfeeding, playing, reading and storytelling. However, parents have to balance their child's well-being against employment, career progression and gender equality. Universally accessible and equitably available parental leave addresses this challenge. CONCLUSION: Distinct from compulsory maternity leave, leave at full or nearly full pay for both parents benefits not only families but also societal well-being and prosperity.
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Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Laura Addati
- Gender, Equality, Diversity and Inclusion Branch, Conditions of Work and Equality Department, International Labour Organization, Geneva, Switzerland
| | - Guðný Björk Eydal
- Faculty of Social Work, School of Social Sciences, University of Iceland, Reykjavík, Iceland
| | - Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Flavia Bustreo
- Fondation Botnar, Governance and Ethics Committee, Partnership for Maternal, Newborn and Child Health (PMNCH), Geneva, Switzerland
| | - Gian Carlo Di Renzo
- Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Department of Obstetrics, Gynecology and Perinatal Medicine, IM Sechenov First State University, Moscow, Russia
- PREIS School, Florence, Italy
| | - Margaret O'Brien
- Thomas Coram Research Unit, Social Research Institute, University College London, London, UK
| | - Mark Hanson
- Faculty of Medicine, Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Chelsea and Westminster Hospital campus, Imperial College London, London, UK
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6
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Malamitsi-Puchner A, Briana DD. Impact of COVID-19 on non-breastfeeding practices. Acta Paediatr 2023; 112:2015. [PMID: 37300875 DOI: 10.1111/apa.16870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/12/2023]
Affiliation(s)
| | - Despina D Briana
- NICU, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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7
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Briana DD, Malamitsi-Puchner A. An Update on Lung Function of Extremely and Very Preterm Infants in Later Life: The Role of Early Nutritional Interventions. Nutrients 2023; 15:3353. [PMID: 37571290 PMCID: PMC10421481 DOI: 10.3390/nu15153353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Birth occurring at ≤32 weeks' gestation ("very preterm") or at ≤28 weeks' gestation ("extremely preterm") potentially poses considerable health problems for the neonate, including respiratory sequelae, not only during the immediate newborn period, but throughout childhood and into adulthood. With the progressive improvements in neonatal care, the survival of extremely preterm and very preterm neonates has improved substantially. However, a considerable percentage of these infants suffer dysfunctions that may trigger, at some stage later in life, the onset of respiratory morbidities. The interruption of the normal development of the respiratory tract caused by preterm birth, in combination with postnatal lung injury caused by various interventions, e.g., mechanical ventilation and oxygen therapy, increases the risk ofthe development of long-term respiratory deficits in survivors. Those infants that are most affected are those who develop chronic lung disease of prematurity (also called bronchopulmonary dysplasia, BPD), but impaired lung function can develop irrespective of BPD diagnosis. Apart from indicating abnormal lung function in survivors of extreme prematurity, recent long-term follow-up studies also emphasize the crucial role of early nutritional intake as an effective strategy, which promotes lung growth and repair. This article will update the associations between extremely/very preterm birth with long-term respiratory outcomes. It will also discuss the protective effect of nutritional interventions, focusing on recently published follow-up data.
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Affiliation(s)
- Despina D. Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Chaidari, 12462 Athens, Greece
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8
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Briana DD, Malamitsi-Puchner A. Breastfeeding provides a protective hug and the benefits have outweighed the risks during the COVID-19 pandemic. Acta Paediatr 2023; 112:1177-1181. [PMID: 36945791 DOI: 10.1111/apa.16769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023]
Abstract
Mothers have been very hesitant about breastfeeding when they have COVID-19 infection or vaccinations. Maternal milk protects neonates through its high biological value, immune factors and anti-infectious molecules and this review shows that the virus that causes COVID-19 is not transmitted through breast milk. COVID-19 vaccines induce anti-spike antibodies with neutralising capacity, and phagocytosis, and no vaccine particles or messenger ribonucleic acid have been detected in breast milk. Most drugs used for maternal COVID-19 infections are safe for breastfed infants. CONCLUSION: The clear benefits of breastfeeding by far outweigh the very low risk of infant infections from COVID-19.
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Affiliation(s)
- Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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9
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Malamitsi-Puchner A, Konstantakos IM. Evidence, hints and assumptions for late pregnancy in the Ancient Mediterranean and Near East. Acta Paediatr 2023. [PMID: 37002716 DOI: 10.1111/apa.16781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
Ancient women, who survived childhood mortality, received good and adequate nutrition, did not work hard and escaped death during childbirth could live fairly long lives. Girls started procreation after marriage, usually at 15 years, had on average seven children, childbearing lasted 14-21 or more years and could happen at the age of 35 or more years. Breastfeeding, usually with contraceptive effect, continued for 2-3 years. Limited actual facts, written evidence and findings, but several hints, assumptions and logical conclusions from secular texts, sacred books, narratives and myths suggest the possibility of late childbearing in the Mediterranean and Near-Eastern ancient world, particularly for the Jews.
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Affiliation(s)
- Ariadne Malamitsi-Puchner
- NICU, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis M Konstantakos
- Faculty of Philology, Department of Classics, National and Kapodistrian University of Athens, Athens, Greece
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10
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Meka K, Jacob CM, Modi N, Bustreo F, Di Renzo GC, Malamitsi-Puchner A, Briana D, Iaia DG, Fogstad H, Tamvada JP, Moreno IO, Hanson M. Valuing maternal, newborn, child and adolescent health for societal progress - Going beyond the economic orthodoxy of gross domestic product. Acta Paediatr 2023; 112:630-634. [PMID: 36656112 DOI: 10.1111/apa.16677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
AIM In view of the long-standing recognition that gross domestic product (GDP) does not capture the unremunerated work largely conducted by women upon which societal well-being depends, to discuss the implications for GDP of maternal, newborn, child and adolescent health (MNCAH), and its influences on health, well-being and prosperity across the life course and across generations. METHODS A wide-ranging discussion of the informal think-tank The Venice Forum was held over two days, with inputs from invited experts in person and online. RESULTS There was consensus that a strong case could be made for inclusion of unremunerated work largely conducted by women as a positive contribution to GDP in view of its impact on future health and prosperity, and conversely exclusion from GDP of outputs from industries which harm health. CONCLUSION Taken with the current challenges from COVID, climate change and conflict, there is a compelling need to redefine economic progress through equitable models and metrics that incorporate short-/medium-/long-term societal value of activities that improve MNCAH.
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Affiliation(s)
- Kiran Meka
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Chandni M Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Flavia Bustreo
- Partnership for Maternal, Newborn and Child Health Board, Geneva, Switzerland
| | - Gian Carlo Di Renzo
- Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynaecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Domenico G Iaia
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Helga Fogstad
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Jagannadha P Tamvada
- Southampton Business School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Ivan Ochoa Moreno
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Hanson
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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11
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Malamitsi-Puchner A, Briana DD. Did the 'lockdown' during the historic Plague of Athens mirror current day efforts to prevent the spread of COVID-19? Acta Paediatr 2023; 112:383-384. [PMID: 36377388 DOI: 10.1111/apa.16595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
| | - Despina D Briana
- NICU, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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12
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Briana DD, Malamitsi-Puchner A. Cardiovascular implications of gestational diabetes mellitus for the mother and fetus/neonate. Curr Med Res Opin 2022; 38:1703. [PMID: 35972208 DOI: 10.1080/03007995.2022.2113695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Paediatrics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Paediatrics, National and Kapodistrian University of Athens Medical School, Athens, Greece
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13
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Briana DD, Papaevangelou V, Malamitsi-Puchner A. Action is needed to tackle the clinical, psychological and socioeconomic impact of perinatal COVID-19. Acta Paediatr 2022; 111:2278-2283. [PMID: 35959999 PMCID: PMC9538449 DOI: 10.1111/apa.16513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has turned perinatal healthcare into a worldwide public health challenge. Although initial data did not demonstrate pregnancy as a more susceptible period to adverse outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, an increasing number of reports now certify maternal illness as a high-risk condition for the development of maternal-fetal complications. Despite the rarity of SARS-CoV-2 vertical transmission, severe maternal illness might induce adverse perinatal and neonatal outcomes. Additionally, perinatal COVID-19 data may raise concerns about long-term harmful consequences to the offspring in the framework of non-communicable diseases. The World Health Organization, as well as scientific literature, consider the protection of the maternal-fetal dyad against COVID-19 as a critical issue and, therefore, strongly promote and encourage vaccination of pregnant and lactating women. Furthermore, the pandemic has triggered an unprecedented recession, leading to historic levels of unemployment and deprivation, while health, societal, economic and gender inequities particularly affecting low-income and middle-income countries, have increased. This mini-review provides an updated brief report on historical, clinical, psychological and socioeconomic aspects of the COVID-19 pandemic based on 10 lectures presented at the 9th Maria-Delivoria-Papadopoulos Perinatal Symposium, held virtually on 19 March 2022.
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Affiliation(s)
- Despina D Briana
- Third Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Greece
| | - Vassiliki Papaevangelou
- Third Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Greece
| | - Ariadne Malamitsi-Puchner
- Third Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Greece
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14
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Briana DD, Malamitsi-Puchner A. Effect of Gestational Diabetes Mellitus and Hypercholesterolemia on Fetal Cardiovascular Disease Risk: The Role of Epigenetics. Curr Vasc Pharmacol 2022; 20:379-380. [PMID: 36123823 DOI: 10.2174/1570161120666220804090725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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15
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Malamitsi-Puchner A, Briana DD. The COVID-19 pandemic and the "Plague of Athens": comparable features 25 centuries apart. J Matern Fetal Neonatal Med 2022; 35:9257-9262. [PMID: 35129047 DOI: 10.1080/14767058.2021.2025357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Motivated by the up to now disastrous outcomes of the COVID-19 pandemic, we attempted a flashback to the so-called "Plague of Athens," which indicated a serious contagious disease, having taken place between 430 and 426 BC. The ancient pandemic was meticulously described by the Athenian historian and general Thucydides. We compared, as much as possible, the following parameters: background conditions, spreading of the pandemics, preceded and concurrent adverse events, duration and waves of the pandemics, symptoms, implicated infectious agents/diseases and mental/psychosocial consequences. The current pandemic was preceded by a global economic crisis, which particularly affected deprived population groups, while the ancient one started on the second year of a catastrophic civil war. Rivalry and different political systems between now (US/China) and then (Athens/Sparta) superpowers were the basis for conspiracy scenarios, concerning origins of the pandemics, which resulted to huge numbers of deaths, particularly in overcrowded and poor areas/cities. Both pandemics not sparing any age, sex, nationality, social group, may have had a zoonotic component, besides being air-born. However, their spreading is/was remarkably rapid, presenting 3-4 waves and lasting for several years. Some somatic signs and symptoms of the diseases coincide. Although for COVID-19, SARS-CoV-2 has been identified as causing agent, the antique pandemic has most probably been attributed to typhoid fever, although this is still a matter of debate. Additionally, both pandemics affected mental health and psychosocial behavior in close similarity. It is noteworthy, that in both eras physicians and healthcare workers, despite physical and psychological exhaustion, in the majority, presented admirable resilience and willingness to help suffering fellow people, often at the expense of their own lives. The considerable number of comparable features between COVID-19 and the "Plague of Athens" confirms that pandemics may present over time important similarities in their origin, evolution and outcomes.
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Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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Briana DD, Papaevangelou V, Syridou G, Paparizou K, Siafakas N, Konstantinidou AE, Malamitsi-Puchner A. Clinical symptoms associated with laboratory findings and placental histopathology in full-term, non-infected neonates born to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive mothers. J Matern Fetal Neonatal Med 2021; 35:8706-8709. [PMID: 34762576 DOI: 10.1080/14767058.2021.1998894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study comprehensively examines clinical symptoms, laboratory findings, and placental pathology in 40 cases of singleton full-term SARS-CoV-2 negative neonates. Their mothers, previously healthy, with uncomplicated pregnancies, were infected peripartum and presented COVID-19 symptoms of various severity. Neonates had predominately diarrhea, the yet unreported absent sucking reflex, elevated COVID-19 inflammatory and ischemia/asphyxia markers as serum ferritin, interleukin-6 and cardiac troponin-T, while placentas demonstrated mild vascular and/or inflammatory lesions. We hypothesize that the above placental lesions may be associated with transient perinatal hypoxia resulting in absent sucking reflex, as well as with inflammatory cytokines transfer causing diarrhea.
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Affiliation(s)
- Despina D Briana
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Garyfallia Syridou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleopatra Paparizou
- First Department of Pathology, Unit of Perinatal Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Siafakas
- Department of Clinical Microbiology, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia E Konstantinidou
- First Department of Pathology, Unit of Perinatal Pathology, National and Kapodistrian University of Athens, Athens, Greece
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Papathanasiou AE, Spyropoulos F, Michael Z, Joung KE, Briana DD, Malamitsi-Puchner A, Mantzoros CS, Christou H. Adipokines and Metabolic Regulators in Human and Experimental Pulmonary Arterial Hypertension. Int J Mol Sci 2021; 22:ijms22031435. [PMID: 33535425 PMCID: PMC7867052 DOI: 10.3390/ijms22031435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
Pulmonary hypertension (PH) is associated with meta-inflammation related to obesity but the role of adipose tissue in PH pathogenesis is unknown. We hypothesized that adipose tissue-derived metabolic regulators are altered in human and experimental PH. We measured circulating levels of fatty acid binding protein 4 (FABP-4), fibroblast growth factor -21 (FGF-21), adiponectin, and the mRNA levels of FABP-4, FGF-21, and peroxisome proliferator-activated receptor γ (PPARγ) in lung tissue of patients with idiopathic PH and healthy controls. We also evaluated lung and adipose tissue expression of these mediators in the three most commonly used experimental rodent models of pulmonary hypertension. Circulating levels of FABP-4, FGF-21, and adiponectin were significantly elevated in PH patients compared to controls and the mRNA levels of these regulators and PPARγ were also significantly increased in human PH lungs and in the lungs of rats with experimental PH compared to controls. These findings were coupled with increased levels of adipose tissue mRNA of genes related to glucose uptake, glycolysis, tricarboxylic acid cycle, and fatty acid oxidation in experimental PH. Our results support that metabolic alterations in human PH are recapitulated in rodent models of the disease and suggest that adipose tissue may contribute to PH pathogenesis.
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Affiliation(s)
- Aimilia Eirini Papathanasiou
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.E.P.); (F.S.); (K.E.J.)
- Harvard Medical School, Boston, MA 02215, USA;
- Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 10679 Athens, Greece; (D.D.B.); (A.M.-P.)
| | - Fotios Spyropoulos
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.E.P.); (F.S.); (K.E.J.)
- Harvard Medical School, Boston, MA 02215, USA;
| | - Zoe Michael
- Harvard Medical School, Boston, MA 02215, USA;
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02215, USA
| | - Kyoung E. Joung
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.E.P.); (F.S.); (K.E.J.)
- Harvard Medical School, Boston, MA 02215, USA;
| | - Despina D. Briana
- Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 10679 Athens, Greece; (D.D.B.); (A.M.-P.)
| | - Ariadne Malamitsi-Puchner
- Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 10679 Athens, Greece; (D.D.B.); (A.M.-P.)
| | - Christos S. Mantzoros
- Harvard Medical School, Boston, MA 02215, USA;
- Division of Endocrinology Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Section of Endocrinology, VA Boston Healthcare System, Harvard Medical School, Boston, MA 02215, USA
- Correspondence: (C.S.M.); (H.C.)
| | - Helen Christou
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (A.E.P.); (F.S.); (K.E.J.)
- Harvard Medical School, Boston, MA 02215, USA;
- Correspondence: (C.S.M.); (H.C.)
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Briana DD, Malamitsi-Puchner A. Chorioamnionitis in utero, schizophrenia in adulthood: limited current evidence-future research focus? J Matern Fetal Neonatal Med 2021; 35:4782-4787. [PMID: 33435777 DOI: 10.1080/14767058.2020.1863370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: Developmental adaptive processes during gestation that are known to be involved in permanent changes in physiology and metabolism or "early life programming" can adversely affect fetal brain development, impacting both brain structure and function.Data: Emerging evidence strongly supports the developmental origin of schizophrenia, which may potentially be a result of prenatal exposure to a diversity of factors, especially infections, in genetically predisposed subjects. Structural and functional brain changes during development of schizophrenia are determined by genetic components, altered expression of schizophrenia risk genes and epigenetic dysregulation. However, the precise mechanisms underlying these relationships remain unclear. Findings from human and animal studies suggest that inflammatory-immune responses and activation of oxidative stress pathways are crucial in mediating intrauterine infection-induced neurodevelopmental and neuropsychiatric diseases.Aim: Considering the high prevalence of intrauterine inflammation in the context of chorioamnionitis during human pregnancy and the paucity of knowledge on fetal programming of schizophrenia, this mini review aims to exclusively consolidate the current evidence supporting a potential association between chorioamnionitis and schizophrenia.
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Affiliation(s)
- Despina D Briana
- NICU, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ariadne Malamitsi-Puchner
- NICU, 3rd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Paraskevas KI, Briana DD, Malamitsi-Puchner A, Mikhailidis DP. Fetal/Infant Origins of Adult Vascular Disease. Curr Vasc Pharmacol 2020; 18:418-420. [PMID: 32129165 DOI: 10.2174/1570161118999200304123040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London, London, United Kingdom
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Briana DD, Malamitsi-Puchner A. Effects of Pregnancy-induced Insulin Resistance on the Fetus and the Future Development of Metabolic Diseases in Adulthood. Curr Vasc Pharmacol 2020; 18:421-422. [PMID: 31441727 DOI: 10.2174/1570161117999190823154608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Malamitsi-Puchner A. Maria Delivoria-Papadopoulos: the legendary pioneer in perinatology and mother of neonatology. J Matern Fetal Neonatal Med 2020. [PMID: 32981393 DOI: 10.1080/14767058.2020.1826134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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Jacob CM, Briana DD, Di Renzo GC, Modi N, Bustreo F, Conti G, Malamitsi-Puchner A, Hanson M. Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health. Lancet Public Health 2020; 5:e624-e627. [PMID: 32971008 PMCID: PMC7505549 DOI: 10.1016/s2468-2667(20)30200-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Resilient societies respond rapidly and effectively to health challenges and the associated economic consequences, and adapt to be more responsive to future challenges. Although it is only possible to recognise resilience retrospectively, the COVID-19 pandemic has occurred at a point in human history when, uniquely, sufficient knowledge is available on the early-life determinants of health to indicate clearly that a focus on maternal, neonatal, and child health (MNCH) will promote later resilience. This knowledge offers an unprecedented opportunity to disrupt entrenched strategies and to reinvest in MNCH in the post-COVID-19 so-called new normal. Furthermore, analysis of the short-term, medium-term, and longer-term consequences of previous socioeconomic shocks provides important insights into those domains of MNCH, such as neurocognitive development and nutrition, for which investment will generate the greatest benefit. Such considerations apply to high-income countries (HICs) and low-income and middle-income countries (LMICs). However, implementing appropriate policies in the post-COVID-19 recovery period will be challenging and requires political commitment and public engagement.
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Affiliation(s)
- Chandni Maria Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton NIHR Biomedical Research Centre, Southampton General Hospital, Southampton, UK.
| | - Despina D Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy; Department of Obstetrics and Gynecology, IM Sechenov First State University of Moscow, Moscow, Russia
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Flavia Bustreo
- Partnership for Maternal, Newborn and Child Health Board, Geneva, Switzerland
| | - Gabriella Conti
- Department of Economics and UCL Social Research Institute, University College London, London, UK; Institute for Fiscal Studies, London, UK
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Mark Hanson
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton NIHR Biomedical Research Centre, Southampton General Hospital, Southampton, UK
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Briana DD, Malamitsi-Puchner A. Intracytoplasmic sperm injection and fetal origins of autism spectrum disorder: an intriguing, though controversial association. J Matern Fetal Neonatal Med 2020; 35:799-805. [PMID: 32079437 DOI: 10.1080/14767058.2020.1730804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Latest knowledge assigns the origins of autism spectrum disorder (ASD)-currently affecting 1% of children- to intrauterine life, when fetal brain develops. Besides genetics, environmental factors, responsible for epigenetic changes contributed to its rising incidence. In vitro fertilization (IVF) and the most widely used intracytoplasmic sperm injection (ICSI) are implicated in epigenetic changes. A series of studies examined the impact of ICSI on ASD in the offspring. Results are usually conflicting, due to inherent problems of study design and power, mixed IVF/ICSI cases and not exclusively ASD diagnoses included. Furthermore, preterm birth, low birthweight infants, advanced parental age, hormonal disturbances, all associated with ICSI, are known factors affecting ASD. While solid data supporting ICSI contribution to currently alarming ASD increase are lacking, exploration of underlying molecular mechanisms would strengthen possible associations. In the meanwhile, ICSI use should be restricted to male-factor infertility cases.
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Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Briana DD, Fotakis C, Kontogeorgou A, Gavrili S, Georgatzi S, Zoumpoulakis P, Malamitsi-Puchner A. Early Human-Milk Metabolome in Cases of Intrauterine Growth-Restricted and Macrosomic Infants. JPEN J Parenter Enteral Nutr 2020; 44:1510-1518. [PMID: 32026505 DOI: 10.1002/jpen.1783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Abnormal fetal growth is associated with short-term and long-term metabolic dysregulation and susceptibility to obesity-related disorders. Maternal milk, the ideal source of infantile nutrition, protects from metabolic diseases in adulthood. By applying nuclear magnetic resonance (NMR) metabolomics, this study investigated the metabolic profile of early human milk/colostrum (EHM/C) at the extremes of fetal-growth conditions, which could affect its nutritional value. METHODS From 98 mothers delivering 60 appropriate-for-gestational-age (AGA), 19 large-for-gestational-age (LGA), and 19 intrauterine growth-restricted (IUGR) full-term neonates, milk samples collected on the third to fourth day post partum were examined by NMR spectroscopy. Multivariate data analysis elicited information from NMR spectra and probed to metabolic signatures of EHM/C. RESULTS LGA and IUGR EHM/C samples depicted increased content in lactose, citric acid, choline, phosphocholine, and N-acetylglutamine. AGA samples exhibited increased isoleucine and valine. Metabolic pathways involved were valine, leucine/isoleucine biosynthesis and degradation, glycerophospholipid metabolism, aminoacyl-transfer RNA biosynthesis, and citrate cycle. Orthogonal projections to latent structures discriminant analysis models were validated. CONCLUSION This holistic metabolomics study framed an increased content of certain essential nutrients in EHM/C samples following the birth of LGA and IUGR infants prone to short- and long-term metabolic disorders, thus stressing additional benefits of early breastfeeding. Assessing the metabolic profile of EHΜ/C enables evaluation of its nutrition value, adjusted to fetal growth, and introduction of appropriate dietary interventions.
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Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Fotakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Anna Kontogeorgou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Gavrili
- Neonatal Intensive Care Unit, "Alexandra" University and State Maternity Hospital, Athens, Greece
| | - Sophia Georgatzi
- Neonatal Intensive Care Unit, "Alexandra" University and State Maternity Hospital, Athens, Greece
| | - Panagiotis Zoumpoulakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
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Lagercrantz H, Malamitsi-Puchner A. Preventing disease in the twenty-first century: a European Union perspective. Pediatr Res 2020; 87:188-189. [PMID: 31689709 DOI: 10.1038/s41390-019-0653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Hugo Lagercrantz
- Astrid Lindgren Children's Hospital and Karolinska Institute, 17165, Solna, Sweden.
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Briana DD, Malamitsi-Puchner A. Intrauterine growth restriction: the controversial role of perinatal adipocytokines in the prediction of metabolic adult disease. J Matern Fetal Neonatal Med 2019; 34:2577-2582. [PMID: 31530060 DOI: 10.1080/14767058.2019.1669556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
"Prenatal/fetal programming," implying structural/functional disorders of developing tissues/organs, consequent to an adverse intrauterine environment leading to asymmetric intrauterine growth restriction (IUGR), predisposes to metabolic syndrome and noncommunicable diseases in adulthood, in the framework of the "Developmental Origins of Health and Disease" (DOHaD) concept. DOHaD consequences are associated with adipose tissue, particularly the visceral one, occurring in relative abundance in IUGR infants. Adipose tissue secretes numerous hormones, collectively called adipocytokines, as leptin, adiponectin, ghrelin, resistin, apelin, visfatin, omentin, vaspin, preadipocyte factor-1 (Pref-1), fatty acid-binding protein-4, lipocalin-2, and others, implicated in fetal growth, body metabolism, energy homeostasis, and insulin resistance. Early identification of adipocytokines as biomarkers predicting later metabolic disorders/diseases in IUGR individuals, enabling relevant protective interventions, would be of utmost importance. Current data do not support this perspective, due to controversial results in the literature, with the eventual exception of visfatin and possibly Pref-1.
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Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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27
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Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Eirini Papathanasiou A, Malamitsi-Puchner A, Gavrili S, Zachaki S, Georgantzi S, Marmarinos A, Christou C, Voulgaris K, Gourgiotis D, Briana DD. Perinatal lipocalin-2 profile at the extremes of fetal growth. J Matern Fetal Neonatal Med 2019; 34:2166-2172. [PMID: 31450995 DOI: 10.1080/14767058.2019.1659774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lipocalin-2 (LCN-2) has been identified as an osteoblast-secreted hormone regulating immunity, inflammation and metabolic homeostasis and has emerged as a diagnostic and prognostic biomarker for acute kidney injury in neonates. We investigated the impact of fetal growth on antepartum maternal serum, cord serum and breast milk LCN-2 concentrations and the associations of the latter with perinatal parameters. METHODS Maternal serum, cord serum and breast milk LCN-2 concentrations were measured by ELISA in samples from 80 mothers who delivered 40 appropriate (AGA), 20 large for gestational age (LGA) and 20 intrauterine growth restricted (IUGR) neonates, classified by customized weight centiles. LCN-2 concentrations were associated with birth weight, customized centile, gender, maternal age and delivery mode. RESULTS Antepartum maternal serum LCN-2 concentrations were significantly higher in women delivering AGA infants compared to the other two groups. Cord blood LCN-2 concentrations were significantly higher compared to maternal ones; furthermore, they were significantly elevated in the IUGR group compared to the LGA one (p = .019). Lowest concentrations were detected in breast milk, which did not differ between the three growth groups. A negative correlation was documented between cord blood LCN-2 concentrations and customized centiles (r: -0.304, p = .007). CONCLUSIONS The higher cord serum LCN-2 concentrations, compared to maternal ones, may point to its fetal origin and potential role in intrauterine growth. The negative correlation of cord LCN-2 concentrations with customized centiles, possibly implies reduced nephron endowment/subclinical kidney damage in IUGR neonates. The extremely low LCN-2 breast milk concentrations could imply that the secretion of LCN-2 from maternal circulation to breast milk is not influenced by factors leading to intrauterine growth pathology.
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Affiliation(s)
| | | | - Stavroula Gavrili
- Neonatal Intensive Care Unit, "Alexandra" University and State Maternity Hospital, Athens, Greece
| | - Sophia Zachaki
- Laboratory of Health Physics, Radiobiology and Cytogenetics, National Center for Scientific Research (NCSR) "Demokritos", Athens, Greece
| | - Sophia Georgantzi
- Neonatal Intensive Care Unit, "Alexandra" University and State Maternity Hospital, Athens, Greece
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry - Molecular Diagnostics, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry - Molecular Diagnostics, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Briana DD, Malamitsi-Puchner A. Novel adipocytokines and lipodystrophic syndromes. Curr Med Res Opin 2019; 35:1653. [PMID: 31144541 DOI: 10.1080/03007995.2019.1625637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Despina D Briana
- Department of Neonatology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ariadne Malamitsi-Puchner
- Department of Neonatology, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Briana DD, Malamitsi-Puchner A. Coronary Intimal Thickening Begins in Fetuses: Proof of Concept for the "Fetal Origins of Adult Disease" Hypothesis. Angiology 2019; 71:89. [PMID: 31220918 DOI: 10.1177/0003319719857384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Briana DD, Malamitsi-Puchner A. Low-grade intraventricular hemorrhage of preterm infants: neurodevelopmental and motor outcome. J Matern Fetal Neonatal Med 2019; 34:646-652. [PMID: 31006295 DOI: 10.1080/14767058.2019.1610741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intraventricular hemorrhage (IVH) is a main complication of prematurity, inversely associated with gestational age and birth weight. Low-grade IVH (I and II), diagnosed by cranial ultrasound, had long been considered rather not to affect neurodevelopmental and motor outcome, a view challenged by several literature reports. However, diversity in studies design, periods of subjects' collection, cohort characteristics, demographic data, maternal or neonatal comorbidities, neuroimaging methods, evaluation tools, short-or-long-term follow-up by the same or different examiners, as well as other parameters and confounders make comparisons among reports very difficult, not allowing solid conclusions. Older, but also newer investigations claim both possible outcomes: impairment or not of cognitive and motor abilities in very preterm infants with low-grade IVH. Thus, the current suggestion in the relevant literature is not to rely only on the results of cranial ultrasounds, but to also implement classic, or even more advanced MRI techniques at term equivalent age to preterm infants with grade I or II IVH. In addition, the continuation of close follow-up during school age is warranted.
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Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Hadjigeorgiou E, Malamitsi-Puchner A, Lolis D, Lazarides P, Nicolopoulos D, Kaskarelis D. Cardiovascular Birth Defects and Antenatal Exposure to
Female Sex Hormones. ACTA ACUST UNITED AC 2019. [DOI: 10.1159/000481008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dessì A, Briana D, Corbu S, Gavrili S, Cesare Marincola F, Georgantzi S, Pintus R, Fanos V, Malamitsi-Puchner A. Metabolomics of Breast Milk: The Importance of Phenotypes. Metabolites 2018; 8:metabo8040079. [PMID: 30463323 PMCID: PMC6315662 DOI: 10.3390/metabo8040079] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 12/31/2022] Open
Abstract
Breast milk is the gold standard of nutrition for newborns. Its composition is tailored to the nutritional needs of the infant and varies between mothers. In recent years, several bioactive molecules have been discovered in addition to the main nutrients, such as multipotent stem cells, hormones, immunoglobulins, and bacteria. Furthermore, the human milk oligosaccharides (HMOs) seem to exert several important protective biological functions. According to the HMOs’ composition, breast milk can be classified as a secretory or non-secretory phenotype. In our study, we investigated the metabolome of milk collected from 58 mothers that delivered neonates at term, that were appropriate, small or large for gestational age, by performing nuclear magnetic resonance spectroscopy (1H-NMR). From the data analysis, two groups were distinguished based on their different types of oligosaccharides, and classified according the mother phenotype: secretory and non-secretory. This information is of major importance given the different biological function of the different HMOs, such as immune-modulation and protection against disease. This would allow us to predict whether the neonate would be, for instance, more prone to developing certain diseases, and to tailor her or his nutrition to fit their needs perfectly and pave the way to a personalized nutrition.
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Affiliation(s)
- Angelica Dessì
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, Azienda University Polyclinic, University of Cagliari, 09124 Cagliari, Italy.
| | - Despina Briana
- National and Kapodistrian University of Athens, 10679 Athens, Greece.
| | - Sara Corbu
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, Azienda University Polyclinic, University of Cagliari, 09124 Cagliari, Italy.
| | - Stavroula Gavrili
- Neonatal Intensive Care Unit, General District, Hospital Alexandra, 11528 Athens, Greece.
| | | | - Sofia Georgantzi
- Neonatal Intensive Care Unit, General District, Hospital Alexandra, 11528 Athens, Greece.
| | - Roberta Pintus
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, Azienda University Polyclinic, University of Cagliari, 09124 Cagliari, Italy.
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, Azienda University Polyclinic, University of Cagliari, 09124 Cagliari, Italy.
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Affiliation(s)
- Despina D. Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Briana DD, Gavrili S, Georgantzi S, Marmarinos A, Voulgaris K, Christou C, Gourgiotis D, Malamitsi-Puchner A. Inhibitors of osteoblastogenesis in early human milk and maternal serum: evidence for protective properties of mother's milk on bone. J Matern Fetal Neonatal Med 2018; 33:1095-1099. [PMID: 30122112 DOI: 10.1080/14767058.2018.1514383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Lactation is associated with a dramatic increase of maternal bone turnover, leading to a reversible bone loss. Early life nutrition may influence later osteoporosis risk. Proteins synthesized by the group of wingless (Wnt) genes are key mediators of osteoblastogenesis and bone formation. We aimed to investigate maternal milk and serum concentrations of the inhibitors of the Wnt signaling pathway, Dickkopf-1 (DKK-1) and sclerostin.Material and methods: In 80 women, maternal milk and serum concentrations of DKK-1 and sclerostin were determined by ELISA on the 3rd-4th day postpartum. Concentrations were associated with various maternal, gestational and neonatal characteristics.Results: DKK-1 and sclerostin were detectable in early milk [mean ± SD: 817.17 ± 259.61 pg/mL, median (range) 258.04 (2452.40-53.17) pg/mL, respectively] at significantly lower concentrations than in maternal serum [mean ± SD: 3375.36 ± 416.75 pg/mL, median (range) 16 200.54 (58 832.00-3012.60) pg/mL, respectively], (p < .000). Maternal milk sclerostin concentrations positively correlated with respective serum ones (r = 0.599, p = .000). Maternal serum and milk sclerostin concentrations positively correlated with maternal body mass index (r = 0.37, p = .001 and r =0.38, p = .000, respectively), while maternal serum sclerostin concentrations were higher in primiparas (p = .002).Conclusion: DKK-1 and sclerostin are present in early human milk at significantly lower concentrations, compared with maternal serum, probably contributing to the short- and long-term benefits of mother's milk for bone health. Moreover, the large amounts of both substances in maternal serum may represent disruption of the Wnt cascade, contributing to the well-known lactation-associated bone loss, which seems to be greater in primiparas and obese mothers.
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Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Gavrili
- Neonatal Intensive Care Unit, General District Hospital "Alexandra", Athens, Greece
| | - Sophia Georgantzi
- Neonatal Intensive Care Unit, General District Hospital "Alexandra", Athens, Greece
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry - Molecular Diagnostics, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry - Molecular Diagnostics, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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Stefa A, Lamprokostopoulou A, Briana DD, Kontogeorgou A, Papageorgiou I, Malamitsi-Puchner A, Tsitsilonis O, Gagos S, Charmandari E. The effect of intrauterine growth on leukocyte telomere length at birth. J Matern Fetal Neonatal Med 2018; 32:3948-3953. [PMID: 29779414 DOI: 10.1080/14767058.2018.1479392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: Telomeres are specialized nucleoprotein structures located at the ends of chromosomes, which play a crucial role in genomic stability. Telomere shortening has been proposed as a biomarker for the onset of age-related diseases. This study aimed to determine whether restricted or increased intrauterine growth affects leukocyte telomere length (LTL) at birth. Materials and methods: One hundred sixty-five (n = 165) full-term neonates participated in the study. Fetuses were classified as intrauterine growth restriction (IUGR, n = 21), large-for-gestational-age (LGA, n = 15), or appropriate-for-gestational-age (AGA, n = 129), based on customized birth-weight standards. Mixed arteriovenous cord blood samples were collected for isolation of leukocyte DNA. The LTL was measured using multiplex monochrome quantitative real-time PCR and telomeric restriction fragments through Southern blot analysis (terminal restriction fragment [TRF]). Results: Despite differences among groups in birth weight, length and head circumference, LTL did not differ among AGA (6.78 ± 0.58), IUGR (10.54 ± 1.80), and LGA (11.95 ± 2.42) neonates (p = .098). Cord blood IGF-1 and IGFBP-3 concentrations were higher in the LGA group. LTL positively correlated with birth length (r = 0.176, p = .032). Conclusions: Intrauterine growth does not seem to affect LTL at birth. Further studies, comprising a larger sample size of IUGR, LGA, and AGA neonates, are required to determine whether growth at birth influences LTL.
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Affiliation(s)
- Alketa Stefa
- Division of Endocrinology and Metabolism, Biomedical Research Foundation of the Academy of Athens , Athens , Greece
| | - Agaristi Lamprokostopoulou
- Division of Endocrinology and Metabolism, Biomedical Research Foundation of the Academy of Athens , Athens , Greece
| | - Despina D Briana
- Department of Neonatology, National and Kapodistrian University of Athens Medical School, Aretaieion University Hospital , Athens , Greece
| | - Anna Kontogeorgou
- Department of Neonatology, National and Kapodistrian University of Athens Medical School, Aretaieion University Hospital , Athens , Greece
| | - Ifigeneia Papageorgiou
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital , Athens , Greece
| | - Ariadne Malamitsi-Puchner
- Department of Neonatology, National and Kapodistrian University of Athens Medical School, Aretaieion University Hospital , Athens , Greece
| | - Ourania Tsitsilonis
- Department of Animal and Human Physiology, Faculty of Biology, University of Athens , Athens , Greece
| | - Sarantis Gagos
- Division of Genetics, Center of Experimental Medicine and Translational Research, Biomedical Research Foundation of the Academy of Athens , Athens , Greece
| | - Evangelia Charmandari
- Division of Endocrinology and Metabolism, Biomedical Research Foundation of the Academy of Athens , Athens , Greece.,Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital , Athens , Greece
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Briana DD, Malamitsi-Puchner A. Calprotectin: a biomarker for both infant/childhood and adult disease. Curr Med Res Opin 2018. [PMID: 29521128 DOI: 10.1080/03007995.2018.1450744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Despina D Briana
- a 1st Department of Paediatrics , "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens , 1 Thivon Street , Athens 11527 , Greece
| | - Ariadne Malamitsi-Puchner
- a 1st Department of Paediatrics , "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens , 1 Thivon Street , Athens 11527 , Greece
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Briana DD, Malamitsi-Puchner A. Developmental origins of adult health and disease: The metabolic role of BDNF from early life to adulthood. Metabolism 2018; 81:45-51. [PMID: 29217485 DOI: 10.1016/j.metabol.2017.11.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022]
Abstract
Accumulating evidence suggests that the origins of adult disease may occur during fetal life. Thus, the concept of "developmental programming" has been introduced and supported by epidemiological and experimental data. This concept supports the idea that the nutritional and hormonal status during pregnancy could interfere in metabolism control. The mechanisms responsible for this "developmental programming" remain poorly documented. Current research indicates that neurotrophins and particularly brain-derived neurotrophic factor (BDNF) may play a crucial role in this process. Although mainly expressed in the nervous system, BDNF and its receptor, tropomyosin-related kinase B (TrkB), are immunolocalized in several regions of the human placenta and have important functions during pregnancy. BDNF serves widespread roles in regulating energy homeostasis in both fetuses and adults, by controlling patterns of fetal growth, adult feeding and physical activity, and by regulating glucose metabolism in peripheral tissues. Impaired BDNF signaling may be implicated in the etiopathogenesis of the metabolic syndrome. Novel BDNF-focused interventions are being developed for obesity, diabetes and neurological disorders. The aim of this article is to provide a brief comprehensive literary review regarding the potential implications of BDNF in "developmental programming", through regulation of metabolism and energy balance from early life to adulthood.
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Affiliation(s)
- Despina D Briana
- Department of Neonatology, National and Kapodistrian University of Athens, Athens, Greece
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Briana DD, Boutsikou M, Marmarinos A, Gourgiotis D, Malamitsi-Puchner A. Perinatal sclerostin concentrations in abnormal fetal growth: the impact of gestational diabetes. J Matern Fetal Neonatal Med 2018; 32:2228-2232. [DOI: 10.1080/14767058.2018.1430135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Despina D. Briana
- Department of Neonatology, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Boutsikou
- Department of Neonatology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Marmarinos
- 2nd Department of Pediatrics, Laboratory of Clinical Biochemistry – Molecular Diagnostics, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Gourgiotis
- 2nd Department of Pediatrics, Laboratory of Clinical Biochemistry – Molecular Diagnostics, National and Kapodistrian University of Athens, Athens, Greece
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Briana DD, Malamitsi-Puchner A. Twins and neurodevelopmental outcomes: the effect of IVF, fetal growth restriction, and preterm birth. J Matern Fetal Neonatal Med 2018; 32:2256-2261. [PMID: 29307249 DOI: 10.1080/14767058.2018.1425834] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This invited review aimed at presenting the evidence concerning neurodevelopmental outcomes, particularly cerebral palsy (CP), motor disability, cognitive impairment, mental retardation, any major disability, blindness and deafness in cases of twins, conceived after in vitro fertilization, presenting fetal/intrauterine growth restriction (FGR/IUGR) or being prematurely born. FGR/IUGR, prematurity and zygosity affect neurodevelopmental outcome; CP is higher in term infants, those presenting with FGR/IUGR, as well as in survivors of intrauterine co-twin death; cognitive ability of twins versus singletons mainly relates to confounding factors, as FGR/IUGR and prematurity, while evidence for differences in behavioral and psychiatric disorders between twins and singletons is limited. The impact of IVF per se has not been documented. Nevertheless, available literature, usually of heterogeneous and retrospective nature, diverges in the criteria for neurodevelopmental delay. Furthermore, differences in selection/exclusion criteria and small mixed cohorts, including the full range of complications, make comparison of the existing studies difficult. Future studies should focus in confirming the lack of IVF impact on twins' neurodevelopment and general health, in comparing long-term outcome of naturally conceived twins with those conceived following assisted reproduction techniques and in including evaluation of individual, longitudinal trajectories of growth, and development. In this respect, worldwide population-based registries will enable more precise description of neurodevelopmental outcomes among twins.
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Affiliation(s)
- Despina D Briana
- a National and Kapodistrian University of Athens, Medical School , Athens , Greece
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Papaevangelou V, Christoni Z, Vliora C, Kottaridi C, Fotiou A, Malamitsi-Puchner A, Mentis A, Karakitsos P, Syggelou A. Neonatal screening for congenital CMV infection stresses the importance of maternal nonprimary infection even in an area where prenatal serology testing is common. J Matern Fetal Neonatal Med 2017; 32:1901-1904. [PMID: 29281927 DOI: 10.1080/14767058.2017.1416605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM AND METHODS Dried blood spots from 2149 newborns were examined to diagnose congenital cytomegalovirus (cCMV). RESULTS Prenatal CMV-IgG antibodies had been measured during prenatal care in 1287 (60.3%) of mothers and 980 (76.1%) of them were found seropositive. cCMV incidence was 0.47%. All newborns were asymptomatic; 9/10 were born post nonprimary maternal infection; two developed sensorineural hearing loss. CONCLUSIONS In a country where prenatal CMV testing is common and therefore a false sense of control might prevail, nonprimary maternal infection should not be overlooked. Indeed, women of childbearing age should be educated on CMV prevention measures irrespectively to their serostatus.
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Affiliation(s)
- Vassiliki Papaevangelou
- a Third Department of Pediatrics , National and Kapodistrian Univeristy of Athens Medical School, "ATTIKON" University Hospital , Athens , Greece
| | - Zoi Christoni
- b Department of Medical Laboratories , University of Applied Sciences of Thessaly , Larissa , Greece
| | - Christianna Vliora
- c General Paediatrics Department , Our Lady's Children's Hospital , Crumlin , Dublin , Ireland
| | - Christine Kottaridi
- d Department of Cytopathology , National and Kapodistrian University of Athens Medical School, "ATTIKON" University Hospital , Athens , Greece
| | - Aikaterini Fotiou
- e Department of Neonatology , Elena Venizelou Materinity Hospital , Athens , Greece
| | - Ariadne Malamitsi-Puchner
- f Department of Neonatology , National and Kapodistrian University of Athens Medical School, Aretaieion Hospital , Athens , Greece
| | - Andreas Mentis
- g Public Health Laboratories , Hellenic Pasteur institute , Athens , Greece
| | - Petros Karakitsos
- d Department of Cytopathology , National and Kapodistrian University of Athens Medical School, "ATTIKON" University Hospital , Athens , Greece
| | - Angeliki Syggelou
- h Second Department of Pediatrics , National and Kapodistrian Univeristy of Athens Medical School, P&A Kyriakou Childrens' Hospital , Athens , Greece
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Abstract
BACKGROUND Socioeconomic factors associated with twins/multiples have been sparsely studied. METHODS Data, regarding twin out of total births from 1996 to 2015, were extracted from databases of the Hellenic Statistical Authority and analyzed. RESULTS Twinning rate in Greece has increased from 1996 and onwards, in parallel with advanced maternal age and decline in total births. Higher twin rates are associated with higher maternal education, better paid parental occupations, and thus wealthier families, married maternal status, while immigrants present a lower twinning rate than Greeks. Lastly, the years of the economic crisis, starting in the year 2008 and still continuing, are characterized by a higher percentage of twins. CONCLUSIONS Our findings should be mainly attributed to the postponement of fertility, as well as the treatment of infertility with transfer of multiple embryos, when assisted reproductive technologies are applied.
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Affiliation(s)
| | | | - Emmanouela Sdona
- a Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Despina D Briana
- a Medical School, National and Kapodistrian University of Athens , Athens , Greece
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Sdona E, Papamichail D, Ragkou E, Kakalou E, Briana DD, Panagiotopoulos T, Malamitsi-Puchner A. Migration status and perinatal parameters in a Greek public maternity hospital: an illustration of the "healthy immigrant effect". J Matern Fetal Neonatal Med 2017; 32:62-66. [PMID: 28830312 DOI: 10.1080/14767058.2017.1371131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although socioeconomic disparities adversely affect health, studies referring to the "healthy immigrant effect" imply more favorable health outcomes in immigrants than natives. We aimed to investigate the impact of immigration on several perinatal parameters. METHODS Birth records (01/01/2010 - 31/12/2014) from a public maternity hospital in Athens, Greece were reviewed for maternal (ethnicity, age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Immigrants were classified by country of origin, according to Human Development Index. Comparison of results between Greeks and immigrants were made. Stratification by maternal age (< and ≥35 years) was conducted to test for confounding and interaction. RESULTS Almost one-third of 7506 deliveries applied to immigrants; 36.3% of Greeks and 19.2% of immigrants [risk ratio (RR) = 0.53, 95% confidence interval (CI) = 0.52-0.54] delivered at ≥35 years; 10.5% of Greek and 7.0% of immigrant neonates weighted <2500 g (RR = 0.67, 95% CI = 0.61-0.74); 10.9% of Greeks and 8.1% of immigrants were born <37 wks (RR = 0.74, 95% CI = 0.67-0.82); 55.7% of Greeks and 48.2% of immigrants delivered by caesarean section (RR = 0.87, 95% CI = 0.85-0.88). CONCLUSION We found that immigrant women deliver at a younger age, vaginally, more mature, and heavier neonates. Furthermore, we confirmed that the protective effect of immigrant status could not be explained by maternal age only.
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Affiliation(s)
- E Sdona
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece
| | - D Papamichail
- b Department of Child Health, National School of Public Health , Athens , Greece
| | - E Ragkou
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece.,c Programme of Postgraduate Education "International Medicine - Health Crisis Management" , Medical School, National & Kapodistrian University of Athens , Athens , Greece
| | - E Kakalou
- c Programme of Postgraduate Education "International Medicine - Health Crisis Management" , Medical School, National & Kapodistrian University of Athens , Athens , Greece
| | - D D Briana
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece
| | - T Panagiotopoulos
- b Department of Child Health, National School of Public Health , Athens , Greece
| | - A Malamitsi-Puchner
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece
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Sdona E, Papamichail D, Ragkou E, Briana DD, Malamitsi-Puchner A, Panagiotopoulos T. Greek economic crisis and impaired perinatal parameters: experience from a public maternity hospital. J Matern Fetal Neonatal Med 2017; 31:2371-2375. [PMID: 28614961 DOI: 10.1080/14767058.2017.1342803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Since 2008, Greece suffers a severe economic crisis. Adverse health outcomes have been reported, but studies on perinatal health are sparse. We aimed to examine the impact of economic crisis on perinatal parameters during early and established crisis periods. Birth records of 14 923 neonates, born in a public maternity hospital from 2005-2014, were reviewed for maternal (age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Univariable analysis tested the association of study variables with time-periods 2005-2007, 2009-2011 and 2012-2014. Multivariable logistic regression analysis identified factors independently associated with low birthweight (LBW) (<2500 g), prematurity (<37 weeks) and caesarean section (CS). During 2012-2014, compared to 2005-2007, LBW rate increased from 8.4 to 10.5% (RR 1.16; 95%CI 1.01-1.33); prematurity from 9.7 to 11.2% (RR 1.09; 95%CI 0.96-1.24), comprising mainly late-preterm neonates; CS from 43.2 to 54.8% (RR 1.21; 95%CI 1.16-1.26). Maternal age ≥30 years was risk factor for LBW, prematurity and CS; LBW was additional risk factor for CS. However, LBW and CSs increased during the study period, independently of maternal age. In conclusion, impaired perinatal parameters, manifested by increasing maternal age, LBW, prematurity and CS rate, were observed during the years of economic decline, with possible adverse consequences for later health.
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Affiliation(s)
- E Sdona
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece
| | - D Papamichail
- b Department of Child Health , National School of Public Health , Athens , Greece
| | - E Ragkou
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece
| | - D D Briana
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece
| | - A Malamitsi-Puchner
- a Department of Neonatology , National and Kapodistrian University of Athens, Aretaieion University Hospital , Athens , Greece
| | - T Panagiotopoulos
- b Department of Child Health , National School of Public Health , Athens , Greece
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Sinanoglou VJ, Cavouras D, Boutsikou T, Briana DD, Lantzouraki DZ, Paliatsiou S, Volaki P, Bratakos S, Malamitsi-Puchner A, Zoumpoulakis P. Factors affecting human colostrum fatty acid profile: A case study. PLoS One 2017; 12:e0175817. [PMID: 28410426 PMCID: PMC5391953 DOI: 10.1371/journal.pone.0175817] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/31/2017] [Indexed: 01/29/2023] Open
Abstract
The role of maternal colostrum to infant development has been extensively studied and presented. Among the main factors which contribute to breast milk composition are maternal diet, age and body mass index, parity, duration of pregnancy and stage of lactation. This study aims to investigate the potential impact of several factors including demographic (i.e. maternal age and nationality) on the colostrum fatty acid profile. Colostrum was collected the third day postpartum in a Greek maternity hospital. Certain lipid quality indices and fatty acid ratios were estimated and results were statistically processed. The main identified fatty acids were palmitic (C16:0), oleic (C18:1ω-9), and linoleic (C18:2ω-6) acids. Among fatty acids, saturated fatty acids predominated (47.61%), followed by monounsaturated fatty acids (39.26%), while polyunsaturated fatty acids had the lowest proportion (13.13%). Values of lipid quality indices were within the reported in the literature ranges. Maternal body mass index, nationality, age, mode of delivery, gender and fetal weight percentile were studied in respect to their potential influence on the fatty acid profile of colostrum fat. Results suggest that colostrum fatty acid profile was mainly dependent on maternal nationality and age rather than mode of delivery and maternal BMI. Regarding the effect of maternal nationality, significant differences were found for saturated and monounsaturated fatty acids. Of the most interesting findings is that colostrum fat from older (≥35 years) mothers had less saturated fat and more appropriate LQIs values. Finally, a reversed correlation was observed between the customized centile of the infants and the colostrum fat content.
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Affiliation(s)
- Vassilia J. Sinanoglou
- Laboratory of Chemistry, Analysis & Design of Food Processes, Instrumental Food Analysis, Department of Food Technology, Technological Educational Institution of Athens, Greece
| | - Dionisis Cavouras
- Medical Image and Signal Processing Laboratory, Department of Biomedical Engineering, Technological Education Institution of Athens, Greece
| | - Theodora Boutsikou
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School Aretaieio University Hospital, Athens, Greece
| | - Despina D. Briana
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School Aretaieio University Hospital, Athens, Greece
| | - Dimitra Z. Lantzouraki
- Laboratory of Chemistry, Analysis & Design of Food Processes, Instrumental Food Analysis, Department of Food Technology, Technological Educational Institution of Athens, Greece
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Stella Paliatsiou
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School Aretaieio University Hospital, Athens, Greece
| | - Paraskevi Volaki
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School Aretaieio University Hospital, Athens, Greece
| | - Sotiris Bratakos
- Laboratory of Chemistry, Analysis & Design of Food Processes, Instrumental Food Analysis, Department of Food Technology, Technological Educational Institution of Athens, Greece
| | - Ariadne Malamitsi-Puchner
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School Aretaieio University Hospital, Athens, Greece
| | - Panagiotis Zoumpoulakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
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Briana DD, Germanou K, Boutsikou M, Boutsikou T, Athanasopoulos N, Marmarinos A, Gourgiotis D, Malamitsi-Puchner A. Potential prognostic biomarkers of cardiovascular disease in fetal macrosomia: the impact of gestational diabetes. J Matern Fetal Neonatal Med 2017; 31:895-900. [PMID: 28298172 DOI: 10.1080/14767058.2017.1300651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Fetal macrosomia is associated with cardiac hypertrophy and increased cardiovascular risk. Cardiac biomarkers may play diagnostic/prognostic role in cardiovascular disease. We tested whether cardiac biomarkers are differentially expressed in cord blood samples of full-term singleton large-for-gestational-age (LGA), as compared to appropriate-for-gestational-age (AGA) pregnancies. METHODS Cardiotrophin-1 (CT-1), Titin, pentraxin (PTX-3) and soluble CD36 (sCD36) concentrations were determined in 80 cord blood samples from a) LGA pregnancies due to maternal diabetes (n = 8), overweight/obese (n = 11), excessive weight gain (n = 7), without specific pathology (n = 14), b) AGA normal pregnancies (controls, n = 40). Neonates were classified as LGA or AGA based on customized birth weight (BW) standards. RESULTS CT-1 and Titin concentrations were higher in LGA than AGA pregnancies (p < .001 and p = .023, respectively). A subgroup analysis (in the LGA group) showed increased CT-1 concentrations only in diabetic pregnancies. PTX-3 and sCD36 concentrations were similar in LGA and AGA fetuses. In the LGA group, PTX-3 concentrations positively correlated with birth-weight (r = .416, p = .008) and respective sCD36 concentrations (r = .443, p = .004). CONCLUSION Higher Titin concentrations in LGAs possibly represent a candidate molecular mechanism underlying the association between fetal macrosomia and cardiomyocyte/diastolic dysfunction. CT-1 is up-regulated only in LGAs exposed to maternal diabetes. PTX-3 and sCD36 are probably not affected by excessive fetal growth.
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Affiliation(s)
- Despina D Briana
- a Department of Neonatology , National and Kapodistrian University of Athens , Athens , Greece
| | - Kleopatra Germanou
- a Department of Neonatology , National and Kapodistrian University of Athens , Athens , Greece
| | - Maria Boutsikou
- a Department of Neonatology , National and Kapodistrian University of Athens , Athens , Greece
| | - Theodora Boutsikou
- a Department of Neonatology , National and Kapodistrian University of Athens , Athens , Greece
| | - Nikolaos Athanasopoulos
- a Department of Neonatology , National and Kapodistrian University of Athens , Athens , Greece
| | - Antonios Marmarinos
- b Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics , National and Kapodistrian University of Athens , Athens , Greece
| | - Dimitrios Gourgiotis
- b Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics , National and Kapodistrian University of Athens , Athens , Greece
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47
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Briana DD, Papastavrou M, Boutsikou M, Marmarinos A, Gourgiotis D, Malamitsi-Puchner A. Differential expression of cord blood neurotrophins in gestational diabetes: the impact of fetal growth abnormalities. J Matern Fetal Neonatal Med 2017; 31:278-283. [DOI: 10.1080/14767058.2017.1281907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Despina D. Briana
- Department of Neonatology, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Papastavrou
- Department of Neonatology, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Boutsikou
- Department of Neonatology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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48
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Negro S, Boutsikou T, Briana DD, Tataranno ML, Longini M, Proietti F, Bazzini F, Dani C, Malamitsi-Puchner A, Buonocore G, Perrone S. Maternal obesity and perinatal oxidative stress: the strength of the association. J BIOL REG HOMEOS AG 2017; 31:221-227. [PMID: 28337896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Maternal obesity is a chronic inflammatory state, which has been shown to induce increased levels of free fatty acids, reactive oxygen species and inflammatory cells. Recent evidence reveals increased levels of lipid peroxidation products in the plasma of obese women during pregnancy. The aim of this study was to test the hypothesis that maternal overweight or obesity is associated with increased oxidative stress (OS) in offspring. Two hundred and forty-five pregnant women and their newborns were prospectively enrolled. Mothers were divided in two groups: lean control - LC (n=175, Group I); overweight or obese (n=70, Group II) according to BMI ≥ 25 before pregnancy. Cord blood F2-isoprostanes (F2-IsoPs), as reliable markers of OS, were measured in all newborns. Lower 1 minute APGAR score and higher weight at discharge were found in Group II neonates, compared to those of Group I (p less than 0.05). Small for gestational age (SGA) newborns of both groups showed increased levels of F2-IsoPs than appropriate (AGA) or large (LGA) for gestational age (GA) (p less than 0.01). SGA newborns of Group II had higher F2-IsoPs levels compared to SGA of Group I (p less than 0.01), which were significantly correlated to maternal BMI at the end of pregnancy (r=0.451, p less than 0.01). Multivariate regression analysis corrected for confounding factors, showed that maternal overweight or obesity was significantly associated with high F2-IsoPs levels in SGA offspring (p less than 0.01). Maternal overweight or obesity is associated with increased OS in their SGA newborns. Data suggest the need of antioxidant protection for both mothers during pregnancy and infants soon after birth.
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Affiliation(s)
- S Negro
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - T Boutsikou
- Department of Neonatology, Aretaieion University Hospital, University of Athens, Greece
| | - D D Briana
- Department of Neonatology, Aretaieion University Hospital, University of Athens, Greece
| | - M L Tataranno
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - M Longini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - F Proietti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - F Bazzini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - C Dani
- Neonatal Intensive Care Unit, University of Florence, Florence, Italy
| | - A Malamitsi-Puchner
- Department of Neonatology, Aretaieion University Hospital, University of Athens, Greece
| | - G Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - S Perrone
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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49
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Malamitsi-Puchner A, Tziotis J, Tsonou A, Protonotariou E, Sarandakou A, Creatsas G. Changes in Serum Levels of Vascular Endothelial Growth Factor in Males and Females Throughout Life. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/107155760000700507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - George Creatsas
- Second Department of Obstetrics and Gynecology, and Department of Hygiene and Epidemiology, University of Athens, Athens, Greece
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Malamitsi-Puchner A, Briana DD, Kontara L, Boutsikou M, Baka S, Hassiakos D, Marmarinos A, Gourgiotis D. Serum Cystatin C in Pregnancies With Normal and Restricted Fetal Growth. Reprod Sci 2016; 14:37-42. [PMID: 17636214 DOI: 10.1177/1933719106298196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate circulating levels of cystatin C (an important endogenous marker of renal function) in mothers, fetuses, and neonates from intrauterine growth-restricted (IUGR; characterized by impaired nephrogenesis) and appropriate-for-gestational-age (AGA) pregnancies. Serum cystatin C levels were measured by enzyme immunoassay in 40 parturients and their 20 IUGR (<or=3rd customized centile, due to gestational pathology) and 20 AGA fetuses and neonates on postnatal day 1 (N1) and 4 (N4). Comparatively, creatinine and urea concentrations were determined in the same samples. Fetal cystatin C levels were higher in the AGA than the IUGR group (P = .001). In both groups, maternal cystatin C levels were lower than fetal (P < .001), N1 (P < .001), and N4 (P < .001) levels. Fetal levels were higher than N1 (P < .001) and N4 (P < .001), and N1 levels were higher than N4 (P = .007) ones. In both groups, no correlation existed between maternal and fetal levels, but positive correlations were found between cystatin C, creatinine, and urea levels in maternal and neonatal samples (in all cases, r >or= 0.376 and P <or= .045). Cystatin C levels did not correlate with gestational age and did not differ between males and females. Fetal cystatin C serum levels are lower in the IUGR group, significantly decrease after birth, and do not correlate with maternal levels in both groups. In addition, serum cystatin C levels positively correlate with respective creatinine and urea levels in the perinatal period.
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Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Division, Second Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece. @aias.gr
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