Glucocorticoid-remediable aldosteronism and pregnancy

Glucocorticoid-remediable aldosteronism (GRA) is a hereditary form of primary hyperaldosteronism that presents with hypokalemia and hypertension from childhood onward. GRA is characterized by the ectopic production of aldosterone in the cortisol-producing zona fasciculata under the regulation of adrenocorticotrophic hormone. Despite the early age of onset, no previous reports of pregnancy and GRA exist. Therefore, we set out to describe the maternal and fetal outcomes of pregnancy in women with GRA. Data regarding the blood pressure and pregnancy outcomes were collected in a retrospective chart review of prenatal and hospital records of 35 pregnancies in 16 women with genetically proven GRA. A total of 6% of pregnancies in women with GRA (GRA+) were complicated by preeclampsia. The published rates of preeclampsia in general obstetric populations vary from 2.5% to 10%. Despite the lack of an apparent increase in the rate of preeclampsia, GRA+ women with chronic hypertension had a high rate (39%) of pregnancy-aggravated hypertension. Starting with a higher baseline blood pressure, maternal blood pressure plotted over the time course of pregnancy followed a quadratic curve similar to that previously described in normal pregnancy. Mean gestational age at delivery was 39.1 weeks. Mean birth weight, excluding the 3 sets of twins, was 3219 g. However, infants of GRA+ mothers with pregnancy-aggravated hypertension tended to have lower birth weights than those that did not (3019 g versus 3385 g, respectively; P=0.08). The primary cesarean section rate was 32%, which is approximately double that seen in other general or hypertensive obstetric populations. In summary, GRA+ women did not seem to have an increased risk of preeclampsia. However, GRA+ women with chronic hypertension seem to be at an increased risk for an exacerbation of their hypertension during pregnancy.

Impact of correlated factors on bone density in individuals with a family history of osteoporosis

Previous studies have suggested that 14-47% of the variation in bone mineral density (BMD) can be predicted using clinical risk factors. The aim of our study was to determine, for the first time, the importance of these factors in individuals with evidence of a genetic predisposition to the disease. The subjects studied were 147 female and 86 male Caucasians, all with a family history of osteoporosis. Linear regression was used to determine whether age, height, weight, and years of reduced estrogen exposure were significant predictors of BMD. Males and females were examined separately, and BMD was measured at the hip and spine. The results show that these risk factors, known to be at work in the general population, are equally important in those with a family history of osteoporosis. It is clear, therefore, that they must be taken into account, and corrected for in genetic studies of the disease.

Influence of processed corn grain in diets of dairy cows on digestion of nutrients and milk composition

Five primiparous Holstein cows (55 d in milk) that were fitted with ruminal and duodenal cannulas were used in a 4 x 5 incomplete Latin square to determine the effects of blends of steam-flaked and dry-rolled corn on site and extent of nutrient digestion and milk yield and composition. Diets were fed as total mixed rations and consisted of 45% forage and 55% concentrate; each diet contained 27% corn grain. Dietary treatments were composed of blends of dry-rolled and steam-flaked corn in ratios of 100:0, 67:33, 33:67, and 0:100. Intake of dry matter; digestibilities of dry matter, organic matter, acid detergent fiber, cellulose, neutral detergent fiber, fatty acids, and N; and microbial efficiency were unaffected by diet. Ruminal, postruminal, and total tract digestion of starch increased linearly, and starch passage to the duodenum decreased linearly, as the proportion of dry-rolled corn in the diet decreased. Ruminal propionate and valerate increased linearly, and acetate, butyrate, isovalerate, and the acetate to propionate ratio decreased linearly, as proportions of dry-rolled corn in the diet decreased; however, no changes in total volatile fatty acid concentrations in ruminal fluid were observed. Ruminal fluid pH was similar across diets. A decrease in dry-rolled corn decreased ruminal ammonia N and plasma urea N linearly. Milk yield and composition, as well as milk N fractions, were similar across diets. Although changes in fatty acid composition of milk fat were small, linear decreases in percentages of trans-C16:1 and cis-9- and cis-10-C18:1, as well as a linear increase in the percentage of C18:2 occurred as the proportion of dry-rolled corn in the diet decreased. An increased proportion of dry-rolled corn in the diet decreased digestion of starch in the rumen, and patterns of volatile fatty acid concentrations shifted accordingly. However, no effects on lactational parameters were observed.