Serum bile acid profile in women during pregnancy and childbed.

Oestrogens produce cholestasis by inhibition of bile acid (BA) transport as well as by inhibition of BA synthesis in the liver. The present work was done to clarify the relevance of altered serum BA profile in 28 healthy pregnant women from the 15th to the 40th weeks of pregnancy with increasing oestrogen serum concentrations in comparison to 6 to 8 weeks after delivery with normalized oestrogen status. For the first time 6 free and 10 taurine- and glycine-conjugated BAs were analysed during the normal pregnancy by HPLC with postcolumn derivatisation and fluorescence detection. The primary BAs cholic (CA) and chenodeoxycholic acid (CDCA) as well as their glycine (G-) and taurine (T-) conjugates amount to nearly 70 % of total BAs in serum and were not changed from the 15th to the 40th weeks of pregnancy, but free and G-CDCA increased significantly after delivery. Among the secondary BAs, which were produced in the intestine by bacteria due to dehydroxylation of the primary bile acids CA and CDCA, only taurine-conjugated deoxycholic acid (T-DCA) decreased significantly after delivery. The free BAs, produced by bacteria in the intestine due to deconjugation, were not changed during pregnancy but had doubled in childbed. Some BAs occurred seldom and in small amounts in the serum, but during pregnancy not more frequent than after delivery. Contrary to expectation the increasing oestrogen concentrations did neither enhance total serum bile acids nor change bile acid profile during pregnancy.

Perinatal morbidity in women with undiagnosed gestational diabetes in northern thuringia in Germany.

INTRODUCTION: Undiagnosed gestational diabetes mellitus (GDM) is associated with severe perinatal complications. PATIENTS AND METHODS: Out of 970 women, infant and maternal morbidity was assessed in 114 mother-children-pairs with an infant birth weight over the 90th percentile (Voigt et al., 1996). It was the aim of this retrospective study to assess the number of mothers with undiagnosed GDM, who have born a macrosomic child. RESULTS: The macrosomia rate in newborns was 12 % in this study excluding macrosomic infants of mothers with preexisting diabetes mellitus. Maternal data: Age 28.3 +/- 5.3 years, adipositas (body-mass-index > 30 kg/m) in 42.1 % vs. 30.4 % in the peer group (p < 0.02), increase in weight > 15 kg during pregnancy in 57.9 % of the mothers who have given birth to a macrosomic child vs. 30.9 % in the peer group (p < 0.0001), family history of diabetes mellitus (28.0 % vs. 11.3 % in the peer group, p = 0.006), preeclampsia in 8.8 % vs. 2.7 % in the peer group (p = 0.002), cervical insufficiency in 2.6 % vs. 0.4 % in the peer group (p = 0.02). After delivery HbA1c was elevated in 38.6 % of the women having born macrosomic infant (mean HbA1c: 5.0 % +/- 0.5). Infant data: neonatal jaundice 16.7 % vs. 4.5 % in the peer group, p < 0.0001. There were no statistically significant differences concerning perinatal condition and malformations. Neonatal hypoglycaemia occurred in 9.6 % of the macrosomic infants. Cord blood insulin levels were significantly elevated in comparison to the peer group of mothers without metabolic disorders and having born eutroph infants (8.4 mU/l [3.0 - 100.0] vs. 5.3 mU/l [3.0 - 30.7], p = 0.01). 11.4 % of all macrosomic infants had cord blood insulin levels above the normal range. CONCLUSION: More than one third of the mothers having born one or more macrosomic infants had an impairment of glucose metabolism immediately after birth. The elevated prevalence of preeclampsia in this group confirms the relationship of hypertension and impaired glucose metabolism during pregnancy. The detection of hyperinsulinaemia, postnatal hypoglycaemia, elevated prevalence of neonatal jaundice with need of further therapy and diabetic fetopathy in macrosomic infants of mothers, whose metabolism was not monitored during pregnancy, pinpoint the need for a diagnostic screening for GDM.

Case report: successful pregnancy and delivery after myocardial infarction and essential thrombocythemia treated with clopidrogel.

We describe a case of a woman with essential thrombocythemia (ET) who had a subsequent successful pregnancy after a myocardial infarction and aortocoronary bypass grafting. We report the therapeutic management with clopidogrel and low molecular weight heparin. A healthy child was born spontaneously after 41 weeks of pregnancy. The placenta was morphologically normal. No maternal cardiac problems occurred.

[Concentration of heavy metals (Pb, Cd, Hg) in maternal blood]. / Untersuchungen zu Schwermetallkonzentrationen (Pb, Cd, Hg) im Blut bei Wöchnerinnen.

BACKGROUND: It was the aim of these investigations to find out, whether or not pregnancy risks result from the heavy metal concentrations of the mother's blood (Pb, Cd, Hg). MATERIALS AND METHODS: The control group is composed of 125 women in child bed. Women with hypertonia during the pregnancy (n = 11), women after premature delivery (n = 25) and after a miscarriage (n = 21) are the risk collective. Blood: The investigations were carried out in EDTA-blood. Questionnaire: Place of residence, profession, nourishment and tooth amalgam surface. From this we received information about risk factors for a heavy metal burden. METHODS: The Cd- and Pb-concentrations were measured by "Graphitrohr-AAS with Zeemancorrection" and the Hg-concentration by "Cold-Vapour-AAS". RESULTS: 1. Women in child bed in the Jena area have a heavy metal concentration of Pb, Cd and Hg in the lower reference range. 2. At the risk pregnancies (hypertonia during the pregnancy, premature delivery and miscarriage) no increased heavy metal burden was found. 3. There was a significant correlation between the blood mercury level of women in child bed and the number of tooth amalgam fillings. DISCUSSION: In the Jena area women in child bed have a heavy metal concentration in the lower reference range. Environmental heavy metal burden producing frequent miscarriage, premature delivery and hypertonias in the pregnancy could not be shown. The tooth amalgam filling significantly increased the Hg-burden. Environmental stress and eating habits may also play a role. CONCLUSION: At the risk pregnancies (hypertonia during the pregnancy, premature delivery and miscarriage) no increased heavy metal burden was found.

[Specific immunotherapy (hyposensitization) with insect venom in pregnancy]. / Spezifische Immuntherapie (Hyposensibilisierung) mit Insektengift in der Schwangerschaft.

BACKGROUND: Pregnancy typically prohibits the specific immunotherapy (SIT) of various allergic conditions, with the exception of pre-existing Hymenoptera venom allergies. International consensus currently recommends the continuation of a well-tolerated SIT with insect venom during pregnancy, since there is a significant risk of anaphylaxis after insect stings with potentially dismal outcomes for mother and fetus. CASE REPORT: We report on a 28-year old woman, becoming pregnant during specific immunotherapy with Hymenoptera venom. SIT was continued during pregnancy and a premature birth occurred at the 24th week. DISCUSSION AND CONCLUSION: Unfortunately, there are still conflicting opinions in Germany regarding SIT during pregnancy, and the decision to perform such therapy is entirely based on knowledge and/or level of comfort of the primary physician. Thus, obstetricians should closely work together with an allergologist in cases of pregnant women with insect sting allergies.

[Procalcitonin as monocytic marker for early diagnosis in septic abortion]. / Procalcitonin als monozytärer Marker für die Frühdiagnostik bei septischem Abort.

BACKGROUND: In search of sensitive and specific markers of systemic infection procalcitonin (PCT) recently was promoted to the focus of clinical research. Little is known about the biology of PCT and until now no data have been presented about clinical importance of PCT in obstetric patients. PATIENT AND METHODS: Daily PCT values in a 17 year old patient with septic abortion were compared with established markers of systemic inflammation. Cultivated monocytes were analyzed by the means of indirect immunofluorescence for intracellular distribution of PCT. Additionally, PCT release into culture medium was examined. RESULTS: PCT values in comparison with established inflammation markers was demonstrated in the patient with septic abortion. Indirect immunofluorescence studies revealed the presence of PCT within monocytes. In the supernatants of monocyte cultures PCT was detectable under control conditions. Stimulation with lipopolysaccharide resulted in the increased PCT concentrations both in the supernatants of healthy and patient monocyte cultures. CONCLUSIONS: In the given patient PCT was superior to other inflammation markers with regard to early and progression diagnosis. Peripheral blood monocytes appear to be a potential site of inflammation-induced PCT production. For the first time intracellular distribution pattern and release of PCT from human monocytes was described. DISCUSSION: Based on the presented data broad clinical studies devoted to PCT evaluation in obstetric patients seem to be promising. As till now the interpretation of increased PCT values depended on empirical knowledge, extensive studies of the potential production site as well as its biological significance should be performed, too.

Nocturnal urinary 6-sulphatoxymelatonin excretion is decreased in primary breast cancer patients compared to age-matched controls and shows negative correlation with tumor-size.

In previous studies a tumor-size dependent decline of the circadian amplitude of serum melatonin was found in primary unoperated breast cancer patients, which was not due to changes of the hepatic metabolism of melatonin since its main peripheral metabolite, 6-sulphatoxymelatonin (aMT6s), showed similar serum levels. The aim of the current study was to verify these previous results by measurements of the nocturnal excretion of aMT6s in urine. The determination of aMT6s was carried out by radioimmunoassay. 17 primary unoperated breast cancer (BC) patients and 34 age-matched control patients with different types of benign gynecological diseases awaiting operation (breast diseases, n=13; ovarian diseases, n=12; and uterine diseases, n=9) were analysed. The median nocturnal urinary aMT6s excretion (22:00-6:00 hr) was significantly lower (-48%, P = 0.033) in BC patients than in controls. Controls showed a significant negative linear regression with age (r = -0.419, P = 0.014). According to multivariate linear regression analysis, BC revealed no age-dependency but a significant negative effect of increasing tumor-size on aMT6s-excretion (P = 0.036) was detected. These results confirm previous findings of a decreased pineal melatonin secretion in BC patients as well as an inverse relationship with tumor-size excluding a possible distortion due to age. The mechanisms involved are unknown but indicate that BC may lead to an impaired production of pineal melatonin. The clinical relevance of these findings from therapeutic and diagnostic point of view is discussed.

Serum concentrations of iodine, thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH) and insulin-like growth factor 1 (IGF-1) during the last trimester of pregnancy, during labour, and in early puerperium of women with normal pregnancy or with intrauterine growth retardation (IUGR).

In women with intrauterine growth retardation (IUGR), insulin-like growth factor 1 (IGF-1) concentrations tended to reduce during the last trimester of pregnancy. Parameters of thyroid function in maternal serum were not distinctly influenced by IUGR, except for high concentrations of iodine. Triiodothyronine (T3) concentrations in cord blood of normal pregnancies was significantly lower than maternal concentrations, but was relatively high when the fetus was growth retarded. The results are discussed in connection with changes of thyroid function and changes of IGF-1 during pregnancy.

[Vitamin B1, B2, A and E and beta-carotene content in transitional breast milk and comparative studies in maternal and umbilical cord blood]. / Gehalte der Vitamine B1, B2, A und E sowie beta-Carotin in transitorischer Frauenmilch und Vergleichsuntersuchungen im Blut der Mütter und im Nabelschnurblut.

The contents of the vitamins B1 (27 ng/ml), B2 (57 ng/ml), A (1.3 micrograms/ml), and E (9.7 micrograms/ml) as well as beta-carotene (0.2 microgram/ml) in transitional human milk were determined for up to 35 women aged between 19 and 31 years. Additionally, the vitamin content in maternal and cord plasma as well as the erythrocytic transketolase- and glutathione-reductase activities of the water soluble vitamins were measured. Dietary recalls were evaluated for the nutritional intake of vitamins. Concerning the fat soluble vitamins, the breast fed newborns received the recommended amounts of the German Society of Nutrition (DGE) for this group. In contrast to this, the supply of the water soluble vitamins (B1: 13.5 micrograms/500 ml; B2: 28.5 micrograms/500 ml) attained only 5 to 10% of the recommendations for newborns during the first two weeks after parturition with breast feeding. Vitamin content of maternal plasma (B1: 6.1 +/- 2.8 ng/ml) and erythrocytic enzyme activities (alpha ETK: 0.86-1.62; alpha EGR: 1.08-1.75) indicated a low or sufficient intake, while the values in cord blood (B1: 19.8 +/- 6.5 ng/ml; alpha ETK: 0.62-1.62; alpha EGR: 1.01-1.47) were in accordance with a satisfactory supply.

[Levels of antioxidants after cesarean section and administration of Multibionta N, Inzolen and selenase]. / Das Verhalten von Antioxidanzien nach Schnittentbindung und Substitution von Multibionta N, Inzolen und selenase.

PATIENTS AND METHOD: In 29 women with the necessity to terminate pregnancy via Cesarean section, lipid peroxidation and antioxidative state were investigated before and 24 hours after the surgical intervention as well as after substitution of antioxidants and trace elements. RESULTS: The results indicate that administration of antioxidants protects at least partially from consequences of surgically induced oxidative burden.

[Behavior of thiobarbituric acid reactive substances, alpha-tocopherol, glutathione and selenium during hypertension in pregnancy]. / Verhalten von thiobarbitursäurereaktiven Substanzen (TBARS), alpha-Tocopherol, Glutathion und Selen während der hypertensiven Erkrankung in der Schwangerschaft.

PATIENTS AND METHOD: In a longitudinal study the changes of serum or plasma levels of TBARS, alpha-tocopherol, glutathione and selenium were investigated comparing 46 pregnant women with hypertensive syndrome and 18 women with normal pregnancies. RESULTS AND CONCLUSIONS: A significant increase in TBARS serum level was found in women suffering from hypertension. There was no correlation between the severity of hypertension and the extent of the TBARS rise. An absolute deficiency of the antioxidants alpha-tocopherol, glutathione and the elements selenium, calcium, magnesium, iron and zinc as a cause or a consequence of hypertension in pregnancy could be excluded. Low serum levels of copper and selenium could decrease the activity of glutathione peroxidase (Gpx) resulting in higher levels of TBARS and glutathione during the last trimester of pregnancy and delivery. Increased concentrations of iron in women with hypertensive syndrome may affect the formation of lipid peroxides. The outcome of children was unaffected by increased lipid peroxide levels when an antihypertensive therapy was consequently performed.

Peroxidative and glutathione status in uterus and placenta after normal and pathological pregnancy.

In 10 women with disturbed pregnancies without hypertension, reduced (GSH) and oxidized glutathione (GSSG) as well as lipid peroxides as thiobarbituric acid reactive substances (TBARS) were determined in the placenta and in the uterine tissue after unexpected stress-induced Caesarian section (group II). Production of TBARS was also measured in vitro in the 9000 x g supernatant of both tissues. The results were compared with those from women after normal pregnancy and expected Caesarian section (group I). After normal pregnancy higher TBARS and lower GSH with higher GSSG/GSH ratio were found in the placenta in comparison to the uterine tissue, indicating an oxidant/antioxidant imbalance in the placenta. No statistically significant differences were shown between the parameters of groups I and II. The possible oxidant stress associated with disturbed pregnancy and subsequent unexpected Caesarian section in this study was insufficient to alter tissue levels of glutathione nor the peroxidative status of placenta and uterus.

Drug use in pregnancy: east German data of an international collaborative study.

In an epidemiological collaborative international study under the auspices of WHO-Euro the drug use in pregnancy was investigated in 22 countries in 14,778 women and in hospitals of three different levels. The East German state Thuringia took part according to the annual birth rate with 300 women in 3 hospitals (Jena, Gera, Greiz). In the international average, 14% of the enrolled women took no drugs during pregnancy before admission to hospital for delivery. In East Germany 44% of the women taking part in the study had no drug administration during pregnancy. The critical use of iron preparations and vitamins there has to be mentioned. Under delivery, 99% of the Thuringian women received drugs. In the puerperium the administration of ergot derivatives and of laxatives exceeds the international average and has to be critically revised, but the administration of antiinfectives in only 1/5 and of analgetics 1/3 of the international average.

[Serum and erythrocyte zinc, copper, magnesium and iron in women with normal pregnancies and pregnancy-at-risk (pregnancy-induced hypertension, fetal growth retardation and hepatosis)]. / Das Verhalten von Zink, Kupfer, Magnesium und Eisen in Serum und Erythrozyten bei Frauen mit normaler und Risikoschwangerschaft (schwangerschaftsinduzierte Hypertonie, fetale Retardierung und Hepatose).

In women with normal pregnancy and with pathological pregnancy (pregnancy-induced hypertension, fetal growth retardation, hepatosis) trace elements concentrations (Fe++, Cu++, Zn++, Mg++) were determined in serum and erythrocytes. The concentrations were partly decreased or increased in both serum and erythrocytes, but these changes were not significant. Thus, the analyses of trace element concentrations can not be used as a marker of the investigated pathological events of pregnancy.

[Plasma level and metabolism of vitamin A (Vitadral) in women of reproductive age]. / Untersuchungen über Plasmaspiegel und Metabolismus von Vitamin A (Vitadral) bei Frauen im fertilen Alter.

Using a sensitive HPLC method, plasma concentrations of vitamin A and metabolites were measured from 6 female volunteers who had taken once daily 0.46 mg/kg BW retinol palmitate (Vitadral) for 10 days. The metabolites all-trans- and 13-cis-retinoic acid were increased significantly (2- and 5-fold, resp.) 6 h after the ist intake. 13-cis-4-oxo retinoic acid the 10th intake in the morning of the 10th day (9.22 +/- 2.77 ng/ml, 4-fold increase). The results show continuous increase of retinoic acids, which have to be considered as potential teratogens, after administration of vitamin A. The plasma concentration of retinol itself did not change, whereas only short-term increases were observed for retinol esters.

[Behavior of selenium in serum and erythrocytes in females with normal and risk pregnancy (pregnancy-induced hypertension, fetal retardation and hepatosis)]. / Das Verhalten von Selen im Serum und Erythrozyten bei Frauen mit normaler und Risikoschwangerschaft (schwangerschaftsinduzierte Hypertonie, fetale Retardierung und Hepatose).

In the course of normal pregnancy the selenium concentration in serum decreases significantly. The selenium concentration is enhanced in pregnant women with intrauterine growth retardation or hepatosis and unchanged in those with pregnancy-induced hypertension in comparison with healthy pregnant women. In our investigations no changes of the intracellular selenium concentrations in erythrocytes were measured in normal as well as in pathological pregnancy.

[Lipid peroxidation in pathologic pregnancy: pregnancy-induced hypertension. I]. / Lipidperoxidation in der pathologischen Schwangerschaft: Schwangerschaftsinduzierte Hypertonie. I. Mitteilung.

Serum concentrations of thiobarbituric acid reagible substance (TBARS) as indicator of lipid peroxidation, alpha-tocopherol and selen have been investigated in women with normal pregnancy and patients suffered from pregnancy-induced hypertension. In the group of patients with pregnancy-induced hypertension we observed an increase in serum concentration of TBARS, where as the serum concentrations of alpha-tocopherol and selen were unchanged. There was no correlation between increase in TBARS concentration and the severity of hypertension.

[The effect of propranolol (Obsidan) as well as propranolol and fenoterol (Partusisten) on the motility of the smooth uterus musculature in vitro]. / Die Wirkung von Propranolol (Obsidan) sowie von Propranolol und Fenoterol (Partusisten) auf die Motalität der glatten Uterusmuskulatur in vitro.

Propranolol (1; Obsidan) relaxes in vitro stripes of smooth muscles of non-pregnant rat's uterus in a concentration dependent manner. In contrast, on uterine muscle stripes of pregnant rats 1 causes small contractions. In an combination of 1 and fenoterol (2; Partusisten) (20:1) 1 prevents the relaxing effect of 2, reported to be an inhibitor of uterine muscle activity. This antagonism is most distinct on stripes of pregnant rat's uterus.

[Resorption of iron in steady-state conditions following administration of Vitaferro to females with anemia in pregnancy and evaluation of hematologic and biochemical iron parameters]. / Untersuchungen zur Resorption von Eisen unter steady-state Bedingungen nach Gabe von Vitaferro an Frauen mit einer Schwangerschaftsanämie und die Wertung hämatologischer und biochemischer Eisenparameter.

Determination of ferritin is suitable for estimation of iron stores as well as for diagnosis of iron deficiency during pregnancy. It shall be used preventively in the 20th gestational week and to control treatment. Determinations of serum iron concentration, iron binding capacity and partial transferrin saturation are less suitable. Substitution of iron should start when a sufficient compensation of the iron deficiency is still possible. For this purpose Vitaferro is a suitable drug.

[The effect of partusisten, dilatol, papaverine and magnesium sulfate on uterine smooth muscle in vitro]. / Die Wirkungen von Partusisten, Dilatol, Papaverin und Magnesiumsulfat auf die glatte Uterusmuskulatur in vitro.

Inhibitory effects of Partusisten, Dilatol, Papaverin and Magnesium-sulfat on the activity of smooth muscle were tested in vitro on 18 isolated stripes of rats uteri, exhibiting both a high sensitivity against oxytocin and a distinct spontaneous activity. Minimal inhibitory concentrations of all drugs tested were determined, and their influence on the frequency and amplitude of contraction as well as on lag phase between inhibition and onset of spontaneous activity were registered. Basing on these experimental data conclusions were drawn concerning their clinical relevance.