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Viard D, Gérard A, Tahiri J, Tieulié N, Van Obberghen E, Drici MD. Triptan overuse during pregnancy: a possible cause of placental hypoperfusion. Eur J Clin Pharmacol 2020; 77:269-270. [PMID: 32886179 DOI: 10.1007/s00228-020-02991-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Delphine Viard
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France.
| | - Alexandre Gérard
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France
| | - Jellila Tahiri
- Department of Obstetrics and Gynecology, University Hospital of Nice, Nice, France
| | - Nathalie Tieulié
- Department of Rheumatology, University Hospital of Nice, Nice, France
| | - Elise Van Obberghen
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France
| | - Milou-Daniel Drici
- Department of Pharmacology, Pharmacovigilance Center, University Hospital of Nice, Nice, France
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Dickson MA, Peterson N, McRae KE, Pudwell J, Tayade C, Smith GN. Carbon monoxide increases utero-placental angiogenesis without impacting pregnancy specific adaptations in mice. Reprod Biol Endocrinol 2020; 18:49. [PMID: 32408878 PMCID: PMC7227344 DOI: 10.1186/s12958-020-00594-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smokers have a reduced risk of developing preeclampsia, possibly attributed to an increase in carbon monoxide (CO) levels. Carbon monoxide is a gasotransmitter that has been implicated in maintaining vascular tone, increasing angiogenesis, and reducing inflammation and apoptosis at physiological concentrations. Moderately increasing CO concentrations may have therapeutic potential to prevent or treat preeclampsia; however, the effects of CO on pregnancy are under studied. Our objective was to investigate the effect of CO on major angiogenic and inflammatory markers in pregnancy, and to evaluate the effect of CO on indicators of placental health. FINDINGS Pregnant CD-1 mice were constantly exposed to either ambient air or 250 ppm CO from conception until gestation day (GD)10.5 or GD16.5. Using a qRT-PCR array, we identified that CO increased expression of major angiogenic genes at the implantation site on GD10.5, but not GD16.5. Pro-inflammatory cytokines in the plasma and tissue lysates from implantation sites in treated mice were not significantly different compared to controls. Additionally, CO did not alter the implantation site phenotype, in terms of proliferative capacity, invasiveness of trophoblasts, or abundance of uterine natural killer cells. CONCLUSIONS This study suggests that CO exposure is pro-angiogenic at the maternal-fetal interface, and is not associated with demonstrable concerns during murine pregnancy. Future studies are required to validate safety and efficacy of CO as a potential therapeutic for vascular insufficiency diseases such as preeclampsia and intrauterine growth restriction.
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Affiliation(s)
- Megan A. Dickson
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
| | - Nichole Peterson
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
| | - Karalyn E. McRae
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston Health Sciences Centre, 76 Stuart St, Kingston, K7L 2V7 Canada
| | - Chandrakant Tayade
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
| | - Graeme N. Smith
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston Health Sciences Centre, 76 Stuart St, Kingston, K7L 2V7 Canada
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Lane SL, Doyle AS, Bales ES, Lorca RA, Julian CG, Moore LG. Increased uterine artery blood flow in hypoxic murine pregnancy is not sufficient to prevent fetal growth restriction†. Biol Reprod 2020; 102:660-670. [PMID: 31711123 PMCID: PMC7068112 DOI: 10.1093/biolre/ioz208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/19/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022] Open
Abstract
Incomplete maternal vascular responses to pregnancy contribute to pregnancy complications including intrauterine growth restriction (IUGR) and preeclampsia. We aimed to characterize maternal vascular dysfunction in a murine model of fetal growth restriction as an approach toward identifying targetable pathways for improving pregnancy outcomes. We utilized a murine model of late-gestation hypoxia-induced IUGR that reduced E18.5 fetal weight by 34%. Contrary to our hypothesis, uterine artery blood flow as measured in vivo by Doppler ultrasound was increased in mice housed under hypobaric hypoxia (385 mmHg; 5500 m) vs normoxia (760 mmHg; 0 m). Using wire myography, uterine arteries isolated from hypoxic mice had similar vasodilator responses to the two activators A769662 and acetylcholine as those from normoxic mice, although the contribution of an increase in nitric oxide production to uterine artery vasodilation was reduced in the hypoxic vs normoxic groups. Vasoconstrictor responses to phenylephrine and potassium chloride were unaltered by hypoxia. The levels of activated adenosine monophosphate-activated protein kinase (AMPK) were reduced with hypoxia in both the uterine artery and placenta as measured by western blot and immunohistochemistry. We concluded that the rise in uterine artery blood flow may be compensatory to hypoxia but was not sufficient to prevent fetal growth restriction. Although AMPK signaling was reduced by hypoxia, AMPK was still receptive to pharmacologic activation in the uterine arteries in which it was a potent vasodilator. Thus, AMPK activation may represent a new therapy for pregnancy complications involving reduced uteroplacental perfusion.
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Affiliation(s)
- Sydney L Lane
- Integrated Physiology PhD Program, University of Colorado Denver Graduate School, Aurora, CO, USA
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandrea S Doyle
- Division of Bioinformatics and Personalized Medicine, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Elise S Bales
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Ramón A Lorca
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Colleen G Julian
- Division of Bioinformatics and Personalized Medicine, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Lorna G Moore
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
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Khalil A, Sharp A, Cornforth C, Jackson R, Mousa H, Stock S, Harrold J, Turner MA, Kenny LC, Baker PN, Johnstone ED, Von Dadelszen P, Magee L, Papageorghiou AT, Alfirevic Z. Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo-controlled double-blind trial. Ultrasound Obstet Gynecol 2020; 55:198-209. [PMID: 31432556 DOI: 10.1002/uog.20851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/07/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Fetal growth restriction (FGR) is associated with maternal cardiovascular changes. Sildenafil, a phosphodiesterase type-5 inhibitor, potentiates the actions of nitric oxide, and it has been suggested that it alters maternal hemodynamics, potentially improving placental perfusion. Recently, the Dutch STRIDER trial was stopped prematurely owing to excess neonatal mortality secondary to pulmonary hypertension. The main aim of this study was to investigate the effect of sildenafil on maternal hemodynamics in pregnancies with severe early-onset FGR. METHODS This was a cardiovascular substudy within a UK multicenter, placebo-controlled trial, in which 135 women with a singleton pregnancy and severe early-onset FGR (defined as a combination of estimated fetal weight or abdominal circumference below the 10th centile and absent/reversed end-diastolic flow in the umbilical artery on Doppler velocimetry, diagnosed between 22 + 0 and 29 + 6 weeks' gestation) were assigned randomly to receive either 25 mg sildenafil three times daily or placebo until 32 + 0 weeks' gestation or delivery. Maternal blood pressure (BP), heart rate (HR), augmentation index, pulse wave velocity (PWV), cardiac output, stroke volume (SV) and total peripheral resistance were recorded before randomization, 1-2 h and 48-72 h post-randomization, and 24-48 h postnatally. For continuous data, analysis was performed using repeated measures ANOVA methods including terms for timepoint, treatment allocation and their interaction. RESULTS Included were 134 women assigned randomly to sildenafil (n = 69) or placebo (n = 65) who had maternal BP and HR recorded at baseline. At 1-2 h post-randomization, compared with baseline values, sildenafil increased maternal HR by 4 bpm more than did placebo (mean difference, 5.00 bpm (95% CI, 1.00-12.00 bpm) vs 1.25 bpm (95% CI, -5.38 to 7.88 bpm); P = 0.004) and reduced systolic BP by 1 mmHg more (mean difference, -4.13 mmHg (95% CI, -9.94 to 1.44 mmHg) vs -2.75 mmHg (95% CI, -7.50 to 5.25 mmHg); P = 0.048). Even after adjusting for maternal mean arterial pressure, sildenafil reduced aortic PWV by 0.60 m/s more than did placebo (mean difference, -0.90 m/s (95% CI, -1.31 to -0.51 m/s) vs -0.26 m/s (95% CI, -0.75 to 0.59 m/s); P = 0.001). Sildenafil was associated with a non-significantly greater decrease in SV index after 1-2 h post-randomization than was placebo (mean difference, -5.50 mL/m2 (95% CI, -11.00 to -0.50 mL/m2 ) vs 0.00 mL/m2 (95% CI, -5.00 to 4.00 mL/m2 ); P = 0.056). CONCLUSIONS Sildenafil in a dose of 25 mg three times daily increases HR, reduces BP and reduces arterial stiffness in pregnancies complicated by severe early-onset FGR. These changes are short term, modest and consistent with the anticipated vasodilatory effect. They have no short- or long-term clinical impact on the mother. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - C Cornforth
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - R Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - H Mousa
- Fetal Medicine Unit, University of Leicester, Leicester, UK
| | - S Stock
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J Harrold
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - M A Turner
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - L C Kenny
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - P N Baker
- College of Life Sciences, University of Leicester, Leicester, UK
| | - E D Johnstone
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester, UK
| | - P Von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Elwany E, Omar S, Ahmed A, Heba G, Atef D. Antenatal dexamethasone effect on Doppler blood flow velocity in women at risk for preterm birth: prospective case series. Afr Health Sci 2018; 18:596-600. [PMID: 30602992 PMCID: PMC6307019 DOI: 10.4314/ahs.v18i3.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Maternal administration of corticosteroids is essential to improve fetal lung surfactant production and hasten the fetal lung maturity in women at risk for preterm birth. Objectives The current study aims to evaluate the effects of dexamethasone on fetal and uteroplacental circulation in pregnancies at risk for preterm birth after 24 hours of its administration. Methods A prospective cross-sectional study was carried out in a tertiary University Hospital and included 52 pregnant women with singleton pregnancies. Doppler studies were performed on maternal uterine arteries, umbilical artery, fetal middle cerebral artery (MCA) and fetal descending aorta and just before dexamethasone administration and repeated 24 hours after completion of the course. Results There was a statistically significant difference between all Doppler indices in the umbilical artery (PI= 1.09±0.4 and 1.05±0.39, RI= 0.66±0.14 and 0.63±0.14; p=0.001), fetal MCA (RI= 0.86±0.12 and 0.83±0.13, PI= 2.19±0.72 and 2.15±0.72; p=0.001) and aorta (RI= 0.9±0.55 and 0.87±0.55; p=0.001, PI= 1.91±0.44 and 1.89±0.44; p=0.040) in comparison before and 24 hours after maternal dexamethasone administration respectively. Also uterine artery PI was significantly different (0.9±0.27 and 0.87±0.26; p=0.001). Conclusion Antenatal dexamethasone for women at risk of preterm birth improves the fetal and uteroplacental blood flow at 24 hours after its administration.
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Affiliation(s)
- Elsnosy Elwany
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shaaban Omar
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abbas Ahmed
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Gaber Heba
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Darwish Atef
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
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Szukiewicz D, Pyzlak M, Szewczyk G, Stangret A, Trojanowski S, Bachanek M, Braksator W, Wejman J. High Glucose Level Disturbs the Resveratrol-Evoked Curtailment of CX3CL1/CX3CR1 Signaling in Human Placental Circulation. Mediators Inflamm 2017; 2017:9853108. [PMID: 28655972 PMCID: PMC5471565 DOI: 10.1155/2017/9853108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/01/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022] Open
Abstract
Hyperglycemia-induced hyperactivity of chemokine CX3CL1 (fractalkine) occurs in the human placenta. Anti-inflammatory/antioxidant activities of resveratrol (3,5,4'-trihydroxy-trans-stilbene) are related to the modulation of chemokine CX3CL1 and its receptor, CX3CR1, signaling pathways. We examined the influence of high glucose (25 mmol/L glucose; HG group; N = 36) on resveratrol-mediated effects on CX3CL1 and TNF-α production by the placental lobule, CX3CR1 expression and contents of CX3CR1, TNF-α receptor 1 (TNFR1), and NF-κB proteins in placental tissue. The placental lobules perfused under normoglycemic conditions formed the control NG group (N = 36). Resveratrol (50 and 100 μM; subgroups B and C) administered into the perfusion fluid lowered the production of both CX3CL1 and TNF-α. The reductions in CX3CL1 levels were more evident in the NG group. CX3CR1 expression was significantly higher in the NG subgroups B and C compared to the HG subgroups B and C (385.2 and 426.5% versus 199.3 and 282.4%, resp.). An increase in CX3CR1 protein content in placental lysates was observed in the NG subgroups B and C. Also, resveratrol significantly decreased NF-κBp65 protein content only in the NG group, not affecting hyperglycemia-elicited TNFR1 upregulation. In conclusion, euglycemia assures optimal effects of resveratrol pertaining to CX3CL1/CX3CR1 signaling in the placenta. Future studies on resveratrol are needed, especially those including maternal-fetal risk assessments.
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Affiliation(s)
- Dariusz Szukiewicz
- Department of General & Experimental Pathology with Centre for Preclinical Research and Technology (CEPT), Second Faculty of Medicine, Medical University of Warsaw, ul. Pawinskiego 3C, 02-106 Warsaw, Poland
| | - Michal Pyzlak
- Department of General & Experimental Pathology with Centre for Preclinical Research and Technology (CEPT), Second Faculty of Medicine, Medical University of Warsaw, ul. Pawinskiego 3C, 02-106 Warsaw, Poland
| | - Grzegorz Szewczyk
- Department of General & Experimental Pathology with Centre for Preclinical Research and Technology (CEPT), Second Faculty of Medicine, Medical University of Warsaw, ul. Pawinskiego 3C, 02-106 Warsaw, Poland
| | - Aleksandra Stangret
- Department of General & Experimental Pathology with Centre for Preclinical Research and Technology (CEPT), Second Faculty of Medicine, Medical University of Warsaw, ul. Pawinskiego 3C, 02-106 Warsaw, Poland
| | - Seweryn Trojanowski
- Department of Obstetrics & Gynecology, Second Faculty of Medicine, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw, Poland
| | - Michal Bachanek
- Department of Obstetrics & Gynecology, Second Faculty of Medicine, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw, Poland
| | - Wojciech Braksator
- Department of Cardiology, Hypertension, and Internal Medicine, Second Faculty of Medicine, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw, Poland
| | - Jaroslaw Wejman
- Department of Pathology, Professor Witold Orlowski Public Clinical Hospital, Medical Center for Postgraduate Education, ul. Czerniakowska 231, 00-416 Warsaw, Poland
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Lo JO, Schabel MC, Roberts VHJ, Wang X, Lewandowski KS, Grant KA, Frias AE, Kroenke CD. First trimester alcohol exposure alters placental perfusion and fetal oxygen availability affecting fetal growth and development in a non-human primate model. Am J Obstet Gynecol 2017; 216:302.e1-302.e8. [PMID: 28153658 PMCID: PMC5334435 DOI: 10.1016/j.ajog.2017.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/22/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prenatal alcohol exposure leads to impaired fetal growth, brain development, and stillbirth. Placental impairment likely contributes to these adverse outcomes, but the mechanisms and specific vasoactive effects of alcohol that links altered placental function to impaired fetal development remain areas of active research. OBJECTIVE Recently, we developed magnetic resonance imaging techniques in nonhuman primates to characterize placental blood oxygenation through measurements of T2* and perfusion using dynamic contrast-enhanced magnetic resonance imaging. The objective of this study was to evaluate the effects of first-trimester alcohol exposure on macaque placental function and to characterize fetal brain development in vivo. STUDY DESIGN Timed-pregnant Rhesus macaques (n=12) were divided into 2 groups: control (n=6) and ethanol exposed (n=6). Animals were trained to self-administer orally either 1.5 g/kg/d of a 4% ethanol solution (equivalent to 6 drinks/d) or an isocaloric control fluid from preconception until gestational day 60 (term is G168). All animals underwent Doppler ultrasound scanning followed by magnetic resonance imaging that consisted of T2* and dynamic contrast-enhanced measurements. Doppler ultrasound scanning was used to measure uterine artery and umbilical vein velocimetry and diameter to calculate uterine artery volume blood flow and placental volume blood flow. After noninvasive imaging, animals underwent cesarean delivery for placenta collection and fetal necropsy at gestational day 110 (n=6) or 135 (n=6). RESULTS Fetal weight and biparietal diameter were significantly smaller in ethanol-exposed animals compared with control animals at gestational day 110. By Doppler ultrasound scanning, placental volume blood flow was significantly lower (P=.04) at gestational day 110 in ethanol-exposed vs control animals. A significant reduction in placental blood flow was evident by dynamic contrast-enhanced magnetic resonance imaging. As we demonstrated recently, T2* values vary throughout the placenta and reveal gradients in blood deoxyhemoglobin concentration that range from highly oxygenated blood (long T2*) proximal to spiral arteries to highly deoxygenated blood (short T2*). Distributions of T2*throughout the placenta show significant global reduction in T2* (and hence high blood deoxyhemoglobin concentration) in ethanol-exposed vs control animals at gestational day 110 (P=.02). Fetal brain measurements indicated impaired growth and development at gestational day 110, but less so at gestational day 135 in ethanol-exposed vs control animals. CONCLUSION Chronic first-trimester ethanol exposure significantly reduces placental perfusion and oxygen supply to the fetal vasculature later in pregnancy. These perturbations of placental function are associated with fetal growth impairments. However, differences between ethanol-exposed and control animals in placental function and fetal developmental outcomes were smaller at gestational day 135 than at gestational day 110. These findings are consistent with placental adaptation to early perturbations that allow for compensated placental function and maintenance of fetal growth.
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Affiliation(s)
- Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | - Victoria H J Roberts
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Katherine S Lewandowski
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Kathleen A Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Antonio E Frias
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Christopher D Kroenke
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR; Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
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Karahanoglu E, Altinboga O, Akpinar F, Demirdag E, Ozdemirci S, Akyol A, Yalvac S. Nifedipine increases fetoplacental perfusion. J Perinat Med 2017; 45:51-55. [PMID: 27387329 DOI: 10.1515/jpm-2016-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/03/2016] [Indexed: 11/15/2022]
Abstract
AIM Our aim is to evaluate the effect of nifedipine on fetoplacental hemodynamic parameters. METHODS A retrospective study was conducted at a tertiary center with 30 patients for whom nifedipine treatment was used as a tocolytic therapy for preterm labor. Initiation of this treatment was at 31.6±2.5 weeks of gestation. We combined the pulse Doppler imaging parameters with grayscale imaging via the Bernoulli theorem, which is called the "continuity equation", to get the fetoplacental perfusion (FPP). Evaluated parameters were the resistance index (RI), the pulsatility index (PI), systole/diastole ratios (S/D), the velocity-time integral of the umbilical artery (VTI), the radius of the umbilical artery, the peak systolic velocity and the mean pressure gradient in the umbilical artery. From these parameters, the FPP was acquired. RESULTS We found that the RI, the PI and the S/D ratio did not change after treatment with nifedipine. The mean pressure gradient, the VTI and the peak systolic velocity increased after treatment with nifedipine. Nifedipine increases FPP from 166±73.81 beat.cm3/min to 220±83.3 beat.cm3/min. DISCUSSION Although nifedipine had no effect on the PI, the RI or the S/D, it increased the mean pressure gradient, the VTI and FPP.
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Abstract
Two peptides, pramlintide (37 amino acids), an analog of human amylin, and exenatide, synthetic exendin-4 (39 amino acids), are both in late-stage clinical development as potential new treatments for people with diabetes. Both are potential long-term treatments, and there is the likelihood that some women will become pregnant while using one of these peptide therapies. Therefore, it was important to evaluate the potential for each peptide to cross the placental barrier and thereby result in exposure to the fetus. This was examined using ex vivo perfusions of human placentas. The fetal and maternal side of a cotyledon were cannulated and perfused first with buffer, and then with radioactive antipyrine in order to establish the integrity of the system and the perfusion constants. Either pramlintide or exenatide was then added to each acceptable cotyledon perfusate on the maternal side. Each peptide was evaluated at an initial concentration near the therapeutic plasma concentration and at approximately 10-50 times that concentration in each of the three cotyledons. Maternal and fetal perfusate samples were assayed for peptide concentrations using an immunoassay. The ratio of fetal-to-maternal peptide concentrations during equilibrium perfusion were extremely low (pramlintide ≤ 0.006, exenatide 5 ≤ 0.017). These data demonstrate negligible passage of either peptide across the placental barrier. It is, therefore, likely that maternal use of either peptide during gestation will result in negligible exposure to the fetus.
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Ekin A, Gezer C, Solmaz U, Taner CE, Ozeren M, Dogan A, Uyar I. Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study. J Perinat Med 2016; 44:243-8. [PMID: 26352077 DOI: 10.1515/jpm-2015-0194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/29/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation. METHODS Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately. RESULTS Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (P<0.05). Additionally, return of absent to positive, reversed to absent or from reversed to positive diastolic flow in UA was detected within 24 h in 19 (79.2%) fetuses with absent or reversed UA-EDF. All alterations were transient and maintained up to 72 h. CONCLUSIONS Antenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.
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Ivanova AS, Peretyat'ko LP, Demidov VI, Nazarov SB. [INFLUENCE OF NITRIC OXIDE AND ALPHA-TOCOPHEROL ON STRUCTURAL CHANGES IN PLACENTA DURING VIOLATION OF UTEROPLACENTAL CIRCULATION IN WHITE RATS]. Eksp Klin Farmakol 2015; 78:10-13. [PMID: 26591575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We have studied the effect of nitric oxide and alpha-tocopherol on morphological changes in the placenta of white rats during pregnancy complicated by disorders of the uterine and placental circulation. Violation of the uteroplacental circulation was reproduced by the method of M. M. Vartanova (1984). In white rats with violated uteroplacental blood circulation, the use of L-arginine methyl ester compensates for disturbances of the fetoplacental blood flow. It is established that an increase in nitric oxide and the inhibition of free radical processes in the placenta of experimental animals under conditions of artificially created pathology of pregnancy belong to pathogenetic rather than sanogenetic factors.
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Nazarov SB, Ivanova AS, Novikov AA. Effect of nitric oxide on physical development and erythropoiesis in the offspring of rats with impaired uteroplacental circulation. Bull Exp Biol Med 2013; 154:737-9. [PMID: 23658911 DOI: 10.1007/s10517-013-2043-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/26/2022]
Abstract
We evaluated physical development and activity of erythropoiesis in the offspring of rats with experimentally impaired uteroplacental circulation as well as the effect of exogenous nitric oxide donator used during pregnancy, on offspring development. Exogenous NO producing an anti-hypoxic effects contributes to the increase in somatometric parameters of the offspring on postnatal days 15 and 30. The rates of erythropoiesis in the liver and bone marrow did not differ from the normal; hemopoietic organs were not overstrained, which prevented exhaustion and failure of functional reserves of the erythrocyte system.
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Nugent JL, Wareing M, Palin V, Sibley CP, Baker PN, Ray DW, Farrow SN, Jones RL. Chronic glucocorticoid exposure potentiates placental chorionic plate artery constriction: implications for aberrant fetoplacental vascular resistance in fetal growth restriction. Endocrinology 2013; 154:876-87. [PMID: 23295737 DOI: 10.1210/en.2012-1927] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Fetal growth restriction (FGR) is a serious pregnancy complication, resulting in significant perinatal morbidity and mortality. Increased vascular resistance in the fetoplacental circulation is a hallmark of FGR and is associated with enhanced vasoconstriction of the resistance arteries in the placenta, the chorionic plate arteries (CPAs). Although the cause is unknown, FGR is associated with excess exposure to glucocorticoids (GCs), key mediators of vascular resistance in the systemic circulation. We hypothesized that GCs alter CPA reactivity, thereby contributing to the altered blood flow dynamics seen in FGR. We aimed to examine the acute and chronic effects of GCs on CPA reactivity and the operational mechanisms. Glucocorticoid receptors were highly expressed by CPA. 11β-Hydroxysteroid isoenzyme type 2 was detected within the endothelium, whereas 11β-hydroxysteroid isoenzyme type 1 was absent. Acute GC treatment significantly attenuated U46619-induced constriction. This effect was reversed by cotreatment with mifepristone or an endothelial NOS inhibitor. In contrast, chronic GC treatment potentiated U46619 constriction in a dose-dependent manner, which was partially abolished by mifepristone cotreatment. Similar effects were observed using a novel nonsteroidal glucocorticoid receptor-specific agonist. Chronic treatment with GCs altered the expression of several vasoactive factors, including thromboxane and bradykinin receptors, prokineticin-1, cyclooxygenase-2, and endothelial NOS. In summary, acute and chronic GC treatment exerts contrasting effects on CPA vasoreactivity. These opposing effects are consistent with temporal actions in other vascular beds and reflect activation of distinct nongenomic and genomic pathways. Chronic exposure to elevated GCs may contribute to the raised vascular resistance observed in the fetoplacental circulation in FGR.
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Affiliation(s)
- J L Nugent
- Maternal and Fetal Health Research Centre, University of Manchester, St Mary's Hospital, Research Fifth Floor, Oxford Road, Manchester M13 9WL, United Kingdom
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Nazarov SB, Ivanova AS, Novikov AA. [The role of nitric oxide in regulation of the erythrocyte system state in rat offspring with chronic disturbance of uteroplacental blood circulation]. Eksp Klin Farmakol 2012; 75:21-23. [PMID: 22834124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The effect of exogenous nitric oxide donor deponit-10 (nitroglycerin) on red cell indices in the offspring of rats with experimental disturbances of uteroplacental circulation has been investigated. It is established that fetal hypoxia facilitates the mobilization of functional reserves of the red cell system in the prenatal and early days of postnatal life of offspring in white rats, which is manifested by the growing process of erythropoiesis. Hyperfunction of the erythrocyte system in the first lifedays of pups leads eventually to a depletion of its functional capacities. The administration of an exogenous nitric oxide donor on the background of damaged uteroplacental circulation prevents the depletion and disruption of the functional reserves of the blood red cell system.
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Shuai B, Peng XM, Li RM, Li YL, Hu DH. [Stereological study of the placenta in parturients with different prophylactic measures for hypotension during spinal anesthesia for cesarean section]. Nan Fang Yi Ke Da Xue Xue Bao 2011; 31:1240-1244. [PMID: 21764705] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the optimal approach to the prevention of hypotension during cesarean section for the benefits of both the parturients and the newborns. METHODS Forty singleton full-term pregnant women undergoing elective cesarean delivery were randomly allocated into two equal groups. For prevention of hypotension during spinal anesthesia, ephedrine or pre-anesthetic volume with Voluven was administered. The changes of blood pressure, heart rate, and Apgar scores of the newborns were monitored and recorded, and the umbilical arterial blood gas variables were compared between the two groups. The placental samples were collected and immunohistochemistry for CD34 was performed for stereological study of the placental villous capillaries. RESULTS The umbilical arterial PaCO(2), PaO(2) and Apgar scores showed no significant differences between the two groups (P<0.05). The heart rate, incidence of hypotension and the lactic acid value were significantly higher, and the umbilical arterial pH significantly lower in ephedrine group than in the Voluven group (P>0.05). While the length density of the villous capillaries was comparable between the two groups (P>0.05), the volume density of the villous capillaries was significantly decreased in ephedrine group (P<0.05). CONCLUSION Pre-anesthetic volume expansion with Voluven can maintain stable hemodynamics during spinal anesthesia and also efficiently improve the tissue perfusion, microcirculation and uteroplacental blood flow, thus increasing the oxygen supply to the fetus.
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Affiliation(s)
- Bing Shuai
- Department of Anesthesiology, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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Thuring A, Malcus P, Maršál K. Effect of maternal betamethasone on fetal and uteroplacental blood flow velocity waveforms. Ultrasound Obstet Gynecol 2011; 37:668-672. [PMID: 21618314 DOI: 10.1002/uog.8879] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To investigate the effects of antenatal betamethasone on fetal and uteroplacental hemodynamics. METHODS The study comprised 33 women with singleton high-risk pregnancies (23-33 weeks; 27 pregnancies < 30 weeks) not in labor, but at risk for preterm delivery based on fetal or maternal indications. They were treated with two doses of 12 mg betamethasone intramuscularly 24 h apart to enhance fetal lung maturity. Flow velocity waveforms were recorded with Doppler ultrasound from the umbilical artery, the fetal middle cerebral artery, the ductus venosus and both maternal uterine arteries, once before and twice after betamethasone administration. RESULTS Twenty-one (64%) women delivered within 4 days, nine (27%) women within 5-7 days and three (9%) within 8-15 days after the first dose of betamethasone. Two days after betamethasone, a decrease in pulsatility index was found in the umbilical artery (P = 0.0002) and ductus venosus (P = 0.003). Changes in the umbilical artery waveform from reversed to absent, and from absent to positive diastolic flow, were noted in 12 of 15 cases (P < 0.01). After 4 days, umbilical artery and ductus venosus velocity waveforms in the undelivered fetuses either returned to the type of waveform observed before treatment or showed further deterioration. No significant effects of betamethasone were observed in the fetal middle cerebral artery and uteroplacental circulation. CONCLUSIONS Maternal antenatal betamethasone resulted in a significant transient change in the velocity waveform and a decrease in the pulsatility index in the umbilical artery and ductus venosus, but did not influence uteroplacental circulation. These findings indicate a direct effect of betamethasone on fetal circulation.
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Affiliation(s)
- A Thuring
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden.
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Timmermans S, Jaddoe VWV, Silva LM, Hofman A, Raat H, Steegers-Theunissen RPM, Steegers EAP. Folic acid is positively associated with uteroplacental vascular resistance: the Generation R study. Nutr Metab Cardiovasc Dis 2011; 21:54-61. [PMID: 19819678 DOI: 10.1016/j.numecd.2009.07.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 05/28/2009] [Accepted: 07/03/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Periconception folic acid supplementation may influence early placentation processes and thereby the occurrence of hypertensive pregnancy disorders. For this reason we examined the associations between periconception folic acid supplementation and uteroplacental vascular resistance, blood pressure, and the risks of gestational hypertension and preeclampsia, in 5993 pregnant women, participating in a population-based cohort study. METHODS AND RESULTS Folic acid supplementation was assessed by questionnaire. Mean pulsatility index (PI) and resistance index (RI) of the uterine (UtA) and umbilical arteries (UmA) were measured by Doppler ultrasound in mid- and late pregnancy. Systolic and diastolic blood pressures (SBP, DBP) were measured in early, mid- and late pregnancy. Compared to women who did not use folic acid, preconception folic acid users had a slightly lower UtA-RI in mid-pregnancy [β -0.02, 95% confidence interval (CI) -0.03, -0.01] and late pregnancy [β -0.02, 95% CI -0.03, -0.001], a lower UtA-PI in mid-pregnancy [β -0.06, 95% CI -0.1, -0.03] and late pregnancy [β -0.03, 95% CI -0.05, -0.01], as well as tendencies towards a lower UmA-PI in mid-pregnancy [β -0.02, 95% CI -0.04, -0.001] and late pregnancy [β -0.01, 95% CI -0.02, 0.01]. Additionally, these women had slightly higher SBP and DBP throughout pregnancy. Neither the patterns of blood-pressure change during pregnancy, nor the risk of gestational hypertension and preeclampsia differed between the folic acid categories. CONCLUSION Periconception folic acid supplementation is associated with lower uteroplacental vascular resistance and higher blood pressures during pregnancy. The effects are small and within physiologic ranges and seem not associated with the risk of hypertensive pregnancy disorders.
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Affiliation(s)
- S Timmermans
- The Generation R Study Group, Erasmus MC Rotterdam, Rotterdam, the Netherlands.
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Anton L, Merrill DC, Neves LAA, Gruver C, Moorefield C, Brosnihan KB. Angiotensin II and angiotensin-(1-7) decrease sFlt1 release in normal but not preeclamptic chorionic villi: an in vitro study. Reprod Biol Endocrinol 2010; 8:135. [PMID: 21050477 PMCID: PMC2989977 DOI: 10.1186/1477-7827-8-135] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 11/04/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During preeclampsia, placental angiogenesis is impaired. Factors released from the placenta including vascular endothelial growth factor (VEGF), placental growth factor (PLGF), soluble VEGF receptor 1 (sFlt1), and soluble endoglin (sEng) are regulatory molecules of placental development and function. While the renin angiotensin system has been shown to regulate angiogenic factors in other research fields, these mechanisms have not been extensively studied during pregnancy. METHODS We evaluated the effects of angiotensin II (Ang II) and angiotensin-(1-7) [Ang-(1-7)] on the release of VEGF, PLGF, sFlt1, and sEng from placental chorionic villi (CV). CV were collected from nulliparous third-trimester normotensive and preeclamptic subjects. CV were incubated for 0, 2, 4, and 16 hours with or without Ang II (1 nM and 1 microM) or Ang-(1-7) (1 nM and 1 microM). The release of VEGF, PLGF, sFlt1, sEng, lactate dehydrogenase (LDH), and human placenta lactogen (HPL) was measured by ELISA. RESULTS The release of sFlt1, PLGF, sEng from normal and preeclamptic CV increased over time. Release of sFlt1 and sEng was significantly higher from preeclamptic CV. VEGF was below the detectable level of the assay in normal and preeclamptic CV. After 2 hours, sFlt1 release from normal CV was significantly inhibited with Ang II (1 nM and 1 microM) and Ang-(1-7) (1 nM and 1 microM). There was a time-dependent increase in HPL indicating that the CV were functioning normally. CONCLUSIONS Our study demonstrates a critical inhibitory role of angiotensin peptides on sFlt1 in normal pregnancy. Loss of this regulation in preeclampsia may allow sFlt1 to increase resulting in anti-angiogenesis and end organ damage in the mother.
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Affiliation(s)
- Lauren Anton
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - David C Merrill
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Liomar AA Neves
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Courtney Gruver
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Cheryl Moorefield
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - K Bridget Brosnihan
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Khalil A, Harrington K, Muttukrishna S, Jauniaux E. Effect of antihypertensive therapy with alpha-methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders. Ultrasound Obstet Gynecol 2010; 35:688-694. [PMID: 20201113 DOI: 10.1002/uog.7611] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Antihypertensive drugs lower blood pressure by direct vascular effects or central vasodilatory mechanisms. Their effect on uterine artery Doppler resistance indices in hypertensive disorders of pregnancy is uncertain. This study aimed to evaluate the impact of antihypertensive therapy with alpha-methyldopa on maternal uterine artery Doppler pulsatility index (PI) and resistance index (RI) in women presenting with hypertensive disorders of pregnancy. METHODS This was a cross-sectional study of 51 women with pre-eclampsia, 29 with gestational hypertension and 80 matched normotensive controls. Uterine artery PI and RI were measured at recruitment (between 24 and 40 weeks' gestation) and, in the hypertensive groups, 24-48 h after starting alpha-methyldopa. Differences between mild and severe, and between early- and late-onset pre-eclampsia were compared using the Mann-Whitney test. The Wilcoxon rank sum test was used to compare measurements before and after treatment. RESULTS Prior to treatment, uterine artery PI and RI were significantly higher in women with pre-eclampsia compared with those with gestational hypertension and controls (P < 0.0001). The median uterine artery PI multiple of the median (MoM) was significantly higher (P < 0.0001) in early-onset than in late-onset pre-eclampsia (1.83 (range, 0.88-3.65) vs. 1.19 (range, 0.91-1.72)) and in severe compared with mild disease (2.26 (range, 2.02-3.65) vs. 1.29 (range, 0.88-2.9)). Uterine artery PI- and RI-MoMs in both pre-eclampsia and gestational hypertension, before and after 34 weeks' gestation, were not affected by alpha-methyldopa treatment. CONCLUSIONS Antihypertensive therapy using alpha-methyldopa in women presenting with hypertensive disorders of pregnancy has no significant effect on uterine artery resistance to blood flow, suggesting that it does not impair uteroplacental circulation in these cases.
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Affiliation(s)
- A Khalil
- Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London, London, UK.
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Mills TA, Wareing M, Shennan AH, Poston L, Baker PN, Greenwood SL. Acute and chronic modulation of placental chorionic plate artery reactivity by reactive oxygen species. Free Radic Biol Med 2009; 47:159-66. [PMID: 19389471 DOI: 10.1016/j.freeradbiomed.2009.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 04/01/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
Control of vascular resistance and blood flow in the fetoplacental circulation is incompletely understood. Reactive oxygen species (ROS), physiological and pathophysiological regulators of vascular tone, are elevated in preeclampsia (PE), a disease of pregnancy characterized by increased fetoplacental vascular resistance. We tested the hypothesis that ROS modulate vascular reactivity in placental chorionic plate arteries. Wire myography was used to examine (1) the effects of acute exposure to ROS on arterial function in normal pregnancy and (2) the effects of maternal antioxidant supplementation on arterial reactivity in women at high risk for PE participating in the Vitamins in Pre-eclampsia (VIP) trial. ROS generated by xanthine plus xanthine oxidase enhanced basal tension, vasoconstriction in response to the thromboxane mimetic U46619, and relaxation in response to sodium nitroprusside. Hydrogen peroxide and peroxynitrite increased basal tone and relaxed preconstricted arteries (U44619), respectively. In women at risk for PE, chorionic plate artery constriction in response to U46619 was greater in the women receiving placebo compared to the women supplemented with the antioxidant vitamins C and E. ROS may regulate fetoplacental vascular resistance and blood flow in the short term, and chronic exposure to raised ROS could contribute to elevated fetoplacental vascular resistance in PE and fetal growth restriction (FGR).
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Affiliation(s)
- Tracey A Mills
- Maternal and Fetal Health Research Group, School of Clinical and Laboratory Sciences, The University of Manchester, Manchester M13 0JH, UK.
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Ovári L, Aranyosi J, Balla G. Acute effect of cigarette smoking on placental circulation - a study by carbon-monoxide measurement and Doppler assessment. ACTA ACUST UNITED AC 2009; 96:243-50. [PMID: 19457768 DOI: 10.1556/aphysiol.96.2009.2.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/19/2022]
Abstract
OBJECTIVE Carbon-monoxide (CO) decreases placental vascular impedance. We assessed the consequences of smoking-induced temporary maternal CO-increase on fetal and placental circulation. STUDY DESIGN In a prospective study twenty-nine smoking pregnant women and their fetuses were evaluated. We determined the changes in maternal blood CO levels after smoking, and the concomitant changes in maternal and fetal circulation. Changes in fetal heart rate, uterine artery (UTA), middle cerebral artery (MCA), and descending aorta (DA) flow were measured by Doppler velocimetry. Changes in maternal CO level and umbilical flow value were assessed by paired t-test. The correlation between CO level and placental flow was assessed by partial correlation test. RESULTS CO level increased (mean +/-SD 1.7 +/- 0.065% vs. 2.36 +/- 0.89, p<0.0001). Nicotine-related maternal circulatory parameters changed significantly, but uterine flow values remained unchanged. Fetal heart rate increased, while flow in MCA and DA showed no change. CO-dependent umbilical artery impedance remained unchanged (Pulsatility Index: 0.956 +/- 0.18 vs. 0.948 +/- 0.21). Partial correlation between CO level and umbilical arterial impedance showed no significance (r:-0.324). CONCLUSION Despite significant CO elevation, the mainly CO-regulated placental flow remained unchanged.
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Affiliation(s)
- László Ovári
- University of Debrecen, Department of Obstetrics and Gynecology, Medical and Health Sciences Center H-4012 Debrecen Hungary.
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Maharaj CH, O'Toole D, Lynch T, Carney J, Jarman J, Higgins BD, Morrison JJ, Laffey JG. Effects and mechanisms of action of sildenafil citrate in human chorionic arteries. Reprod Biol Endocrinol 2009; 7:34. [PMID: 19389232 PMCID: PMC2680410 DOI: 10.1186/1477-7827-7-34] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 04/23/2009] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Sildenafil citrate, a specific phosphodiesterase-5 inhibitor, is increasingly used for pulmonary hypertension in pregnancy. Sildenafil is also emerging as a potential candidate for the treatment of intra-uterine growth retardation and for premature labor. Its effects in the feto-placental circulation are not known. Our objectives were to determine whether phosphodiesterase-5 is present in the human feto-placental circulation, and to characterize the effects and mechanisms of action of sildenafil citrate in this circulation. STUDY DESIGN Ex vivo human chorionic plate arterial rings were used in all experiments. The presence of phosphodiesterase-5 in the feto-placental circulation was determined by western blotting and immunohistochemical staining. In a subsequent series of pharmacologic studies, the effects of sildenafil citrate in pre-constricted chorionic plate arterial rings were determined. Additional studies examined the role of cGMP and nitric oxide in mediating the effects of sildenafil. RESULTS Phosphodiesterase-5 mRNA and protein was demonstrated in human chorionic plate arteries. Immunohistochemistry demonstrated phosphodiesterase-5 within the arterial muscle layer. Sildenafil citrate produced dose dependent vasodilatation at concentrations at and greater than 10 nM. Both the direct cGMP inhibitor methylene blue and the cGMP-dependent protein kinase inhibitor Rp-8-Br-PET-cGMPS significantly attenuated the vasodilation produced by sildenafil citrate. Inhibition of NO production with L-NAME did not attenuate the vasodilator effects of sildenafil. In contrast, sildenafil citrate significantly enhanced the vasodilation produced by the NO donor sodium nitroprusside. CONCLUSION Phosphodiesterase-5 is present in the feto-placental circulation. Sildenafil citrate vasodilates the feto-placental circulation via a cGMP dependent mechanism involving increased responsiveness to NO.
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Affiliation(s)
- Chrisen H Maharaj
- Department of Anaesthesia, University College Hospital, Galway, Ireland
- Department of Anaesthesia, Clinical Sciences Institute and National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - Daniel O'Toole
- Department of Anaesthesia, University College Hospital, Galway, Ireland
- Department of Anaesthesia, Clinical Sciences Institute and National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - Tadhg Lynch
- Department of Anaesthesia, University College Hospital, Galway, Ireland
- Department of Anaesthesia, Clinical Sciences Institute and National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - John Carney
- Department of Anaesthesia, University College Hospital, Galway, Ireland
- Department of Anaesthesia, Clinical Sciences Institute and National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - James Jarman
- Department of Anaesthesia, University College Hospital, Galway, Ireland
- Department of Anaesthesia, Clinical Sciences Institute and National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - Brendan D Higgins
- Department of Anaesthesia, University College Hospital, Galway, Ireland
- Department of Anaesthesia, Clinical Sciences Institute and National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - John J Morrison
- Department of Obstetrics and Gynaecology, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Department of Anaesthesia, University College Hospital, Galway, Ireland
- Department of Anaesthesia, Clinical Sciences Institute and National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
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Striuk RI, Bukhonkina IM, Sokova EA, Nemirovskiĭ VB, Kosmacheva AV. [Pharmacotherapy and analysis of the course of pregnancy and perinatal outcomes in women with hypertensive disease]. Kardiologiia 2009; 49:29-32. [PMID: 20038278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Klebanoff MA, Meis PJ, Dombrowski MP, Zhao Y, Moawad AH, Northen A, Sibai BM, Iams JD, Varner MW, Caritis SN, O'Sullivan MJ, Leveno KJ, Miodovnik M, Conway D, Wapner RJ, Carpenter M, Mercer BM, Ramin SM, Thorp JM, Peaceman AM. Salivary progesterone and estriol among pregnant women treated with 17-alpha-hydroxyprogesterone caproate or placebo. Am J Obstet Gynecol 2008; 199:506.e1-7. [PMID: 18456237 PMCID: PMC2794481 DOI: 10.1016/j.ajog.2008.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Revised: 12/05/2007] [Accepted: 03/03/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objectives of the study was to determine whether salivary progesterone (P) or estriol (E3) concentration at 16-20 weeks' gestation predicts preterm birth or the response to 17alpha-hydroxyprogesterone caproate (17OHPC) and whether 17OHPC treatment affected the trajectory of salivary P and E3 as pregnancy progressed. STUDY DESIGN This was a secondary analysis of a clinical trial of 17OHPC to prevent preterm birth. Baseline saliva was assayed for P and E3. Weekly salivary samples were obtained from 40 women who received 17OHPC and 40 who received placebo in a multicenter randomized trial of 17OHPC to prevent recurrent preterm delivery. RESULTS Both low and high baseline saliva P and E3 were associated with a slightly increased risk of preterm birth. However, 17OHPC prevented preterm birth comparably, regardless of baseline salivary hormone concentrations. 17OHPC did not alter the trajectory of salivary P over pregnancy, but it significantly blunted the rise in salivary E3 as well as the rise in the E3/P ratio. CONCLUSION 17OHPC flattened the trajectory of E3 in the second half of pregnancy, suggesting that the drug influences the fetoplacental unit.
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Affiliation(s)
- Mark A Klebanoff
- National Institute of Child Health and Human Development, Bethesda, MD, USA
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Rytlewski K, Olszanecki R, Lauterbach R, Grzyb A, Kiec-Wilk B, Dembinska-Kiec A, Basta A. Effects of oral l-arginine on the pulsatility indices of umbilical artery and middle cerebral artery in preterm labor. Eur J Obstet Gynecol Reprod Biol 2008; 138:23-8. [PMID: 17719167 DOI: 10.1016/j.ejogrb.2007.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 05/17/2007] [Accepted: 06/14/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was the estimation of the influence of oral supplementation with low-dose l-arginine on feto-placental circulation in women with threatened preterm labor. STUDY DESIGN Oral administration of 3g of L-arginine daily or placebo as a supplement to standard tocolytic therapy was tried in 70 women with threatened preterm delivery, randomly assigned to the L-arginine (n=37) or placebo (n=33) groups. Twenty-five and 20 completed the study, respectively. Doppler velocimetry of pulsatility indices (PI) of the umbilical (UA) and middle cerebral (MCA) arteries as well as pregnancy outcome and biochemical markers of nitric oxide synthesis (plasma amino acid and nitrite/nitrate levels, as well as 24 h nitrite/nitrate excretion with urine) were estimated. RESULTS Starting from the second week of therapy, the UA PI values were significantly lower in the L-arginine group than in the placebo group. Moreover, treatment with L-arginine caused a significant increase in MCA PI and cerebro-placental ratio (CPR) values. The changes in feto-placental circulation in the L-arginine group were not associated with any signs of increased nitric oxide synthesis. CONCLUSION Oral supplementation with low doses of L-arginine changed feto-placental blood flow distribution in patients with threatened preterm labor. The exact mechanism of L-arginine action on feto-placental circulation requires further investigation.
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Affiliation(s)
- Krzysztof Rytlewski
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Kraków, Poland.
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Valensise H, Vasapollo B, Novelli GP, Giorgi G, Verallo P, Galante A, Arduini D. Maternal and fetal hemodynamic effects induced by nitric oxide donors and plasma volume expansion in pregnancies with gestational hypertension complicated by intrauterine growth restriction with absent end-diastolic flow in the umbilical artery. Ultrasound Obstet Gynecol 2008; 31:55-64. [PMID: 18098350 DOI: 10.1002/uog.5234] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To evaluate the effect of plasma volume expansion (PVE) and nitric oxide (NO) donors, in addition to antihypertensive therapy for gestational hypertensive pregnancies complicated by intrauterine growth restriction (IUGR) with absent end-diastolic flow (AEDF) in the umbilical artery (UA). METHODS This was a case-control study into which 32 gestational hypertensive pregnancies with IUGR and AEDF were enrolled. Sixteen of these were treated with antihypertensive drugs, NO donors and PVE (Group A), and 16, matched for maternal age, gestational age and fetal conditions, were treated with antihypertensive drugs only (Group B). All patients underwent fetal and uteroplacental assessment and maternal echocardiography to evaluate total vascular resistance (TVR) and cardiac output before and 5-14 days after initiation of treatment. RESULTS After 5-14 days of treatment, the maternal TVR in Group A fell from 2170 +/- 248 to 1377 +/- 110 dynes.s.cm(-5) (P < 0.01), and that in Group B fell from 2090 +/- 260 to 1824 +/- 126 dynes.s.cm(-5) (P < 0.01), with the reduction being greater in Group A than in Group B (P < 0.01). There was a significant increase in cardiac output in Group A after 5-14 days of treatment vs. baseline (6.19 +/- 0.77 vs. 4.32 +/- 0.66, P < 0.001), and, after treatment, cardiac output was significantly greater in Group A than it was in Group B (6.19 +/- 0.77 vs. 4.70 +/- 0.44, P < 0.001). Reappearance of end-diastolic flow in the UA occurred in 14/16 patients in Group A but in no patients in Group B (87.5% vs. 0%, P < 0.05). The interval between detection of UA-AEDF and delivery was 28 +/- 16 days in Group A and 11 +/- 6 days in Group B (P < 0.05). CONCLUSION Administration of NO donors and PVE in gestational hypertensive pregnancies affected by IUGR and UA-AEDF appears to improve both maternal and fetal hemodynamics, inducing prolongation of gestation.
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Affiliation(s)
- H Valensise
- Department of Obstetrics and Gynecology, Perinatal Medicine, Frascati (Rome), Rome, Italy.
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Milchev N, Markova D, Dimitrova E. [Use of phlebodia in pregnant women with feto-placental insufficiency (preeclampsia)]. Akush Ginekol (Sofiia) 2008; 47 Suppl 1:15-17. [PMID: 18935851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Nanovskaya TN, Nekhayeva IA, Hankins GDV, Ahmed MS. Transfer of methadone across the dually perfused preterm human placental lobule. Am J Obstet Gynecol 2008; 198:126.e1-4. [PMID: 18166326 DOI: 10.1016/j.ajog.2007.06.073] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 03/15/2007] [Accepted: 06/29/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to determine the effect of gestational age and P-glycoprotein expression on transplacental transfer of methadone. STUDY DESIGN Dual perfusion of placental lobule was utilized. Methadone (200 ng/mL) and its [3H]-isotope were cotransfused from the maternal-to-fetal circuit with the marker compound antipyrine (20 microg/mL) and its [14C]-isotope. Concentration of the drugs in trophoblast tissue and both circuits was determined by liquid scintillation spectrometry. RESULTS Fetal transfer rate of methadone in preterm placentas was 19 +/- 5.8%, and in term placentas it was 31 +/- 9.7% (P < .01). Clearance index of methadone in preterm placentas (0.57 +/- 0.2) was lower than in term placentas (0.95 +/- 0.3, P < .01). P-glycoprotein expression was higher in preterm than term placentas. CONCLUSION The ex vivo transfer of methadone across preterm placentas is 30% lower than in term placentas.
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Affiliation(s)
- Tatiana N Nanovskaya
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555-0587, USA
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Abstract
OBJECTIVE To determine whether delivery mode influences placental chorionic plate arterial and venous vascular reactivity. METHODS Normal term placentas were obtained after vaginal delivery or cesarean section. Chorionic plate arterial and venous function was assessed by wire myography. RESULTS Sodium nitroprusside-induced arterial relaxation increased post cesarean section at 20% oxygen. Decreased U46619-induced venous contraction was observed in vaginal deliveries at 7% oxygen. Sodium nitroprusside-induced relaxation increased in vaginal delivery at 20% oxygen. CONCLUSION Delivery mode does not alter chorionic plate arterial vascular reactivity under physiological conditions, however venous reactivity was modified, a factor for consideration when interpreting functional experimental data.
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Affiliation(s)
- Tracey A Mills
- Division of Human Development, The University of Manchester, Manchester, UK.
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He W, Greenwell RJ, Brooks DM, Calderón-Garcidueñas L, Beall HD, Coffin JD. Arsenic exposure in pregnant mice disrupts placental vasculogenesis and causes spontaneous abortion. Toxicol Sci 2007; 99:244-53. [PMID: 17569693 DOI: 10.1093/toxsci/kfm162] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Arsenic is an abundant toxicant in ground water and soil around areas with extractive industries. Human epidemiological studies have shown that arsenic exposure is linked to developmental defects and miscarriage. The placenta is known to utilize vasculogenesis to develop its circulation. The hypothesis tested here states the following: arsenic exposure causes placental dysmorphogenesis and defective placental vasculogenesis resulting in placental insufficiency and subsequent spontaneous abortion. To test this hypothesis, pregnant mice were exposed to sodium arsenite (AsIII) through drinking water from conception through weanling stages. Neonatal assessment of birth rates, pup weights, and litter sizes in arsenic exposed and control mothers revealed that AsIII-exposed mothers had only 40% the fecundity of controls. Preterm analysis at E12.5 revealed a loss of fecundity at E12.5 from either 20 ppm or greater exposures to AsIII. There was no loss of fecundity at E7.5 suggesting that spontaneous abortion occurs during placentation. Histomorphometry on E12.5 placentae from arsenic-exposed mice revealed placental dysplasia especially in the vasculature. These results suggest that arsenic toxicity is causative for mammalian spontaneous abortion by virtue of aberrant placental vasculogenesis and placental insufficiency.
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Affiliation(s)
- Wenjie He
- Department of Biomedical and Pharmaceutical Sciences and Center for Environmental Health Sciences, The University of Montana, Missoula, Montana 59812, USA
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Goyarts T, Dänicke S, Brüssow KP, Valenta H, Ueberschär KH, Tiemann U. On the transfer of the Fusarium toxins deoxynivalenol (DON) and zearalenone (ZON) from sows to their fetuses during days 35–70 of gestation. Toxicol Lett 2007; 171:38-49. [PMID: 17544604 DOI: 10.1016/j.toxlet.2007.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 04/11/2007] [Accepted: 04/12/2007] [Indexed: 11/21/2022]
Abstract
Eleven pregnant sows with a body weight between 153 and 197 kg were fed a control diet (CON, 0.15 mg DON and 0.0035 mg ZON/kg diet) or a diet containing 15% of Fusarium toxin contaminated triticale (MYCO, 4.42 mg DON and 0.048 mg ZON/kg diet) in the period of day 35 and 70 of gestation. The indirect effect of feed intake was separated from the direct effects of the Fusarium toxins by the restricted feeding regimen where all sows were fed the same amount of feed (2000 g/d) over the whole study. At the end of experiment, fetuses were delivered by Caesarian section and samples of serum, bile, urine, liver, kidney and spleen of euthanatized sows and fetuses were taken to analyze the concentrations of DON, ZON and their metabolites. Feeding the Fusarium toxin contaminated diet to pregnant sows caused neither adverse effects on performance, organ weights and maintenance of pregnancy of sows nor on fetus weight and length. Furthermore, no teratogenic or embryolethal effects could be observed in the MYCO group. Hematological and clinical-chemical parameters of sows and fetuses were not affected by feeding, with the exception of significantly lower GLDH (glutamate dehydrogenase) serum activities in MYCO sows. The carry over of DON and ZON from the diet to the sow or fetus tissues was calculated by the diet ratio (sum of concentrations of all metabolites in the physiological specimen divided by the dietary toxin concentration), while the fetus ratio was evaluated by the sum of concentrations of all metabolites in the physiological specimen of the fetus divided by that of the sows. DON and deepoxy-DON were found in urine, bile, serum, liver, kidney and spleen of sows of the MYCO group, but not in the bile of fetuses (spleen not analyzed). ZON and its metabolite alpha-zearalenol (alpha-ZOL) were detected in urine and bile of sows, while all specimens of fetuses as well as serum and liver of sows were negative for ZON metabolites. The maximum diet ratios for urine and bile in sows of the MYCO group were 0.84 and 0.05 for DON metabolites and 1.2 and 3.8 for ZON metabolites, underscoring the differences in metabolism and excretion of both toxins. The maximum diet ratio of DON and deepoxy-DON into liver, kidney and spleen of MYCO sows were 0.003, 0.007 and 0.003, respectively. The maximum fetus ratio of DON and deepoxy-DON into urine, bile, serum, liver and kidney of fetuses were 0.006, 0, 0.5, 0.88, and 0.33, while the maximum placental ratio (sum of toxin concentrations in the physiological specimen of the fetus divided by the toxin serum concentration of the sow) were 0.64, 0, 0.50, 0.70 and 0.52, respectively. Therefore, it can be concluded that the developing fetus is exposed to DON between the gestation days 35 and 70 when the sows are fed a Fusarium toxin contaminated diet. ZON concentration in the MYCO diet was too low to get reliable results for fetus or placental ratios.
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Affiliation(s)
- T Goyarts
- Institute of Animal Nutrition, Federal Agricultural Research Centre Braunschweig (FAL), Bundesallee 50, D-38116 Braunschweig, Germany
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Parry S, Zhang J. Multidrug resistance proteins affect drug transmission across the placenta. Am J Obstet Gynecol 2007; 196:476.e1-6. [PMID: 17466710 DOI: 10.1016/j.ajog.2007.02.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 02/02/2007] [Accepted: 02/20/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We studied the role of multidrug resistance proteins in regulating transplacental transmission of corticosteroids and protease inhibitors. STUDY DESIGN We performed quantitative polymerase chain reaction and FACS analyses to study MDR1 (encodes P-glycoprotein) and MRP-1 expression in extravillous (HTR-8/SVneo) and villous (BeWo) trophoblast cells treated with saquinavir, a multidrug resistance protein substrate. We measured H3-dexamethasone and H3-ritonavir transfer across confluent, syncytialized BeWo cells before and after treatment with agents that inhibit multidrug resistance proteins. RESULTS Compared with baseline expression, messenger RNA and protein levels were increased significantly in trophoblast cells after treatment with saquinavir. H3-dexamethasone and H3-ritonavir levels increased in BeWo cells after treatment with anti-P-glycoprotein antibodies or cyclosporine A. Transfer of H3-labeled drugs from the apical (eg, maternal) to basolateral (eg, fetal) side of the syncytialized BeWo cell monolayer was increased significantly when cells were pretreated with anti-P-glycoprotein antibodies. CONCLUSION Multidrug resistance proteins regulate drug levels in trophoblast cells and may mediate transmission of therapeutic agents across the placenta.
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Affiliation(s)
- Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Salvesen KA, Vanky E, Carlsen SM. Metformin treatment in pregnant women with polycystic ovary syndrome--is reduced complication rate mediated by changes in the uteroplacental circulation? Ultrasound Obstet Gynecol 2007; 29:433-7. [PMID: 17330831 DOI: 10.1002/uog.3965] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To study a possible effect of metformin on the uteroplacental circulation. METHODS Forty pregnant women with polycystic ovary syndrome (PCOS) were enrolled in a randomized, double-blind, placebo-controlled trial of metformin (1700 mg/day) during pregnancy. Doppler ultrasound examinations of the uterine arteries were performed at 12, 19, 24, 32 and 36 gestational weeks and of the umbilical artery at 19, 24, 32 and 36 gestational weeks. RESULTS There was a greater mean bilateral uterine artery pulsatility index (PI) at 12 weeks (1.95 vs. 1.58, P = 0.02), and a greater reduction in mean PI from 12 to 19 weeks (P = 0.03) in metformin-treated women. There were no differences in mean PI values between groups at 19, 24, 32 or 36 gestational weeks. Pregnancy complications, such as preterm delivery before 32 weeks, severe pre-eclampsia or serious postpartum events, occurred only in the placebo group (7 of 22 vs. 0 of 18, P = 0.01). There were no associations between uterine artery Doppler measurements and pregnancy complications. We found no differences between groups in mean umbilical artery PI at 19, 24, 32 or 36 gestational weeks. CONCLUSIONS In this small randomized trial, metformin treatment in pregnancy reduced uterine artery impedance between 12 and 19 weeks of gestation, and this was associated with reduced complication rate. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- K A Salvesen
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway.
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Juul SE, Aylward E, Richards T, McPherson RJ, Kuratani J, Burbacher TM. Prenatal Cord Clamping in Newborn Macaca nemestrina: A Model of Perinatal Asphyxia. Dev Neurosci 2007; 29:311-20. [PMID: 17762199 DOI: 10.1159/000105472] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 09/08/2006] [Indexed: 11/19/2022] Open
Abstract
Our objective was to establish a nonhuman primate model of perinatal asphyxia appropriate for preclinical evaluation of neuroprotective treatment strategies under conditions that closely resemble human neonatal emergencies, and to begin testing the safety and efficacy of erythropoietin neuroprotective treatment. Prior to delivery by hysterotomy, the umbilical cords of near term Macaca nemestrina (n = 8) were clamped for times ranging between 12 and 15 min. Animals received erythropoietin (5,000 U/kg/dose x 2 i.v., n = 3), or vehicle (n = 5) after resuscitation. We assessed physiologic parameters, continuous electroencephalogram, magnetic resonance imaging/spectroscopy, safety parameters and behavior. Animals were euthanized at 4 months of age. Mean birth weight was 507 +/- 62 g. Initial arterial pH ranged from 6.75 to 7.12, with base deficits of 17-25 mEq. Animals were flaccid at birth, with attenuated electroencephalograms, and seizures occurred in 3 of 8 animals. We demonstrated magnetic resonance imaging/spectroscopy changes consistent with hypoxia (elevated lactate levels were present in some animals), significant motor and behavioral abnormalities (particularly with 15 min of cord clamping), and evidence of gliosis at the time of death. We have established a reproducible model of moderate to severe perinatal hypoxic-ischemic injury in M. nemestrina newborns. This model, which combines structural, biochemical, and behavioral assessments over time can be used to assess the safety and efficacy of neuroprotective strategies.
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Affiliation(s)
- Sandra E Juul
- University of Washington, Department of Pediatrics, Division of Neonatology, Seattle, Wash. 98195-6320, USA.
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Czajkowski K, Sienko J, Mogilinski M, Bros M, Szczecina R, Czajkowska A. Uteroplacental circulation in early pregnancy complicated by threatened abortion supplemented with vaginal micronized progesterone or oral dydrogesterone. Fertil Steril 2006; 87:613-8. [PMID: 17126337 DOI: 10.1016/j.fertnstert.2006.07.1506] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 07/18/2006] [Accepted: 07/18/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the influence of vaginal micronized progesterone and oral dydrogesterone supplementation on uteroplacental circulation in early pregnancy that is complicated by threatened abortion. DESIGN Randomized, parallel group, double-blind, double dummy-controlled study. SETTING Tertiary care university hospital. PATIENT(S) Fifty-three patients with threatened abortion and a living embryo. INTERVENTION(S) Three hundred milligrams of micronized vaginal progesterone or 30 mg of oral dydrogesterone daily supplementation for 6 weeks, serial transvaginal Doppler ultrasound measurement of pulsatility index, resistance index, and systolic/diastolic ratio of the spiral arteries, the uterine arteries, and the intrachorionic area. MAIN OUTCOME MEASURE(S) Uteroplacental blood flow. RESULT(S) The study demonstrated that vaginal progesterone administration, but not oral dydrogesterone treatment, results in the decrease in the spiral artery pulsatility and resistance index and systolic/diastolic ratio. Insignificant decrease in pulsatility index and resistance index of the uterine artery was observed at >9 weeks and was not associated with treatment regimen. Dydrogesterone treatment was only accompanied by the decrease in the uterine artery systolic/diastolic ratio. CONCLUSION(S) Vaginal progesterone and oral dydrogesterone supplementation have a different influence on the uteroplacental circulation in early pregnancy that is complicated by threatened abortion.
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Affiliation(s)
- Krzysztof Czajkowski
- Second Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Bainbridge SA, Belkacemi L, Dickinson M, Graham CH, Smith GN. Carbon monoxide inhibits hypoxia/reoxygenation-induced apoptosis and secondary necrosis in syncytiotrophoblast. Am J Pathol 2006; 169:774-83. [PMID: 16936254 PMCID: PMC1698837 DOI: 10.2353/ajpath.2006.060184] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pre-eclampsia, a hypertensive disorder of pregnancy, affects 5 to 7% of pregnancies. Oxidative stress-induced placental injury and subsequent release of placental debris into the maternal circulation are key pathogenic events in the progression of pre-eclampsia. Women who smoke cigarettes throughout pregnancy are 33% less likely to develop this disorder than nonsmoking women. We postulated that elevated carbon monoxide concentrations in serum of smoking women inhibits apoptosis and debris shedding of trophoblast cells exposed to ischemia-reperfusion injury because carbon monoxide has cytoprotective effects on endothelial and smooth muscle cells in culture. This may be responsible for the reduced risk of pre-eclampsia in smoking women. To assess the cytoprotective properties of carbon monoxide within placental tissue, carbon monoxide treatments were administered to in vitro hypoxia/reoxygenation-insulted villous explants cultured from term human placenta. Induction of apoptosis was assessed using molecular and morphological approaches. Placental villous explants treated with carbon monoxide demonstrated 60% less hypoxia/reoxygenation-induced apoptosis in the differentiated syncytiotrophoblast layer compared with untreated explants undergoing a similar insult. In addition, retention of intact syncytial membranes was observed in carbon monoxide-treated explants. These observations indicate that carbon monoxide has potent antiapoptotic properties within human placenta and may hold therapeutic potential in the treatment of pre-eclampsia.
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Affiliation(s)
- Shannon A Bainbridge
- Department of Anatomy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada, K7L 2V7
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Wareing M, Greenwood SL, Fyfe GK, Baker PN, Taggart MJ. Glibenclamide Inhibits Agonist-induced Vasoconstriction of Placental Chorionic Plate Arteries. Placenta 2006; 27:660-8. [PMID: 16026833 DOI: 10.1016/j.placenta.2005.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 05/16/2005] [Accepted: 05/16/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preliminary data suggest that K(ATP) channels may be expressed in placental arteries and veins [Wareing M, Turner C, Greenwood SL, Baker PN, Fyfe GK. Expression of mRNA encoding K+ channels in chorionic plate arteries and veins. J Soc Gynecol Investig 2004;11:353A]. However, no data exist on glibenclamide's effects in placental chorionic plate arteries. AIM To assess the effect of glibenclamide on placental chorionic plate arterial vasoconstriction. METHODS Arteries were dissected from placental chorionic plate biopsies obtained at term from uncomplicated pregnancies (N=63). Arteries were mounted onto a wire myograph in HCO3- -buffered physiological salt solution (PSS) at 37 degrees C (5% O2/5% CO2 bubbling) and normalised at 0.9 of L5.1 kPa. Constriction viability was assessed with 120 mmol l(-1) potassium solution (KPSS). Dose-response curves were produced with the thromboxane-mimetics U46619 and U44069 (10(-10)-2 x 10(-6)M), arginine vasopressin (10(-10)-5 x 10(-8)M) and endothelin-1 (10(-11)-3 x 10(-7)M) in the presence or absence of 50 micromol l(-1) glibenclamide. The effect of glibenclamide on arginine vasopressin- and U46619-induced constriction was also assessed in the presence of the cyclo-oxygenase inhibitor indomethacin (10 micromol l(-1)). RESULTS Pre-incubation with 50 micromol l(-1) glibenclamide significantly right-shifted dose-response curves to all vasoconstrictive agonists tested (repeated measures ANOVA). Indomethacin did not modify the inhibitory effect of glibenclamide. CONCLUSION Glibenclamide's effects on agonist-induced constrictions are unlikely to be via an inhibition of ATP-sensitive K+ channels, and with U46619- and U44069-induced constrictions, glibenclamide may be acting as a competitive antagonist of thromboxane receptors.
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Affiliation(s)
- M Wareing
- Maternal and Fetal Health Research Centre, University of Manchester, St. Mary's Hospital, Hathersage Road, Manchester, M13 0JH, UK.
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Abstract
The adaptation of contractile mechanisms of the uterine artery to pregnancy is not fully understood. The present study examined the effect of pregnancy on the uterine artery baseline Ca2+ sensitivity. In beta-escin-permeabilized arterial preparations, Ca2+ -induced concentration-dependent contractions were significantly decreased in uterine arteries from pregnant animals compared with those of nonpregnant animals. Time-course studies showed that Ca2+ increased phosphorylation of 20-kDa myosin light chain (MLC20), which preceded the tension development in vessels from both pregnant and nonpregnant animals. When compared with vessels from nonpregnant animals, there was a significant increase in the protein level of MLC20 and an accordance increase in the level of Ca2+ -induced phosphorylated MLC20 (MLC20-P) in uterine arteries during pregnancy. Simultaneous measurements of MCL20-P levels and contractions stimulated with Ca2+ in the same tissues demonstrated a significant attenuation in the tension-to-MLC20-P ratio in uterine arteries during pregnancy. Activation of PKC with phorbol 12,13-dibutyrate (PDBu) potentiated Ca2+ -induced contractions in uterine arteries from nonpregnant but not pregnant animals. Accordingly, inhibition of PKC attenuated Ca2+ -induced contractions in uterine arteries from nonpregnant but not pregnant animals. PDBu produced contractions in the presence or absence of Ca2+ in the beta-escin-permeabilized arteries, which were significantly decreased in uterine arteries from pregnant compared with nonpregnant animals. The results suggest that pregnancy upregulates the thick-filament regulatory pathway by increasing MLC20 phosphorylation but downregulates the thin-filament regulatory pathway by decreasing the contractile sensitivity of MLC20-P, resulting in attenuated baseline Ca2+ sensitivity in the uterine artery. In addition, PKC plays an important role in the regulation of basal Ca2+ sensitivity, which is downregulated during pregnancy.
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Affiliation(s)
- Daliao Xiao
- Department of Physiology and Pharmacology, Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
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Erkinaro T, Kavasmaa T, Päkkilä M, Acharya G, Mäkikallio K, Alahuhta S, Räsänen J. Ephedrine and phenylephrine for the treatment of maternal hypotension in a chronic sheep model of increased placental vascular resistance †. Br J Anaesth 2006; 96:231-7. [PMID: 16377647 DOI: 10.1093/bja/aei305] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 11/12/2022] Open
Abstract
BACKGROUND We hypothesized that ephedrine and phenylephrine are equal with respect to uterine and placental haemodynamics and fetal acid-base status after exposure to maternal hypoxaemia and hypotension in a chronic sheep model of increased placental vascular resistance (R(UA)). METHODS At 114-135 days gestation, chronically instrumented fetal sheep underwent placental embolization leading to increased R(UA). Twenty-four hours after embolization, the ewes were anaesthetized and randomized to receive boluses of ephedrine (n=7) or phenylephrine (n=6) for epidural-induced hypotension after maternal hypoxaemia. Uterine (Q(UtA)) and placental (Q(UA)) volume blood flows and uterine vascular resistance (R(UtA)) and R(UA) were recorded. Uterine (PI(UtA)) and umbilical artery (PI(UA)) pulsatility indices were obtained by Doppler ultrasonography. Fetal arterial blood samples were analysed for acid-base values and lactate concentrations. RESULTS During hypotension, Q(UtA), fetal pH, BE, and Po(2) decreased whereas R(UtA), PI(UtA), R(UA), and fetal lactate concentration increased. With ephedrine, Q(UtA), R(UtA), PI(UtA), R(UA), and fetal Po(2) returned to baseline. Fetal pH, BE, and lactate concentration did not change from hypotensive values. With phenylephrine, Q(UtA) remained lower (P=0.007) and R(UtA) (P=0.007), PI(UtA) (P=0.013), and R(UA) (P=0.050) higher than at baseline. Fetal Po(2) returned to baseline and fetal pH and BE did not change from hypotensive values. However, fetal lactate concentration increased further (mean difference 1.49, 95% confidence interval 0.72-2.26 mmol litre(-1); P=0.004). CONCLUSIONS In a chronic sheep model of increased placental vascular resistance, compared with ephedrine administration, phenylephrine administration was associated with impaired uterine and placental haemodynamics and increased fetal lactate concentrations.
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Affiliation(s)
- T Erkinaro
- Department of Anaesthesiology and Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 21, FIN-90029 OYS, Finland.
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Sweeney M, Jones CJP, Greenwood SL, Baker PN, Taggart MJ. Ultrastructural features of smooth muscle and endothelial cells of isolated isobaric human placental and maternal arteries. Placenta 2005; 27:635-47. [PMID: 16029888 DOI: 10.1016/j.placenta.2005.05.010] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 05/13/2005] [Accepted: 05/14/2005] [Indexed: 11/18/2022]
Abstract
The ability of a blood vessel to develop tone is dependent upon morphological parameters of the smooth muscle cells (SMC), including density, relationship with the endothelium and subcellular distribution of myofilaments and intracellular organelles. Consequently, wall ultrastructure of isolated human placental chorionic plate arteries (n=12), fixed when pressurised to mimic their in vivo geometry, was examined qualitatively using electron microscopy, and compared with maternal arteries (omental, n=10, myometrial, n=6). Arteries from women with uncomplicated pregnancy were tested for contractile viability before fixing, with some vessels post-fixed in osmium-ferricyanide for sarcoplasmic reticulum (SR) identification. In contrast to maternal arteries, placental arteries had no internal elastic lamina but exhibited considerable extracellular matrix separating circularly orientated SMC. Human SMC contained tightly packed arrays of myofilaments running parallel to the plasma membrane, enveloping cellular organelles. Synthetic SMC, with few myofilaments and much rough SR, were observed in placental arteries only. SR in SMC from maternal arteries was located centrally, often encircling mitochondria, and also near the plasma membrane associated with caveolae. Positive SR staining was rarely observed in SMC of placental arteries. This study highlights ultrastructural differences between placental and maternal arteries that may underlie specialised mechanisms of regulating vascular tone in the placenta.
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MESH Headings
- Adult
- Chorion/blood supply
- Chorion/physiology
- Electromyography/methods
- Endothelium, Vascular/physiology
- Endothelium, Vascular/ultrastructure
- Female
- Humans
- Microscopy, Electron, Transmission
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/physiology
- Muscle, Smooth, Vascular/ultrastructure
- Myometrium/blood supply
- Myometrium/physiology
- Omentum/blood supply
- Omentum/physiology
- Placental Circulation/drug effects
- Placental Circulation/physiology
- Pregnancy
- Pressure
- Sarcoplasmic Reticulum/ultrastructure
- Umbilical Arteries/physiology
- Umbilical Arteries/ultrastructure
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Affiliation(s)
- M Sweeney
- Maternal and Fetal Health Research Centre, Division of Human Development, University of Manchester, 1st Floor St. Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK.
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Nakamura H, Matsuzaki I, Hatta K, Ogino K. Physiological involvement of placental endothelin-1 and prostaglandin F2alpha in uteroplacental circulatory disturbance in pregnant rats exposed to heat stress. Can J Physiol Pharmacol 2005; 82:225-30. [PMID: 15181460 DOI: 10.1139/y04-011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/22/2022]
Abstract
Several studies suggest that heat stress affects placental functions including uteroplacental circulation, subsequently leading to pregnancy failure and birth weight reduction. To clarify the involvement of endothelin and placental prostaglandin (PG) systems in the uteroplacental circulation during heat stress, we examined the effects of i.v. administration of the endothelin receptor antagonist bosentan and the cyclooxygenase inhibitor indomethacin on uteroplacental blood flow and on placental PGE2 and PGF2alpha levels and their 13,14-dyhydro-15-keto-metabolites (PGEM and PGFM, respectively) in heat-exposed or non-heat-exposed pregnant rats. The administration of bosentan or indomethacin did not change uteroplacental blood flow in non-heat-exposed pregnant rats. In contrast, heat reduced uteroplacental blood flow in pregnant rats, but the reduction was reversed by the administration of bosentan or indomethacin before heat exposure. Heat did not change placental PGE2 or PGEM levels, but in pregnant rats it increased placental PGF2alpha and PGFM levels, which were reversed by bosentan or indomethacin. Our results suggest that the activation of placental endothelin receptor and PGF2alpha systems are involved in the uteroplacental circulatory disturbances produced by heat. PGF2alpha systems activated by heat may be involved in the vasoconstricting effects of endothelin-A and -B receptors during heat exposure.
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Affiliation(s)
- Hiroyuki Nakamura
- Department of Environmental Medicine, Kochi University School of Medicine, Japan.
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Gogarten W, Struemper D, Gramke HF, Van Aken H, Buerkle H, Durieux M, Marcus MAE. Assessment of volume preload on uteroplacental blood flow during epidural anaesthesia for Caesarean section. Eur J Anaesthesiol 2005; 22:359-62. [PMID: 15918384 DOI: 10.1017/s026502150500061x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Epidural and spinal anaesthesia are the preferred mode of anaesthesia for Caesarean section. Volume preloading is recommended to prevent maternal hypotension and a reduction in uteroplacental blood flow, although positive effects of volume preloading on maternal cardiac output and arterial pressure are debatable. Doppler measurements of the umbilical artery beyond deriving pulsatility indices are not routinely performed. METHODS After Institutional Review Board approval and written informed consent, 14 consecutiVe women with epidural anaesthesia for Caesarean section received either hydroxyethyl starch 500 mL or gelatine 500 mL. Haemodynamic variables monitored were maternal arterial pressure, maximal blood flow velocity and pulsatility indices of the uterine artery derived from Doppler measurements. CONCLUSIONS Maternal arterial pressure and pulsatility indices in both groups did not change from baseline after intravenous colloid infusion. However, uterine blood flow increased significantly in both groups. The effectiveness of volume preloading may therefore be better described by changes in maximum uterine blood flow velocity than by pulsatility indices or maternal arterial pressure.
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Affiliation(s)
- W Gogarten
- Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany
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Bisseling TM, Wouterse AC, Steegers EAP, Elving L, Russel FGM, Smits P. Dysfunction of the cyclo-oxygenase pathway in the foetoplacental circulation in Type 1 diabetes mellitus. Diabet Med 2005; 22:503-6. [PMID: 15787680 DOI: 10.1111/j.1464-5491.2005.01437.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM In diabetes, perinatal morbidity is significantly increased. This may partly be related to functional changes in the foetoplacental vascular bed. In diabetes models, a defect in the cyclo-oxygenase pathway is a common observation. Therefore, we hypothesized that the human foetoplacental circulation of diabetic patients is characterized by dysfunction of the cyclo-oxygenase pathway, as well. METHODS We performed ex-vivo perfusions of isolated placental cotyledons from healthy women (n = 14) and from patients with Type 1 diabetes (n = 9). The contribution of cyclo-oxygenase products to foetoplacental vascular tone was quantified by measuring the response to the cyclo-oxygenase inhibitor indomethacin. RESULTS Baseline foetoplacental arterial pressure was comparable between controls and diabetic women (mean +/- sem, 21.7 +/- 1.2 vs. 24.4 +/- 2.0 mmHg). Maximum foetoplacental arterial pressure at highest dose of indomethacin was 32.8 +/- 3.0 mmHg in controls vs. 27.3 +/- 2.3 mmHg in diabetic women. The indomethacin-induced increase in pressure was reduced in diabetes (2.9 +/- 0.7 vs. 11.2 +/- 2.4 mmHg in controls, P = 0.01). CONCLUSIONS Under baseline conditions, the net effect of all cyclo-oxygenase products in the foetoplacental vascular bed is vasodilation. In diabetes, this vasodilator effect seems significantly impaired.
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Affiliation(s)
- T M Bisseling
- Department of Pharmacology-Toxicology, University Medical Cenger, Nijmegen, the Netherlands
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Itakura A, Mizutani S. Involvement of placental peptidases associated with renin-angiotensin systems in preeclampsia. Biochim Biophys Acta 2005; 1751:68-72. [PMID: 15893965 DOI: 10.1016/j.bbapap.2005.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 05/17/2004] [Accepted: 03/01/2005] [Indexed: 11/24/2022]
Abstract
Preeclampsia is characterized by pregnancy-induced hypertension accompanied with protein urea and generalized edema. Preeclampsia develops during the second half of pregnancy and resolves postpartum promptly, implicating the placenta as a primary cause in the disorder. Normal pregnancy is associated with reductions in arterial pressure and attenuated pressor response to exogenous infused angiotensin II (ANG II). In contrast, women with preeclampsia show the similar sensitivity to the pressor effect of ANG II as do non-pregnant women. To elucidate the involvement of placental peptidases associated with renin-angiotensin systems, we determined the localization of angiotensin-converting enzyme (ACE) and aminopeptidase A (AP-A), ANG II degrading enzyme, in the placenta and compared the expression of mRNA and protein in uncomplicated and preeclamptic placenta. In addition, AP-A expression in trophoblastic cells treated with ANG II and ACE expression in HUVECs under hypoxic condition were analyzed, respectively. The expression of both peptidases in the preeclamptic placenta was significantly higher than those from uncomplicated. ACE was primarily localized to venous endothelial cells of stem villous whereas AP-A expression was recognized in the trophoblast and pericytes of fetal arterioles and venules within stem villous. Hypoxia induced ACE expression in HUVECs while both hypoxia and ANG II evoked AP-A expression in trophoblast. These results suggested that hypoxic condition in preeclampsia induces ACE activation in feto-placental unit to maintain the fetal hemodynamics and placental AP-A plays a role as a component of the barrier of ANG II between mother and fetus.
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Affiliation(s)
- Atsuo Itakura
- Maternity and Perinatal Care Center, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Magness RR, Phernetton TM, Gibson TC, Chen DB. Uterine blood flow responses to ICI 182 780 in ovariectomized oestradiol-17beta-treated, intact follicular and pregnant sheep. J Physiol 2005; 565:71-83. [PMID: 15774510 PMCID: PMC1464500 DOI: 10.1113/jphysiol.2005.086439] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Oestrogen dramatically increases uterine blood flow (UBF) in ovariectomized (Ovx) ewes. Both the follicular phase and pregnancy are normal physiological states with elevated levels of circulating oestrogen. ICI 182 780 is a pure steroidal oestrogen receptor (ER) antagonist that blocks oestrogenic actions in oestrogen-responsive tissue. We hypothesized that an ER-mediated mechanism is responsible for in vivo rises in UBF in physiological states of high oestrogen. The purpose of the study was to examine the effect of an ER antagonist on exogenous and endogenous oestradiol-17beta (E2beta)-mediated elevations in UBF. Sheep were surgically instrumented with bilateral uterine artery blood flow transducers, and uterine and femoral artery catheters. Ovx animals (n = 8) were infused with vehicle (35% ethanol) or ICI 182 780 (0.1-3.0 microg min(-1)) into one uterine artery for 10 min before and 50 min after E2beta was given (1 microg kg(-1) I.V. bolus) and UBF was recorded for an additional hour. Intact, cycling sheep were synchronized to the follicular phase using progesterone, prostaglandin F2alpha(PGF2alpha) and pregnant mare serum gonadotrophin (PMSG). When peri-ovulatory rises in UBF reached near peak levels, ICI 182 780 (1 or 2 microg (ml uterine blood flow)-1) was infused unilaterally (n = 4 sheep). Ewes in the last stages of pregnancy (late pregnant ewes) were also given ICI 182 780 (0.23-2.0 microg (ml uterine blood flow)-1; 60 min infusion) into one uterine artery (n = 8 sheep). In Ovx sheep, local infusion of ICI 182 780 did not alter systemic cardiovascular parameters, such as mean arterial blood pressure or heart rate; however, it maximally decreased ipsilateral, but not contralateral, UBF vasodilatory responses to exogenous E2beta by approximately 55-60% (P < 0.01). In two models of elevated endogenous E2beta, local ICI 182 780 infusion inhibited the elevated UBF seen in follicular phase and late pregnant ewes in a time-dependent manner by approximately 60% and 37%, respectively; ipsilateral >> contralateral effects (P < 0.01). In late pregnant sheep ICI 182 780 also mildly and acutely (for 5-30 min) elevated mean arterial pressure and heart rate (P < 0.05). We conclude that exogenous E2beta-induced increases in UBF in the Ovx animal and endogenous E2beta-mediated elevations of UBF during the follicular phase and late pregnancy are partially mediated by ER-dependent mechanisms.
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Affiliation(s)
- Ronald R Magness
- Department of Obstetrics and Gynecology, Perinatal Research Laboratories, University of Wisconsin-Madison, Atrium B Meriter Hospital, Madison, WI 53715, USA.
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Byers MJ, Zangl A, Phernetton TM, Lopez G, Chen DB, Magness RR. Endothelial vasodilator production by ovine uterine and systemic arteries: ovarian steroid and pregnancy control of ERalpha and ERbeta levels. J Physiol 2005; 565:85-99. [PMID: 15774511 PMCID: PMC1464491 DOI: 10.1113/jphysiol.2005.085753] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Pregnancy and the follicular phase are physiological states of elevated oestrogen levels and rises in uterine blood flow (UBF). The dramatic increase in utero-placental blood flow during gestation is required for normal fetal growth and development. Oestrogen exerts its vasodilatory effect by binding to its specific oestrogen receptors (ER) in target cells, resulting in increased expression and activity of endothelial nitric oxide synthase (eNOS) to relax vascular smooth muscle (VSM). However, the regulation of endothelial versus VSM ERalpha and ERbeta expression in uterine arteries (UAs) during the ovarian cycle, pregnancy and with exogenous hormone replacement therapy (HRT) are currently unknown. ER mRNA and protein localization was determined by in situ hybridization (ISH) using 35S-labelled riboprobes and immunohistochemistry (IHC), respectively. UA endothelial (UAendo), UA VSM, omental artery endothelium (OA endo), and OA VSM proteins were isolated and ERalpha and ERbeta protein expression was determined by Western analysis. We observed by ISH and IHC that ERalpha and ERbeta mRNA and protein were localized in both UAendo and UA VSM. Immunoblot data demonstrated ovarian hormone specific regulation of ERalpha and ERbeta protein in UAendo and UA VSM. Compared to luteal phase sheep, both ERalpha and ERbeta levels in UAendo were elevated in follicular phase sheep. Whereas ERbeta was elevated by pregnancy in UAendo and UA VSM, ERalpha was not appreciably altered. eNOS was increased in UAendo from follicular and pregnant sheep. Ovariectomized ewes (OVEX) had substantially reduced UAendo ERbeta, but not UAendo ERalpha or OAendo ERalpha and ERbeta. In contrast, OVEX increased UA VSM ERalpha and ERbeta and decreased OA VSM ERalpha and ERbeta. Treatment with oestradiol-17beta (E2beta), but not progesterone or their combination, increased UAendo ERalpha levels. The reduced ERbeta in UAendo from OVEX ewes was reversed by E(2)beta and progesterone treatment. While ERalpha and eNOS were not elevated in any other reproductive or non-reproductive endothelia tested, ERbeta was augmented by pregnancy in uterine, mammary, placenta, and coronary artery endothelia. ERalpha and ERbeta mRNA and protein are expressed in UA endothelium with expression levels depending on the endocrine status of the animal, indicating UA endothelium is a target for oestrogen action in vivo, and that the two receptors appear to be differentially regulated in a spatial and temporal fashion with regard to the reproductive status or HRT.
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Affiliation(s)
- Michael J Byers
- Perinatal Research Laboratories, University of Wisconsin-Madison Medical School, Department of Obstetrics and Gynecology, Atrium-B Meriter Hospital/Park , Madison, WI 53715, USA
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Bisseling TM, Versteegen MG, van der Wal S, Copius Peereboom-Stegeman JJH, Borggreven JMPM, Steegers EAP, van der Laak JAWM, Russel FGM, Smits P. Impaired KATP channel function in the fetoplacental circulation of patients with type 1 diabetes mellitus. Am J Obstet Gynecol 2005; 192:973-9. [PMID: 15746700 DOI: 10.1016/j.ajog.2004.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/24/2022]
Abstract
OBJECTIVE The increased perinatal morbidity in diabetes may be partly related to vascular dysfunction. Because potassium channels play an important role in the regulation of vascular tone, this study explores the impact of diabetes on potassium channel function in the fetoplacental vascular bed. STUDY DESIGN Vascular potassium channel function was investigated by ex vivo dual perfusion of isolated placental cotyledons (n = 47). Appropriate control experiments were carried out to exclude nonspecific effects. RESULTS Glibenclamide (KATP channel blocker) increased perfusion pressure to a maximum fetoplacental arterial pressure of 37 +/- 6 mm Hg in controls versus 15 +/- 6 mm Hg in diabetes (P < .05). 4-Aminopyridine (KV channel blocker) equally increased fetoplacental arterial pressure in controls, and in diabetes (21 +/- 4 mm Hg vs 22 +/- 2 mm Hg). Apamin and charybdotoxin (KCa channel blockers) caused a negligible rise in fetoplacental arterial pressure. CONCLUSION In the fetoplacental circulation, KATP channels and KV channels significantly contribute to baseline vascular tone. In diabetes, vascular KATP channel function is impaired.
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Affiliation(s)
- Tanya M Bisseling
- Department of Pharmacology-Toxicology, University Medical Center, Nijmegen, The Netherlands
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Kurdi W, Fayyad A, Thakur V, Harrington K. Delayed normalization of uterine artery Doppler waveforms is not a benign phenomenon. Eur J Obstet Gynecol Reprod Biol 2005; 117:20-3. [PMID: 15474238 DOI: 10.1016/j.ejogrb.2003.10.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2003] [Revised: 10/14/2003] [Accepted: 12/10/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the pregnancy outcome in patients with abnormal uterine artery Doppler flow velocity waveforms (FVW's) at 19-21 weeks, which were subsequently normal by 24-26 weeks, and to study the effect of low-dose aspirin on these waveforms. DESIGN The study group consisted of 49 patients who had abnormal uterine artery flow velocity waveforms (FVW's) at 19-21 weeks. These women were initially commenced on 100 mg slow-release aspirin at 20 weeks, which was discontinued at the follow-up visit, after confirming normal uterine artery Doppler FVW. The control group consisted of 730 patients with normal uterine artery Doppler waveforms at 19-21 weeks. The main outcome measures were: small for gestational age (SGA) <10th centile, pre-eclampsia, placental abruption, and perinatal mortality rate (PMR). RESULTS When compared with the control group, the study group had an increased risk of placental abruption (2% versus 0.27%, P = 0.05) 95% Confidence Intervals CI = 0.01-0.13), low birth weight (3087 versus 3383 gm, P = 0.0003), SGA <10th centile (32.7% versus 11.9%, P </= 0.0001 , CI = 0.14 -0.5), and PMR (2/49 versus 1/730, P < 0.0001 , CI = 0.003-0.37). CONCLUSIONS These findings suggest that delayed normalisation of the uterine artery Doppler waveform is not a benign phenomenon. This subgroup of patients is at increased risk of pregnancy complications, in particular SGA and placental abruption. These patients could benefit from serial ultrasound scans in the third trimester to evaluate fetal growth and well-being. Aspirin does not appear to play a major part in modifying uterine artery blood flow.
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Affiliation(s)
- Wesam Kurdi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Ates U, Ata B, Armagan F, Has R, Sidal B. Acute effects of maternal smoking on fetal hemodynamics. Int J Gynaecol Obstet 2004; 87:14-8. [PMID: 15464770 DOI: 10.1016/j.ijgo.2004.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 06/17/2004] [Accepted: 06/21/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate acute effects of cigarette smoking on fetal hemodynamics. METHOD Sixty seven women between 32nd to 40th weeks of gestation were evaluated. Maternal blood pressure and heart rate, fetal heart rate (FHR) tracing, umbilical and fetal middle cerebral arterial (MCA) color Doppler measurements were evaluated. Pre- and postsmoking results were compared with paired t-test. RESULTS Maternal heart rate significantly increased after smoking. Baseline FHR and FHR variability remained unchanged. The number of participants who had a reactive NST was 60 in 67 before smoking (89.5%) and decreased to 47 after smoking (70.1%) (p=0.009). There were no significant changes between maximum and minimum flow velocities, pulsatility index (PI), resistance index (RI) and systolic/diastolic flow ratio (S/D) of umbilical and middle cerebral arteries. CONCLUSION The nicotine load of a single cigarette may be inadequate to cause a detectable decrease in utero-placental blood flow; however, smoking prior to the FHR recording may alter the FHR reactivity.
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Affiliation(s)
- U Ates
- Department of Obstetrics and Gynecology, Vakif Gureba Hospital, Adnan Menderes Bulvari, Fatih, Istanbul, Turkey
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