Decidual cell FKBP51-progesterone receptor binding mediates maternal stress-induced preterm birth.

Depression and posttraumatic stress disorder increase the risk of idiopathic preterm birth (iPTB); however, the exact molecular mechanism is unknown. Depression and stress-related disorders are linked to increased FK506-binding protein 51 (FKBP51) expression levels in the brain and/or FKBP5 gene polymorphisms. Fkbp5-deficient (Fkbp5-/-) mice resist stress-induced depressive and anxiety-like behaviors. FKBP51 binding to progesterone (P4) receptors (PRs) inhibits PR function. Moreover, reduced PR activity and/or expression stimulates human labor. We report enhanced in situ FKBP51 expression and increased nuclear FKBP51-PR binding in decidual cells of women with iPTB versus gestational age-matched controls. In Fkbp5+/+ mice, maternal restraint stress did not accelerate systemic P4 withdrawal but increased Fkbp5, decreased PR, and elevated AKR1C18 expression in uteri at E17.25 followed by reduced P4 levels and increased oxytocin receptor (Oxtr) expression at 18.25 in uteri resulting in PTB. These changes correlate with inhibition of uterine PR function by maternal stress-induced FKBP51. In contrast, Fkbp5-/- mice exhibit prolonged gestation and are completely resistant to maternal stress-induced PTB and labor-inducing uterine changes detected in stressed Fkbp5+/+ mice. Collectively, these results uncover a functional P4 withdrawal mechanism mediated by maternal stress-induced enhanced uterine FKBP51 expression and FKPB51-PR binding, resulting in iPTB.

N95 Filtering Facepiece Respirator Use during Pregnancy: A Systematic Review.

OBJECTIVE: This study was aimed to systematically review the use of filtering facepiece respirators, such asN95 masks, during pregnancy. STUDY DESIGN: A comprehensive search for primary literature using Medline, Embase, Scopus, Web of Science, and ClinicalTrials.gov was conducted from inception until April 2020 to find articles reporting outcomes of pregnant women using filtering facepiece respirator (FFR). Studies were selected if they included the use of FFR in pregnant women and reported an outcome of interest including physiologic changes (heart rate, respiratory rate, pulse oximetry, and fetal heart rate tracing) or subjective measures (thermal or exertional discomfort or fit). The Newcastle-Ottawa Quality Assessment scale was used to assess the risk of bias. The main outcome was to describe the physiologic changes in pregnant women compared with nonpregnant women. Due to the small number of studies and heterogeneity of reported outcomes a meta-analysis was not conducted. Results of the studies were synthesized into a summary of evidence table. RESULTS: We identified four studies, three cohort studies and one crossover study, comprising 42 women using FFR during pregnancy. Risk of bias was judged to be low. Studies were consistent in showing no significant increase in maternal heart rate, respiratory rate, oxygen saturation, and fetal heart rate between pregnant and nonpregnant women using N95 FFRs for short durations. Repeat fit testing was not supported for women gaining the recommended amount of weight during pregnancy. No evidence was found to reach conclusions about prolonged N95 FFR use in pregnancy. CONCLUSION: Limited duration N95 FFR use during pregnancy is unlikely to impart risk to the pregnant women or her fetus. KEY POINTS: · Limited N95 use unlikely to impart risk to pregnant woman/fetus.. · Prolonged N95 use in pregnancy is unstudied.. · Repeat fit testing in pregnancy likely unnecessary..

A Case of Retroperitoneal Synovial Sarcoma in Pregnancy Treated with Antepartum Doxorubicin plus Ifosfamide Chemotherapy.

We report a case of a 25-year-old pregnant woman diagnosed with a large, unresectable retroperitoneal synovial sarcoma. Successful neoadjuvant treatment with doxorubicin plus ifosfamide prepartum and continuing postpartum resulted in significant disease response allowing for later tumor resection. Following the first prepartum chemotherapy cycle, a decreased amniotic fluid index was noted, representing a potential complication of chemotherapy. Induction of labor was performed at 33 weeks gestation with excellent outcome in the newborn. This case highlights the complex medical decision-making process in the setting of cancer diagnosed during pregnancy, balancing oncologic and obstetric concerns, and to our knowledge is only the second reported case of synovial sarcoma treated with neoadjuvant cytotoxic chemotherapy in the antepartum period.