Fetal cardiovascular hemodynamics in type 1 diabetic pregnancies at near-term gestation.

INTRODUCTION: Poor glycemic control in maternal type 1 diabetes mellitus during pregnancy can affect fetal cardiac and placental function. However, studies concerning fetal central hemodynamics have revealed conflicting results. We hypothesized that in pregnancies complicated by maternal type 1 diabetes, fetal cardiovascular and placental hemodynamics are comparable to the control fetuses at near-term gestation. In addition, we investigated the relation between newborn serum biomarkers of cardiac function and fetal cardiovascular and placental hemodynamics. Furthermore, we studied whether maternal diabetes is associated with placental inflammation. MATERIAL AND METHODS: In this prospective case-control study, fetal central and peripheral hemodynamics were assessed by ultrasonography in 33 women with type 1 diabetes and in 67 controls with singleton pregnancies between 34+2 and 40+2 gestational weeks. Newborn umbilical cord serum was collected to analyze cardiac natriuretic peptides (atrial and B-type natriuretic peptides) and troponin T concentrations. Placental tissue samples were obtained for cytokine analyses. RESULTS: Fetal ventricular wall thicknesses were greater and weight-adjusted stroke volumes and cardiac outputs were lower in the type 1 diabetes group than in the control group. Pulsatility in the aortic isthmus and inferior vena cava blood flow velocity waveforms was greater in the type 1 diabetes group fetuses than in the controls. A positive correlation was found between branch pulmonary artery and aortic isthmus pulsatility index values. Umbilical artery pulsatility indices were comparable between the groups. Umbilical cord serum natriuretic peptide and troponin T concentrations were elevated in the type 1 diabetes fetuses. These cardiac biomarkers correlated significantly with cardiovascular hemodynamics. Placental cytokine levels were not different between the groups. CONCLUSIONS: In maternal type 1 diabetes pregnancies, fetal cardiovascular hemodynamics is impaired. Maternal type 1 diabetes does not seem to alter placental vascular impedance or induce placental inflammation.

How young adults with autism spectrum disorder watch and interpret pragmatically complex scenes.

The aim of the current study was to investigate subtle characteristics of social perception and interpretation in high-functioning individuals with autism spectrum disorders (ASDs), and to study the relation between watching and interpreting. As a novelty, we used an approach that combined moment-by-moment eye tracking and verbal assessment. Sixteen young adults with ASD and 16 neurotypical control participants watched a video depicting a complex communication situation while their eye movements were tracked. The participants also completed a verbal task with questions related to the pragmatic content of the video. We compared verbal task scores and eye movements between groups, and assessed correlations between task performance and eye movements. Individuals with ASD had more difficulty than the controls in interpreting the video, and during two short moments there were significant group differences in eye movements. Additionally, we found significant correlations between verbal task scores and moment-level eye movement in the ASD group, but not among the controls. We concluded that participants with ASD had slight difficulties in understanding the pragmatic content of the video stimulus and attending to social cues, and that the connection between pragmatic understanding and eye movements was more pronounced for participants with ASD than for neurotypical participants.

Ascites in newborns - a diagnostic challenge.

Isolated fetal ascites is a rare finding in prenatal ultrasound examination. The finding is always aberrant and requires further exploration. More than half of fetal ascites findings are associated with structural anomalies. Other causes include prenatal infections and genetic disorders. The cause and time of detection of ascites have an influence on the baby's prognosis. In spite of careful examinations the cause of ascites frequently remains open during pregnancy. During the first hours of life the baby needs intensive care, and when necessary, etiologic exploration will be simultaneously continued.

Diagnosis and treatment of severe hemolytic disease of the fetus and newborn: a 10-year nationwide retrospective study.

OBJECTIVE: Outcome after intrauterine transfusions due to severe hemolytic disease of the fetus and newborn. DESIGN: Nationwide population-based retrospective cohort study. SETTING: All women treated with intrauterine transfusions for hemolytic disease of the fetus and newborn in Finland in 2003-2012. POPULATION: 339 intrauterine transfusions, performed in 104 pregnancies of 84 women. METHODS: Information on antenatal screening of red cell antibodies and red cell units issued for intrauterine transfusion was obtained from the Finnish Red Cross Blood Service database, and obstetric and neonatal data from hospital records. MAIN OUTCOME MEASURES: Procedure-related complications, perinatal mortality, neonatal morbidity. RESULTS: Overall survival was 94.2% (95% confidence interval 89.7-98.7). There were four fetal and two neonatal deaths. Procedure-related fetal loss rate was 1.2% (95% confidence interval 0.04-2.4) per procedure and 3.8% (95% confidence interval 0.1-7.5) per pregnancy. Of the four procedure-related losses, three were due to technically difficult intrauterine transfusions causing infection and preterm birth. Of the live born infants, 19% (95% confidence interval 11.3-26.7) were born before 32 weeks' gestation. The incidence of severe neonatal morbidity (respiratory distress syndrome, severe cerebral injury, sepsis) was 22.2% (95% confidence interval 13.4-30.2). Poor outcome (death, severe neonatal morbidity) was negatively associated with gestational age at first transfusion (p = 0.001) and at birth (p = 0.00006). Follow-up of the infants was too incomplete to assess the neurodevelopmental outcome. CONCLUSIONS: Although overall survival is comparable with previous studies, our concern is procedure-related infections and preterm births. Close collaboration between the university hospitals is needed to ensure timely treatment, operator skills and systematic follow-up of the children.

Emotions in freely varying and mono-pitched vowels, acoustic and EGG analyses.

Vocal emotions are expressed either by speech or singing. The difference is that in singing the pitch is predetermined while in speech it may vary freely. It was of interest to study whether there were voice quality differences between freely varying and mono-pitched vowels expressed by professional actors. Given their profession, actors have to be able to express emotions both by speech and singing. Electroglottogram and acoustic analyses of emotional utterances embedded in expressions of freely varying vowels [a:], [i:], [u:] (96 samples) and mono-pitched protracted vowels (96 samples) were studied. Contact quotient (CQEGG) was calculated using 35%, 55%, and 80% threshold levels. Three different threshold levels were used in order to evaluate their effects on emotions. Genders were studied separately. The results suggested significant gender differences for CQEGG 80% threshold level. SPL, CQEGG, and F4 were used to convey emotions, but to a lesser degree, when F0 was predetermined. Moreover, females showed fewer significant variations than males. Both genders used more hypofunctional phonation type in mono-pitched utterances than in the expressions with freely varying pitch. The present material warrants further study of the interplay between CQEGG threshold levels and formant frequencies, and listening tests to investigate the perceptual value of the mono-pitched vowels in the communication of emotions.

[Fetal arrhythmias]. / Sikiön rytmihäiriöt.

The majority of referrals for fetal arrhythmias represent benign atrial premature beats. However, a small number of fetuses might have life-threatening conditions associated with bradycardia or tachycardia. Fetal echocardiography is essential to establish the diagnosis. Transplacental treatment is most often used to prevent heart failure. There is no clinical trial evidence as to the drug of first choice. Prognosis is determined by the type of arrhythmia, the association with structural cardiac anomaly and the co-existence of intrauterine cardiac failure. Treatment of fetal dysrhythmias should be executed in experienced maternal-fetal medicine centers.

Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: a randomized controlled trial.

PURPOSE: To test the efficacy and safety of ursodeoxycholic acid (UDCA) in the treatment of patients with intrahepatic cholestasis of pregnancy (ICP). METHODS: In the randomized (double-blind, placebo-controlled) study 20 pregnant women with ICP received (random allocation of) either 450 mg/day UDCA or placebo for 14 days during the third trimester of pregnancy. The severity of pruritus was registered and itching scores were assessed before the treatment and weekly thereafter. The effects of UDCA on liver function and fetoplacental hormone production were measured with covering laboratory testing: serum levels of alanine aminotransferase (ALAT), total bile acids (TBA), estradiol, progesterone, prolactin, cholesterol, HDL-cholesterol, triglycerides, activated partial thromboplastin time, fibrinogen D-dimers (FIDD) and platelet count were assessed before the treatment and weekly thereafter. Data on pregnancy and delivery outcome were recorded and analyzed. RESULTS: UDCA was well tolerated. A significant improvement in itching scores was detected in 2 weeks in the group receiving UDCA. Serum levels of ALAT and TBA fell after 2 weeks treatment. The other laboratory values were not modified by the treatment. CONCLUSIONS: UDCA improves maternal itching scores and liver function tests without interfering with the fetoplacental estrogen production in patients with ICP. UDCA is well tolerated by pregnant women. No fetal or neonatal side-effects could be detected.

Influence of the intentional voice quality on the impression of female speaker.

This study examines the relationship of voice quality and speech-based personality assessment of Finnish-speaking female speakers. Five Finnish-speaking female subjects recorded a text passage with eight different vocal qualities. Samples that passed the preselection test for the voice qualities were played to 50 Finnish-speaking listeners, who reported speaker impressions on a scale of 18 opposite trait pairs. Voices produced with forward placement received assessments of femininity and friendliness. Readers speaking with backward placement were considered less feminine, while breathy voice evoked assessments of emotionality and implausibility. Tense phonation as well as creakiness, nasality, and denasality gave rise to numerous negative notions. The results suggest that voice stereotypes have both internationality and cultural dependency.

Vowel formants from the wave equation.

This article describes modal analysis of acoustic waves in the human vocal tract while the subject is pronouncing [o]. The model used is the wave equation in three dimensions, together with physically relevant boundary conditions. The geometry is reconstructed from anatomical MRI data obtained by other researchers. The computations are carried out using the finite element method. The model is validated by comparing the computed modes with measured data.

Antenatal Doppler measurements and early brain injury in very low birth weight infants.

OBJECTIVE: To determine the correlation between fetoplacental blood flow and brain injury and volumes in very low birth weight (VLBW) infants. STUDY DESIGN: Antenatal blood flow from the umbilical artery (UA), middle cerebral artery (MCA), and descending aorta was determined in 70 VLBW infants. The directions of the total diastolic flow of the aortic isthmus and the end-diastolic flow of ductus venosus also were measured. Serial brain ultrasound examinations and MRI at term were performed to assess brain abnormalities. On the basis of brain imaging findings, the newborn infants were classified as normal (n = 14), intermediate brain pathology (n = 31), and major pathology (n = 25) groups. RESULTS: Abnormalities in fetoplacental blood flow were not related to anatomic brain lesions. However, an abnormal UA/MCA pulsatility index ratio was associated with reduced total brain volume (mean, 360 mL; SD, 32.5 mL) and reduced cerebral volume (344 mL; SD, 28.4 mL) compared with infants with normal UA/MCA pulsatility index ratio (mean, 405 mL; SD, 51.3 mL, P = .01, and mean, 368 mL; SD, 52.3 mL, P = .012), respectively. CONCLUSIONS: Redistribution of fetal blood flow in VLBW infants is associated with reduced brain volume at term age. Neurodevelopmental follow-up of this cohort will clarify the significance of these blood flow changes on development.

Pharmacokinetics of fluoxetine and norfluoxetine in pregnancy and lactation.

BACKGROUND: The aim of this prospective clinical trial was to investigate the pharmacokinetics of fluoxetine and its active metabolite, norfluoxetine, during pregnancy, delivery, and lactation in mothers and their infants. METHODS: Eleven mothers taking fluoxetine and their infants were enrolled in the study. A control group of 10 women who were not taking psychotropic medication were prospectively matched for confounding obstetric characteristics at the time of delivery. Trough plasma samples and breast milk samples were collected from mother-infant pairs during pregnancy, at delivery, and up to 2 months after delivery in the fluoxetine group. The pregnancy outcome was recorded, and the growth and neurologic development of the children were followed up to the age of 1 year in both study groups. RESULTS: The fluoxetine dose from 20 mg to 40 mg once daily resulted in relatively low trough fluoxetine-norfluoxetine concentrations during pregnancy (range, 317-850 nmol/L). The mean norfluoxetine/fluoxetine metabolic ratio was 2.4-fold higher during late pregnancy than at 2 months after delivery (P = .0072). At delivery, the infant plasma fluoxetine and norfluoxetine concentrations were 65% and 72%, respectively, of those found in mothers. The mean estimated infant exposures from breast milk to fluoxetine-norfluoxetine were 2.4% and 3.8% of the maternal weight-adjusted daily dose at age 2 weeks and age 2 months, respectively. The pregnancy outcome, as well as the growth and neurologic development of all infants up to 1 year of age, was normal. CONCLUSION: Common clinical doses of fluoxetine resulted in relatively low concentrations of fluoxetine during pregnancy, which can be explained at least partly by increased demethylation of fluoxetine by cytochrome P450 (CYP) 2D6. This might indicate that these low blood levels could lead to therapeutic failure, and clinicians should be alert to this possibility so that depression in pregnancy is not undertreated.