Benefit of antenatal corticosteroids by year of birth among preterm infants in Canada during 2003-2017: a population-based cohort study.

OBJECTIVE: To evaluate the changes in the associations of antenatal corticosteroids (ACS) with neonatal mortality and severe neurological injury over time (2003-17). DESIGN: National, population-representative, retrospective cohort study. SETTING: Level III neonatal intensive care units participating in the Canadian Neonatal Network. POPULATION: All infants born at 230/7 -336/7 weeks of gestation (n = 43 456). METHODS: We estimated the associations between exposure to ACS and neonatal outcomes by year of birth. Year of birth was considered both continuously and categorically as three consecutive epochs. MAIN OUTCOME MEASURE: Neonatal mortality and severe neurological injury. RESULTS: The absolute rates of neonatal mortality and severe neurological injury decreased during the study period in both the ACS and No ACS groups. For infants born at 230/7 -306/7 weeks of gestation, ACS was associated with similar reductions in neonatal mortality across the three epochs (9.0% versus 18.1%, adjusted relative risk [aRR] 0.54, 95% CI 0.47-0.61 in 2003-09; 7.6% versus 19.6%, aRR 0.51, 95% CI 0.44-0.59 in 2010-13; and 7.3% versus 14.5%, aRR 0.56, 95% CI 0.46-0.68 in 2014-17) and in severe neurological injury (13.2% versus 25.8%, aRR 0.57, 95% CI 0.50-0.64 in 2003-09; 7.4% versus 17.4%, aRR 0.53, 95% CI 0.43-0.66 in 2010-14; and 7.2% versus 14.8%, aRR 0.59, 95% CI 0.48-0.74 in 2014-17). CONCLUSION: Despite the ongoing improvements in neonatal care of preterm infants, as reflected by the gradual decrease in the absolute rates of neonatal mortality and severe neurological injury, the association of ACS treatment with neonatal mortality and severe neurological injury among extremely preterm infants born at 23-30 weeks of gestation has remained stable throughout the study period of 15 years. TWEETABLE ABSTRACT: Despite the gradual decrease in the rates of neonatal mortality and severe neurological injury, antenatal corticosteroids remain an important intervention in the current era of neonatal care.

Effects of quercetin on Aroclor 1254-induced expression of CYP450 and cytokines in pregnant rats.

The present study aimed to investigate the protective effect of quercetin on polychlorinated biphenyls (PCB)-induced liver and embryo damage in pregnant Sprague-Dawley rats. Pregnant rats were divided into five groups, and then were orally gavaged daily with peanut oil (vehicle) or a commercial PCB mixture (Aroclor 1254) - with or without co-treatment with 75, 150, or 300 mg/kg quercetin - on gestation days (GD) 4-7. At GD 9, all rats were euthanized, and their blood, liver, and uterus were collected. Expressions of CYP450 mRNA and protein in liver, cytokines (IFNγ, IL-2, IL-4, and IL-6) and IFNγ/IL-4 ratios in liver and sera, liver morphology, and the status of implanted embryos were analyzed. The results showed Aroclor 1254 treatment alone caused hepatic cord damage (i.e. cell disorganization, swelling, decreased cytoplasm, vacuolization), and that quercetin co-treatment appeared to mitigate this damage. Similarly, levels of CYP1A1 and CYP2B1 mRNA in livers of Aroclor 1254-only-treated rats were significantly higher than those in rats co-treated with quercetin. Hepatic and sera levels of IFNγ, IL-2, IL-6, and IFNγ/IL-4 ratios, and the ratio of delayed-development embryos, all increased in Aroclor 1254-treated rats, but were relatively decreased as a result of quercetin co-treatments. IL-4 levels were decreased by Aroclor 1254 and tended to increase back to normal when quercetin was used. The results indicated that quercetin imparted a protective effect against Aroclor 1254-induced toxicity in pregnant rats, in part, by modulating levels of important pro-inflammatory cytokines and reducing induced CYP1A1 and CYP2B1 expression.

Prenatal influences on bone health in children.

INTRODUCTION: Optimising bone health might reduce the burden of both fractures in childhood and fragility fractures in later life. A number of maternal dietary and non-dietary factors have been identified that might influence offspring bone health and represent targets for intervention. AREAS COVERED: This article will outline the accrual of bone mineral throughout the life course and how observational and intervention studies have shown that maternal diet, in particular maternal calcium and 25-hydroxyvitamin D [25(OH)D] status, and lifestyle are associated with offspring bone mineralization. Studies examining the effects of maternal micronutrient supplementation on offspring bone mineral density (BMD) will also be discussed. EXPERT COMMENTARY: There is a wealth of observational evidence relating maternal diet to offspring BMD. However, high quality randomized controlled trials, such as the ongoing MAVIDOS study, are needed before these findings can be definitively translated into public health advice.

Análisis del maltrato prenatal en Cataluña entre los años 2011 y 2014 / Analysis of prenatal abuse in catalonia between the years 2011 and 2014

Introducción: El maltrato prenatal es aquel acto intencionado o negligente que causa un efecto nocivo al feto. Es un tipo de maltrato difícil de diagnosticar y manejar. Algunos indicadores de sospecha son la ausencia de control gestacional, el consumo materno de tóxicos o la problemática social del entorno materno. Objetivo: Analizar los casos de maltrato prenatal registrados en Cataluña entre 2011 y 2014 para identificar el perfil de riesgo. Métodos: Estudio descriptivo de corte transversal de una muestra de 222 casos de maltrato prenatal registrados en Cataluña entre 2011 y 2014. Resultados: La edad media materna fue de 28,11 años. El 63% de los casos eran de nacionalidad española, un 76% estaba sin trabajo, el 60% no había seguido un correcto control gestacional, un 76% tenía interrupciones de embarazo previas, un 20% manifestaba haber sido maltratada por la pareja. Fueron frecuente los antecedentes de problemática social (76% intervención social; 30,5% retenciones de hijos previos; 13% tutela de la madre por la administración; 7% privación de libertad), con tasas elevadas de infección por enfermedades de transmisión vertical (VIH 4,95%, VHC 9%, coinfección VIH + VHC 1,8%), el 73% manifestó consumo de tóxicos (por orden de frecuencia cannabis, cocaína y heroína). En los neonatos, destacó el alto índice de prematuridad (26,3%) y el diagnóstico de síndrome de abstinencia en 34 casos. En el 51,6% el hijo está en la actualidad con su madre. Conclusiones: En nuestra población de referencia con diagnóstico de maltrato prenatal destacan unos índices elevados de consumo materno de tóxicos, infección por VIH-VHC, desempleo, antecedentes de intervención social previa y mal control gestacional (AU)

Introduction: Foetal abuse is that intentional or negligent act that causes a harmful effect to the foetus. It is a type of abuse difficult to diagnose and handle. Some indicators of suspicion are the absence of gestational control, the maternal consumption of toxic substances, or the problematic maternal social environment. Objective: To analyse the cases of foetal abuse registered in Catalonia between 2011 and 2014 to identify the risk profile. Methods: A cross-sectional descriptive study was conducted on a sample of 222 cases of prenatal abuse registered in Catalonia between 2011 and 2014. Results: The mean maternal age was 28.11 years, with 63% of Spanish nationality, 76% were unemployed, 60% had not followed correct gestational control, 76% had previous pregnancy interruptions, 20% reported to have been mistreated by the partner, had history of social problems (76% social intervention, 30.5% previous child retention, 13% custody of the mother by the administration, 7% deprivation of liberty), with high rates of mother-to-child transmission of infection (HIV 4.95%, HCV 9%, HIV + HCV co-infection 1.8%), and 73% reported toxic use (in order of frequency, cannabis, cocaine and heroin). In newborns, the rate of prematurity (26.3%) is highlighted, as well as the diagnosis of withdrawal syndrome in 34 cases. Just over half (51.6%) of the infants are currently with their mother. Conclusions: In our reference population with a diagnosis of prenatal abuse, there are high rates of maternal toxic consumption, HIV-HCV infection, unemployment, history of previous social intervention, and poor gestational control (AU)

Fetal liver injury ameliorated by migration inhibitory factor inhibition in a rat model of acute pancreatitis in pregnancy.

AIM: This study was designed to investigate and assess fetal liver injury in a rat model of acute pancreatitis in pregnancy (APIP) as well as its possible mechanisms and potential therapeutic targets. METHODS: The APIP model was induced by sodium taurocholate in Sprague-Dawley rats during the third trimester. ISO-1, a macrophage migration inhibitory factor (MIF) antagonist, was given before the induction of APIP. In addition, sham-operated rats at later gestation were set as controls. Histological changes in the fetal liver and maternal pancreas were assessed. Amylase and lipase activity as well as the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-1ß were examined. The expression of MIF in fetal liver was determined by immunochemistry and the expression of NF-κB, IκBα, high mobility group box-1 protein (HMGB1), TNF-α, and IL-1ß in fetal liver was determined by Western blot analysis. Ultrastructures of hepatic cells in fetal rats were observed under transmission electron microscopy. RESULTS: ISO-1 ameliorated the following: (i) pathological injuries in maternal pancreas and fetal liver; (ii) levels of TNF-α and IL-1ß in maternal serum; and (iii) levels of MIF, myeloperoxidase, NF-κB, HMGB1, TNF-α, and IL-1ß in fetal liver. CONCLUSION: Pathological damage and an inflammatory response in fetal liver were induced by APIP, and MIF inhibition ameliorated fetal liver injury by inhibiting the inflammatory cascade.

Prophylactic Interleukin-2 Treatment Prevents Fetal Gut Inflammation and Injury in an Ovine Model of Chorioamnionitis.

BACKGROUND: Chorioamnionitis results from an infection of the fetal membranes and is associated with fetal adverse outcomes notably in the intestine. Using a translational ovine model, we showed that intra-amniotic exposure to inflammatory stimuli decreased the regulatory/effector T (Treg/Teff) cell balance in the gut, which was accompanied by intestinal inflammation and mucosal injury. We thus aimed to augment the Treg/Teff cell ratio in the fetal gut by prophylactic IL-2 treatment and evaluate whether it is sufficient to prevent chorioamnionitis-induced intestinal inflammation and mucosal injury. METHODS: Fetal sheep (122 d of gestation) were intra-amniotically exposed to lipopolysaccharide for 2 or 7 days with or without prophylactic IL-2 treatment (4 d). We evaluated the infiltration of inflammatory cells in the ileum and mesenteric lymph nodes. Cytokine gene expression was analyzed in fetal ileum and the inflammatory changes were correlated with gut wall integrity. RESULTS: IL-2 administration preferentially increased intestinal Treg cells and thus the Treg/Teff cell ratio. Prophylactic IL-2 treatment reduced the lipopolysaccharide-induced influx of neutrophils and CD3(+) T cells and decreased the messenger RNA levels of proinflammatory cytokines including IL-6 and IL-17 in the fetal ileum. Importantly, prophylactic IL-2 treatment prevented mucosal damage without inducing fetal adverse treatment outcomes. CONCLUSIONS: Our data show that prophylactic IL-2 treatment prevents fetal intestinal inflammation and mucosal injury in the context of experimental chorioamnionitis. Modulation of the Treg/Teff cell balance may contribute to the protective effects of IL-2.

Committee opinion no. 633: Alcohol abuse and other substance use disorders: ethical issues in obstetric and gynecologic practice.

Alcohol abuse and other substance use disorders are major, often underdiagnosed health problems for women, regardless of age, race, ethnicity, and socioeconomic status, and have resulting high costs for individuals and society. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines substance use disorder as a pathologic pattern of behaviors related to the use of any of 10 separate classes of substances, including alcohol and licit and illicit substances. In order to optimize care of patients with substance use disorder, obstetrician-gynecologists are encouraged to learn and appropriately use routine screening techniques, clinical laboratory tests, brief interventions, and treatment referrals. The purpose of this Committee Opinion is to propose an ethical framework for incorporating such care into obstetric and gynecologic practice and for resolving common ethical dilemmas related to substance use disorder.

Role of oxidative injury in affecting the foetal & placental weights on exposure to tobacco smoke.

OBJECTIVE: To investigate the role of oxidative injury in affecting foetal and placental weights in mice by exposing them to tobacco smoke with or without supplementation with antioxidants. METHODS: The randomized control trial of pregnant mice at day one of gestation was conducted at Anatomy Department CPSP Regional Center Islamabad, from March 2005 to October 2005. The mice were divided into three groups: Group C had controls, while the two other groups, groups S and SV were exposed to secondary tobacco smoke in a whole body exposure chamber with and without supplementation with vitamins respectively. At term, the animals were sacrificed and the placentae and foetuses were weighed. The average values were calculated. The means for each group were analysed and the foetal placental ratio was calculated. SPSS 17 was used for statistical analysis. RESULTS: There were 44 mice; 15(34%) each in S and SV groups, while Group C had 14(32%) mice who acted as the controls. The mean foetal weight in Group S was 0.65±0.52g which was significantly less (p<0.0001) than1.48±0.19g in Group C. The mean foetal weight in Group SV was 0.97±0.65g which was not significantly different from S (p=0.124). The mean placental weight in Group S was 0.16±0.02g which was significantly less than 0.21±0.05gin Group C (p=0.014). In Group SV it was significantly more than Group S (p<0.0001). The ratio of mean foetal and mean placental weights in the groups C, S and SV were 7.05, 3.92 and4.41 respectively. CONCLUSIONS: Prenatal exposure to tobacco smoke decreased the mean foetal and placental weights and the foetal-placental ratio. This may partly be attributed to oxidative injury induced by free radicals in the tobacco smoke as it is prevented to some extent by simultaneous administration of antioxidants.

Fall prevention in our healthiest patients: assessing risk and preventing injury for moms and babies.

Attention is needed in preventing patient falls in newborns and in obstetric units of hospitals. The majority of prenatal, postpartum, and newborn falls are preventable. Little effort has been made to address fall risk during the prenatal period, during labor, and after delivery in the postpartum period for moms and babies. Risk factors for falls in these populations have been identified, and targeted risk assessments and fall prevention interventions have been developed to eliminate these falls. Evidence demonstrates success in reducing falls with a variety of low-cost but high-return initiatives, comprising prenatal education, patient and family engagement, implementation of unique fall risk assessment tools, postpartum mobility assessments, and changes in patient rounding frequency.

[Cell phones: health risks and prevention]. / Telefoni cellulari: rischi per la salute e strategie di prevenzione.

The paper describes first of all the electromagnetic radiation of cellular phones and presents the physical parameters used to measure and evaluate the absorption of emissions of radio stations and cellular phones. It then presents selected research results of the experimental studies in vivo and in vitro which examine the biological effects of the emissions of cellular phones. The review of the epidemiologic evidence focuses in particular the epidemiologic studies on the use of cell phones and brain tumours, identifying some of the reasons of the conflicting results obtained. Studies dealing with the health risks involved in the increasing use of cellular phones by adolescents and children, more sensitive to this exposure, are also presented showing the need for special caution. The problem of hypersensitivity observed in some individuals is also briefly discussed. Finally the paper presents a summary of the main prevention measures necessary in order to reduce the risks in the framework of the "precautionary principle" including prevention policies and exposure limits in various countries.

Fear of the unknown: ionizing radiation exposure during pregnancy.

Ionizing radiation during pregnancy can negatively impact a fetus. In light of the Fukushima nuclear plant disaster in Japan, we discuss existing knowledge on the health effects of radiation and preventive measures for pregnant women. Overall, the risk of exposure to radiation is limited but severe defects can result from fetal radiation exposure >100 mGy equivalent to 10 rad (>1000 chest x-rays). While such high-level exposure rarely occurs during single medical diagnostic procedures, caution should be exercised for pregnant women. As a protective public health measure in light of a disaster, evacuation, shielding, and elimination of ingested radioactive isotopes should all be considered. Detailed radiation reports with health effects and precautionary measures should be available for a population exposed to more than background radiation.

Escolha da melhor via de parto para o feto prematuro em apresentação cefálica / Choice of the best mode of delivery for the preterm fetus in cephalic presentation

A prematuridade é um dos maiores problemas da obstetrícia contemporânea. Possui etiologia multifatorial e sua incidência se mantém elevada em todo o mundo apesar das propostas terapêuticas e assistenciais. A escolha da melhor via de parto para o nascituro pré-termo é um dos aspectos fundamentais para a obtenção de melhores resultados neonatais. O objetivo desta revisão foi avaliar a escolha da melhor via de parto para o feto prematuro em apresentação cefálica. Artigos observacionais e de revisão sistemática mostraram-se polêmicos, suferindo a necessidade de novos estudos com metodologia prospectiva. Concluímos que a cesariana não deve ser recomendada como estratégia benéfica rotineira para esses fetos com vistas a diminuir morbidade e mortalidade neonatais na ausência de outras indicações obstétricas para a realização do parto por via alta.

Prematuriry is one of the biggest problems of the contemporary obstetrics. It has multifactor etiology and its incidence remains high incidence all over the world despite proposals of assistance and therapeutics. Choosing the best mode of delivery for the premature infant is a fundamental aspect to reach the best neonatal results. The objective of this review was to evaluate the choice of the best mode of delivery for the preterm vertex fetuses. Observational articles and systematic reviews proved to be con troversial, suggesting the need for further studies using prospective methodology. We have come to the conclusion that cesarean section should not be recommended as routine beneficial strategy for these fetuses, aiming at reducing neonatal morbidity and mortality, in the absence of other obstetric indications for this mode of delivery.

Qual é a melhor via de parto para o feto prematuro?: [revisão] / What is the best delivery mode for the premature fetus?: [review]

A cesárea do prematuro extrema em apresentação cefálica tem sido proposta como estratégia obstétrica para melhorar os resultados neonatais em situações em que o nascimento é necessário ou inevitável. Os benefícios propostos para esse grupo de recém-nascidos incluem o menor risco de estresse causado pelas contrações uterinas do trabalho de parto e dos possíveis traumas decorrentes da passagem pelo canal vaginal. Sobre o tema, alguns estudos retrospectivos e observacionais foram publicados com resultados conflitantes. As evidências não são consistentes e conclusivas o suficiente para recomendar a cesárea, e há necessidade de estudos prospectivos para verificar os benefícios da via abdominal para essa população. Estudos retrospectivos sugerem fortemente que a cesárea é a melhor via de parto para os prematuros em apresentação pélvica, embora não tenham sido realizados estudos prospectivos para confirmar esses achados.

Cesarean delivery of the very preterm cephalic fetuses has been proposed as an obstetric strategy to improve neonatal outcome in situations in which preterm delivery is necessary or inevitable. The purported benefits of cesarean section to this group of infants include avoiding the stress of labor contractions and the potential trauma of passage through the birth canal. A number of retrospective and observational studies have also shown conflicting results. The evidence is not strong and conclusive enough to recommend routine cesarean delivery so further prospective studies are warranted to assess the potential benefit of cesarean delivery in this population. Retrospective studies strongly support cesarean delivery as the method of choice for a preterm breech presentation even though prospective randomized trials have not been conducted to confirm this concept.

Pesticides and health risks.

Pesticides are a category of chemicals formulated to kill or repel a pest or halt its reproduction. In this article we review the toxicological and epidemiological literature; describe common potential pesticide exposures; and focus on the associated health risks to fetal development. Clinical implications are reviewed, and recommendations are made regarding the integration of this environmental health concern into nursing education, practice, research, and policy/advocacy work. Recommendations for pesticide elimination and reduction in health care settings are included.

Peptidergic agonists of activity-dependent neurotrophic factor protect against prenatal alcohol-induced neural tube defects and serotonin neuron loss.

INTRODUCTION: Prenatal alcohol exposure via maternal liquid diet consumption by C57BL/6 (B6) mice causes conspicuous midline neural tube deficit (dysraphia) and disruption of genesis and development of serotonin (5-HT) neurons in the raphe nuclei, together with brain growth retardation. The current study tested the hypothesis that concurrent treatment with either an activity-dependent neurotrophic factor (ADNF) agonist peptide [SALLRSIPA, (SAL)] or an activity-dependent neurotrophic protein (ADNP) agonist peptide [NAPVSIPQ, (NAP)] would protect against these alcohol-induced deficits in brain development. METHODS: Timed-pregnant B6 dams consumed alcohol from embryonic day 7 (E7, before the onset of neurulation) until E15. Fetuses were obtained on E15 and brain sections processed for 5-HT immunocytochemistry, for evaluation of morphologic development of the brainstem raphe and its 5-HT neurons. Additional groups were treated either with SAL or NAP daily from E7 to E15 to assess the potential protective effects of these peptides. Measures of incomplete occlusion of the ventral canal and the frequency and extent of the openings in the rhombencephalon were obtained to assess fetal dysraphia. Counts of 5-HT-immunostained neurons were also obtained in the rostral and caudal raphe. RESULTS: Prenatal alcohol exposure resulted in abnormal openings along the midline and delayed closure of ventral canal in the brainstem. This dysraphia was associated with reductions in the number of 5-HT neurons both in the rostral raphe nuclei (that gives rise to ascending 5-HT projections) and in the caudal raphe (that gives rise to the descending 5-HT projections). Concurrent treatment of the alcohol-consuming dams with SAL prevented dysraphia and protected against the alcohol-induced reductions in 5-HT neurons in both the rostral and caudal raphe. NAP was less effective in protecting against dysraphia and did not protect against 5-HT loss in the rostral raphe, but did protect against loss in the caudal raphe. CONCLUSIONS: These findings further support the potential usefulness of these peptides for therapeutic interventions in pregnancies at risk for alcohol-induced developmental deficits. Notably, the ascending 5-HT projections of the rostral raphe have profound effects in regulating forebrain development and function, and the descending 5-HT projections of the caudal raphe are critical for regulating respiration. Protection of the rostral 5-HT-system may help prevent structural and functional deficits linked to abnormal forebrain development, and protection of the caudal systems may also reduce the increased risk for sudden infant death syndrome associated with prenatal alcohol exposure.

Tecnología doppler y movimientos respiratorios fetales / Doppler technology and fetal respiratory movements

La tecnología ultrasónica Doppler ha resultado ser una herramienta fundamental para la evaluación de la fisiología fetal, dando información importante sobre el estado hemodinámico fetal. Teniendo en cuenta que no sólo el desarrollo y crecimiento normal del feto y su bienestar intraúterino depende de una adecuada función de la circulación útero placentaria y feto placentaria, sino de otras estructuras orgánicas, es por lo que este método abre una línea de investigación dentro del campo de la fisiología fetal. El propósito de esta revisión es exponer de forma clara los conceptos relacionados con el desarrollo y fisiología de la respiración fetal abordando técnicas no invasivas de evaluación del bienestar fetal como la tecnología Doppler color y con la cual es posible estudiar el movimiento del líquido amniotico a través del flujo trasnasal. Es pues factible analizar, cualitativa y cuantitativamente, las ondas de velocidad de dicho flujo a través del análisis espectral de los movimientos respiratorios fetales, relacionados intimamente con la máxima producción de esteroides fetales responsables de la madurez pulmonar fetal. Se presentan las diferentes metodologías y recursos diagnósticos aplicados en los últimos años en la evaluación de los movimientos respiratorios en el bienestar fetal y su importancia. Se realiza una breve descripción de la fisiología y desarrollo del sistema respiratorio fetal

Doppler ultrasound technology has been the main tool for monitoring fetal physiology, giving important information about fetal haemodinamic status. We are aware that normal fetal growing and development and its intra womb wellbeing depends on an accurate uterus-placental blood circulation as fetal-placental, but with other organic structures, and this is the reason why this method opens a wide investigation line in the field of fetal physiology. Our purpose is to expose clearly the concepts involved in fetal breath development and physiology with non invasive techniques of fetal wellbeing such as color Doppler technology, by witch is possible to study the movement of amniotic flux through transnasal flux, as we can evaluate quantitatively by the velo-city waves of such flux through the spectral analysis of fetal breath movement, closely related to the higher production of fetal steroids responsible of fetal lung maturation. Different methodologies are presented and diagnostic resources applied in this last years over the bresth movements and its relation to fetal wellbeing and its importance. We also do a description of fetal breath system development and physiology