Social stress predicts preterm birth in twin pregnancies.

OBJECTIVE: To investigate whether stress, anxiety and depression predict preterm birth in twin pregnancies. METHODS: A prospective cohort study with a convenience sample of women pregnant with dichorionic, diamniotic twins. They were interviewed at 24-28 weeks using the Life Events and Difficulties Schedule and the Hospital Anxiety and Depression Scale. Corticotrophin-releasing hormone, ACTH and cortisol levels were assessed at 28 weeks. The main outcome was premature delivery; there were 42 preterm and 73 term births. RESULTS: Preterm births (<37 weeks) were predicted by higher levels of social stress: 24/42 (57.1%) of women labouring prematurely and 14/73 (19.2%) of those giving birth at term had experienced a severe life event and/or marked social difficulty in the preceding year (<0.001). In logistic regression controlling for age, anxiety and depression, the experience of a severe life event during the year preceding the interview (OR =15.6; 95%CI: 3.0 to 80.8) and a marked difficulty in a close relationship (OR = 17.8; 95%CI: 1.7 to 192) were the factors predicting preterm birth. Levels of CRH, cortisol and ACTH at 28 weeks were not associated with preterm birth. Of the women whose pregnancy lasted less than 34 weeks (early preterm birth) 15/16 had experienced a severe life event and/or marked social difficulty compared to a third (9/26) of those delivering at 34-36 weeks (late preterm birth) and 14/73 of women whose pregnancy reached term (p < .001). CONCLUSION: Experience of severe social stress predicts preterm birth in twin pregnancies.

Nutritional advice for improving outcomes in multiple pregnancies.

BACKGROUND: Multiple pregnancies are associated with higher rates of perinatal mortality and morbidity than singleton pregnancies, mainly due to an increased risk of preterm birth. Because fetal outcome is best at a particular range of maternal weight gain, it has been suggested that women with multiple pregnancies should take special diets (particularly high-calorie diets) designed to boost weight gain. However, 'optimal weight gain' in the mother in retrospective studies may merely reflect good growth of her babies and delivery at or near term (both associated with a good outcome) and artificially boosting weight gain by nutritional input may confer no advantage. Indeed, a high-calorie diet may be unpleasant to consume, and could lead to long-term problems of being overweight. It is therefore important to establish if specialised diets are actually of benefit to women with multiple pregnancies and their babies. OBJECTIVES: To assess the effects of specialised diets or nutritional advice for women with multiple pregnancies (two or more fetuses). SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 June 2015). SELECTION CRITERIA: Randomised controlled trials, 'quasi-random' studies, and cluster-randomised trials of women with multiple pregnancies (two or more fetuses) either nulliparous or multiparous and their babies. Cross-over trials and studies reported only as abstracts were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: We identified no trials for inclusion in this review. MAIN RESULTS: A comprehensive search of the Cochrane Pregnancy and Childbirth Group's Trials Register found no potentially eligible trial reports. AUTHORS' CONCLUSIONS: There is no robust evidence from randomised trials to indicate whether specialised diets or nutritional advice for women with multiple pregnancies do more good than harm. There is a clear need to undertake a randomised controlled trial.

Nutritional advice for improving outcomes in multiple pregnancies.

BACKGROUND: Multiple pregnancies are associated with higher rates of perinatal mortality and morbidity than singleton pregnancies, mainly due to an increased risk of preterm birth. Because fetal outcome is best at a particular range of maternal weight gain, it has been suggested that women with multiple pregnancies should take special diets (particularly high-calorie diets) designed to boost weight gain. However, 'optimal weight gain' in the mother in retrospective studies may merely reflect good growth of her babies and delivery at or near term (both associated with good outcome) and artificially boosting weight gain by nutritional input may confer no advantage. Indeed, a high-calorie diet may be unpleasant to consume, and could lead to long-term problems of being overweight. It is therefore important to establish if specialised diets are actually of benefit to women with multiple pregnancies and their babies. OBJECTIVES: To assess the effects of specialised diets or nutritional advice for women with multiple pregnancies (two or more fetuses). SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2011). SELECTION CRITERIA: Randomised controlled trials, 'quasi-random' studies, and cluster-randomised trials of women with multiple pregnancies (two or more fetuses) either nulliparous or multiparous and their babies. Crossover trials and studies reported only as abstracts were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: We identified no trials for inclusion in this review. MAIN RESULTS: A comprehensive search of the Cochrane Pregnancy and Childbirth Group's Trials Register found no potentially eligible trial reports. AUTHORS' CONCLUSIONS: There is no robust evidence from randomised trials to indicate whether specialised diets or nutritional advice for women with multiple pregnancies do more good than harm. There is a clear need to undertake a randomised controlled trial.

Allergen-induced increases in bone marrow T lymphocytes and interleukin-5 expression in subjects with asthma.

Inhaled allergen challenge of subjects with atopic asthmatic increases bone marrow eosinophil progenitor cells. Interleukin-5 (IL-5) specifically induces growth and maturation of eosinophils. This study examined the effect of allergen challenge on the number of bone marrow total and CD3+ cells expressing IL-5 protein and IL-5 mRNA in subjects with asthma who developed either allergen-induced isolated early responses, or early and late asthmatic responses (dual responders). At 24 hours after allergen challenge, dual responders had significantly greater blood and airway eosinophilia compared with early responders. There were significant increases in the percentage of bone marrow CD3+ cells (p < 0.005) in both groups. However, there were significant differences in the increases in bone marrow IL-5 mRNA+ (p < 0.005), CD3+ (p < 0.005), and IL-5 mRNA+ CD3+ (p < 0.005) cells between the dual and early responder groups. These results suggest that, in subjects with atopic asthma, inhaled allergen causes trafficking of T lymphocytes to the bone marrow, and that in subjects who develop late responses and greater blood and airway eosinophilia after inhalation of allergen, there is a significant increase in the ability of bone marrow cells, particularly T lymphocytes, to produce IL-5.

IL-10 production in circulating T cells differs between allergen-induced isolated early and dual asthmatic responders.

BACKGROUND: IL-10 is an anti-inflammatory cytokine released from various cells, including T cells. The role of IL-10 in asthma pathogenesis remains uncertain. Allergen inhalation by atopic asthmatic subjects results in 2 bronchoconstrictor phenotypes: isolated early response and dual response. Persistence of allergen-induced airway inflammation is a feature of dual responders. OBJECTIVES: The kinetics of IL-10 production in circulating T cells were investigated to examine a potential role of IL-10 in allergen-induced responses and airway inflammation. METHODS: Fourteen subjects with mild asthma (7 isolated early and 7 dual responders) were challenged with allergen. PBMCs taken before and 24 hours after allergen challenge were processed for intracellular IL-10 staining with fluorescent-conjugated anti-IL-10 antibody. The frequency of IL-10-producing cells was assessed for CD4(+) and CD8(+) T-cell subsets by using flow cytometry. RESULTS: Before allergen administration, the frequency of IL-10-producing CD4(+) cells was significantly higher in dual than in isolated early responders. IL-10-producing CD4(+) cells significantly increased after allergen in early responders, whereas IL-10-producing CD4(+) cells significantly decreased in dual responders. Simultaneous assessments of IL-5-producing T cells did not show any differences between each group before or after allergen administration. CONCLUSIONS: These results suggest that the contrasting profiles of IL-10 production may be associated with the different time course of allergen-induced airway inflammation between allergen-induced early and dual responders.

Bone marrow contribution to eosinophilic inflammation

Allergen-induced bone marrow responses are observed in human allergic asthmatics, involving specific increases in eosinophil-basophil progenitors (Eo/B-CFU), measured either by hemopoietic assays or by flow cytometric analyses of CD34-positive, IL-3 alpha-positive, and/or IL-5-responsive cell populations. The results are consistent with the upregulation of an IL-5-sensitive population of progenitors in allergen-induced late phase asthmatic responses. Studies in vitro on the phenotype of developing eosinophils and basophils suggest that the early acquisition of IL-5 alpha, as well as the capacity to produce cytokines such as GM-CSF and IL-5, are features of the differentiation process. These observations are consistent with findings in animal models, indicating that allergen-induced increases in bone marrow progenitor formation depend on hemopoietic factor(s) released post-allergen. The possibility that there is constitutive marrow upregulation of eosinophilopoiesis in allergic airways disease is also an area for future investigation.