Beverage consumption and the prevalence of tooth loss in pregnant Japanese women: the Osaka Maternal and Child Health Study

Recently, there has been growing interest in the impact of beverage consumption on dental health because changes have occurred in the types and quantities of beverage consumed. This cross-sectional study investigated the relationship between consumption frequencies of various beverages and the prevalence of tooth loss among young adult women. Study subjects were 1002 pregnant Japanese women. Tooth loss was defined as previous extraction of one or more teeth. Dietary habits were evaluated by a validated dietary history questionnaire. Logistic regression analysis was used to estimate the odds ratios and their 95% confidence intervals of tooth loss. Adjustment was made for age, gestation, parity, cigarette smoking, passive smoking at home and at work, family income, education, changes in diet in the previous one month, season when data were collected and body mass index. Of the 1002 subjects, 256 women had lost one or more teeth. Coffee consumption was independently associated with an increased prevalence of tooth loss. When subjects were divided according to consumption of coffee with or without sugar, an increased prevalence of tooth loss was found only in subjects who consumed coffee without addition of sugar. Compared with the lowest consumption of green tea, the intermediate but not the highest consumption of green tea was associated with an increased prevalence of tooth loss. There was no measurable association of intake of milk, black tea, cola, or 100% fruit juice with the prevalence of tooth loss. The findings suggest that coffee consumption might be associated with an increased prevalence of tooth loss among young adult women.

Prenatal Genetic Diagnosis of Severe Perinatal (Lethal) Hypophosphatasia

Hypophosphatasia is an inherited disorder characterized by defective bone mineralization and a deficiency in tissue-nonspecific alkaline phosphatase (TNSALP) activity. This disorder is caused by various mutations of the TNSALP gene. We report here the prenatal diagnosis of the perinatal (lethal) type of hypophosphatasia in a sibling of an affected infant. The infant had been found to have hypophosphatasia on the basis of both clinical and radiologic manifestations and the finding of a homozygous single T nucleotide deletion at 1559 (1559delT) of the TNSALP gene on molecular analysis. Both parents were carriers with a heterozygous mutation in the same position, although they were not consanguineous. After their next child had been conceived, fetal genomic DNA was extracted from cultured cells of amniotic fluid at 15 weeks' gestation. The fetus had a homozygous 1559delT mutation. An ultrasonography examination at 19 weeks' gestation showed marked hypomineralization of all bony structures. A prenatal genetic diagnosis for hypophosphatasia in combination with ultrasonography is thus considered to be useful for confirming the diagnosis of hypophosphatasia, which presents with a wide variety of phenotypes. As a result, prenatal genetic counseling for hypophosphatasia with collaboration between obstetricians and clinical genetics teams.

Laparoscopic adrenalectomy on a patient with primary aldosteronism during pregnancy

A pregnant 26-year-old woman was referred for evaluation and management of progressive hypertension and hypokalemia at 14 weeks of gestation. Her plasma aldosterone level was markedly elevated and magnetic resonance imaging showed a right adrenal tumor. Primary aldosteronism due to an aldosterone producing-adenoma was diagnosed. Because of progressive severe hypertension, a laparoscopic adrenalectomy was performed at 17 weeks of gestation. The procedure was completed without complication, and plasma aldosterone and potassium levels rapidly improved post-operatively. However, her hypertension persisted and the growth retardation of the fetus was found. Regrettably, intrauterine fetal death was confirmed at 26 weeks of gestation. Histological examination of the placenta revealed that the placental artery had very thick walls which had apparently caused a critical failure in fetal blood flow. The optimal timing of laparoscopic surgery during pregnancy and perioperative management were subsequently discussed.

Oxidative stress promotes the regression of fetal liver hemopoiesis

Although apoptosis is believed to play an important role in the ontogenetic development of animals, the molecular mechanism that triggers the regression of liver hemopoiesis during the perinatal period is not known. Apoptosis is induced by many factors such as a decrease in growth factors and increased oxygen stress. Since hepatic gamma-glutamyl transferase (GT) levels change markedly during the perinatal period in rodents, the metabolism of glutathione (GSH), a naturally occurring major antioxidant, might change significantly in and around liver cells. Hemopoietic cells but not hepatocytes exhibit significant apoptosis in thiol-free medium and the hemopoietic apoptosis can be inhibited by various thiols, such as L-cysteine, N-acetyl-L-cysteine, and GSH. The contribution of GSH levels in and around fetal liver cells in the triggering of apoptosis in hemopoietic cells is discussed.

Plasma Levels of Neopterin and Biopterin in the Umbilical Vessels and the Maternal Vein

Tetrahydrobiopterin (BH4) is a highly bioactive pterin required for nitric oxide synthase and monooxygenases of aromatic amino acids, and is involved in the synthesis of nitric oxide, catecholamines and Serotonin. Although these functions imply that pterin metabolism plays critical roles in human development, the intrauterine metabolism is unclear. To elucidate the pterin metabolism in the human feto-placental unit, blood was obtained from the umbilical artery and vein, and the maternal vein, and plasma biopterin and neopterin concentrations were analyzed by the high-performance liquid chromatography method. To clarify the effect of labor, data was also compared between the transvaginal delivery (TV) and the caesarean delivery (CS). The levels of biopterin and the neopterin, and neopterin/biopterin ratio were higher in the fetal plasma than in the maternal plasma. Biopterin levels in the umbilical artery were higher than those in the umbilical vein. There were significant correlations in either biopterin or neopterin between the fetal plasma and the maternal plasma. There was no significant difference in the fetal pterin levels between TV and CS. The results suggest the stimulated BH4 synthesis in the fetoplacental unit, the independent homeostasis of the fetal pterin metabolism, and the possibility of dynamic movements of pterins among the fetus, the placenta and the mother.

Occlusion of the external cervical os after conization in a postpuerperal amenorrheic woman

INTRODUCTION

Complete occlusion of the cervical canal following conization is an uncommon complication.

CASE REPORT

We encountered a case in a woman with lactation amenorrhea who after conization to treat cervical intraepithelial neoplasia (CIN) 3 developed hematometra and did not resume menstruation. This case was diagnosed early by ultrasonic tomography and magnetic resonance imaging (MRI).

CONCLUSION

Postpuerperal amenorrheic women should be managed with care because of the increased risk of occlusion of the cervical duct after conization.

Promotion of human blastocyst formation by red cell hemolysate

Recently, blastocyst transfer has been increasingly performed to improve the implantation rate achieved by in vitro fertilization and embryo transfer. This has created the need for new culture methods to improve in vitro blastulation. Culture with erythrocyte hemolysate promotes the development of early mouse embryos due to an antioxidant effect. The present study investigated whether erythrocyte hemolysate could also promote blastulation of human embryos. Eighty surplus embryos were obtained from 15 patients who gave informed consent. These embryos were cultured for 2 to 7 days after oocyte retrieval in medium with or without erythrocyte hemolysate. Blastocyst formation was observed in 53% and 28% of the embryos grown in hemolysate-supplemented and control cultures, respectively. The blastulation rate was significantly higher in hemolysate-supplemented culture than in control group (p = 0.02). These results suggest that culture medium supplemented with erythrocyte hemolysate may promote the blastulation of human embryos.

Decreased plasma tetrahydrobiopterin in pregnant women is caused by impaired 6-pyruvoyl tetrahydropterin synthase activity

Tetrahydrobiopterin (BH4) is an essential cofactor of nitric oxide synthase as well as a cofactor of aromatic amino acid hydroxylases. However, its role in pregnancy is not yet understood. We evaluated the concentrations of BH4 throughout normal pregnancy and puerperium, and compared them with those of non-pregnant women by measuring its oxidation product biopterin. In addition, we also measured 6-pyruvoyl tetrahydropterin synthase (PTPS) activities, the rate-limiting enzyme in synthesizing BH4, in pregnant women at the 30th gestational week and non-pregnant women. Although the urinary biopterin levels did not remarkably change, plasma biopterin levels significantly decreased from the 10th gestational week to the 1st day of postpartum compared with those of non-pregnant women. There was no significant difference in PTPS activities between pregnant and non-pregnant women. However, the proportion of reticulocytes, which have been shown to possess high PTPS activity, is significantly higher in pregnant women than in non-pregnant women. Our results suggest that decreased plasma BH4 levels in pregnancy is caused by impaired PTPS activity.

Primary abdominal pregnancy associated with severe ovarian hyperstimulation syndrome

An uncommon case of primary abdominal pregnancy that was detected after rapid resolution of OHSS is reported. A 27-years-old nulligravida woman underwent ovarian hyperstimulation with human menoposal gonadotrophin (hMG) at another clinic and was admitted to our hospital with severe OHSS. Intravenous fluid therapy, albumin supplementation, and abodminal paracentesis was performed. The patient's massive ascites rapidly resolved, and she was discharged from our hospital. However, 4 weeks later, at about the 8th gestational week, she was readmitted to our hospital because of strong suspicion of abdominal pregnancy. Ultrasonography revealed a gestational sac (GS) and fetus with heartbeat in Douglas' pouch and an emergency laparotomy was performed. Both fallopian tubes, both ovaries and the uterus were completely intact and the GS was found on the anterior surface of the rectum. After removing GS, the muscle layer and serosal layer of the rectum were repaired. No bowel complications developed, and the post operative course was uneventful. To our knowledge, this is the first report of this very rare variant of ectopic pregnancy complicated by OHSS.

Conservative management of placental polyp with oral administration of methotrexate

Surgical treatment is usually selected for placental polyp accompanied by massive bleeding but patients wishing to conserve their fecundity require conservative management. A 35-year old nullipara was diagnosed as having placental polyp on the basis of typical episodes, and detection of placental polypeptide hormones and blood flow by Doppler ultrasonography and dynamic magnetic resonance imaging. Oral administration of methotrexate (2.5 mg, three times a day for 5 days) was repeated for three cycles because surgical treatment was rejected. Serum human placental lactogen, blood flow and the polyp disappeared sequentially following chemotherapy. This report thus advocates considering conservative management for placental polyp.

Involvement of phenotypes and serum levels of haptoglobin in the outcome of in vitro fertilization and embryo transfer

Haptoglobin (Hp) possesses many functions in the immune system and angiogenesis as well as scavenging released hemoglobin, and thus it is speculated that Hp may also play a critical role in the reproductive process. To investigate the possible involvement of Hp in the outcome of in vitro fertilization and embryo transfer (IVF-ET), the serum Hp of 50 patients who underwent IVF-ET was analyzed by the Western blot method. The results showed a higher pregnancy rate in the patients with the Hp2-2 phenotype (38%) than in those with the Hp2-1 phenotype (16%) (p = 0.08), and the serum alpha 2 subunit levels in the patients who achieved pregnancy within four attempts at IVF-ET were higher than in the others (p < 0.05). The results of this study suggest that Hp is involved in the outcome of IVF-ET.

Effects of cocaine and ethanol on mouse fetuses

In the presence of ethanol, cocaine is metabolized to its ethyl homolog, cocaethylene. To investigate the embryotoxic effects of cocaethylene, pregnant ICR mice receiving ethanol orally during pregnancy were treated with 50 mg/kg/day cocaine i.p. on days 7, 8 and 9 of gestation. Treatment with either cocaine or ethanol alone did not affect the fetal mortality rate or the mean fetal body weight. Concurrent cocaine and ethanol treatment increased the fetal mortality rate, and decreased the mean fetal body weight, although teratogenicity was not noted. These results suggest that concurrent use of cocaine and ethanol during pregnancy is more harmful to fetal body weight gain and their lives than the use of either drug alone, at least in the present experimental settings.

Triple marker screening for trisomy 21, trisomy 18 and open neural tube defects in singleton pregnancies of native Japanese pregnant women

OBJECTIVE

To report the results of prenatal triple marker screening on a population of Japanese pregnant women.

METHODS

From April 1994 through March 1999, a total of 32,925 native Japanese women with singleton pregnancies requested a triple marker-screening test. Multiples of the median values for 3 markers and individual risks for each patient were calculated following adjustment for the Japanese weight correction factor. The risk cut-off values used for Down syndrome (T21), open spina bifida (OSB) and trisomy 18 (T18) were 1: 295, 1: 290, and 1: 100, respectively. Follow-up information was collected postpartum and statistically analyzed.

RESULTS

Detection rates (DR) of T21 for women less than 35 years, over 35 years and overall were 58, 94, and 83%, respectively. DR of T18 for women less than 35 years, over 35 years and overall were 75, 79, and 79%, respectively. DR of open neural tube defects (ONTD) was 100%.

CONCLUSIONS

The first cumulative data of an intervention program and prospective follow-up studies in Japan have proven to be similar to other published reports. Individual risk values were calculated for each pregnancy for T21, T18 and ONTD. This screening program is more effective than age-dependent screening for detecting T21, T18 and ONTD pregnancies.

Stimulation of fetal granulopoiesis by intrauterine injection of recombinant human granulocyte colony- stimulating factor into rat fetuses

The small neutrophil reserve and exaggerated release of stored neutrophils are factors which predispose neonates to neutrophil reserve exhaustion during bacterial sepsis. Our objective is to try to improve in utero the myelopoietic function of the fetus before delivery. In the first series, recombinant human (rh) granulocyte colony-stimulating factor (G-CSF) (rhG-CSF; 100 microg/kg) was injected subcutaneously into rat fetuses at the indicated times to assess drug absorption and fetal response. In the second series, rhG-CSF (100 microg/kg) or saline (control) was injected into the fetuses once every other day to investigate the effect of repeated injections of rhG-CSF on enhancing fetal myelopoiesis preceding birth. Delivery was performed by cesarean section on embryonic day 21. The plasma concentration of G-CSF was determined by ELISA. The effect of rhG-CSF injection on granulopoiesis was assessed by measurement of the neutrophil count in the fetal peripheral blood and by histological examination of the fetal bone marrow, spleen, and liver. Fetally administered rhG-CSF enhanced fetal myelopoiesis preceding birth.

Role of glutathione metabolism and apoptosis in the regression of liver hemopoiesis

Although apoptosis has been believed to play important roles in ontogenic development of animals, the molecular mechanism that triggers the regression of liver hemopoiesis during perinatal period is not known. Apoptosis is induced by many factors, such as decrease in growth factors and increased oxygen stress. Because hepatic gamma-glutamyltransferase (GGT) changes markedly during the perinatal period of a rodent, metabolism of glutathione (GSH), a naturally occurring major antioxidant, might change significantly in and around liver cells. To know the possible involvement of apoptosis and GSH metabolism in the regression of hemopoiesis, hepatocytes and hemopoietic cells were isolated from fetal rat liver. Biochemical analysis revealed that, during the perinatal period, hepatic GGT levels transiently increased predominantly with hepatocytes, suggesting a marked change in thiol status in and around these cells. Cell culture analysis revealed that hemopoietic cells but not hepatocytes exhibited a marked apoptosis in a thiol-free medium, as judged from DNA fragmentation. The apoptosis of hemopoietic cells was inhibited by various thiols, such as L-cysteine, N-acetyl-L-cysteine (NAC), and GSH. These observations suggested that a marked change in GSH status in and around liver cells might play critical roles in triggering apoptosis of hemopoietic cells, thereby enhancing the regression of liver hemopoiesis.

DNA fragmentation of oocytes in aged mice

To investigate whether female fertility decreases with age due to poor oocyte quality, we examined the presence of DNA fragmentation in ovulated oocytes from young, mature and aged mice. Oocytes from three age groups of female mice (7-8, 20-24 and 40-48 weeks) were retrieved from the oviducts 15 h after human chorionic gonadotrophin (HCG) injection. Oocytes from each mouse were incubated in a CO2 incubator for 0-60 h in human tubal fluid (HTF). After incubation, each oocyte was stained with the terminal deoxynucleotidyl transferase-mediated dUDP nick-end labelling (TUNEL) method. The rate of DNA fragmentation (interpreted as apoptotic changes) was significantly higher for oocytes from aged mice, and the fertilization rate was significantly lower, compared with oocytes from young and mature mice. Our results suggest that DNA fragmentation of oocytes might be one of the reasons for poor oocyte quality and lower fertility in the aged group.