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PubMed2001

Occupational fatigue and preterm premature rupture of membranes. National Institute of Child Health and Human Development Maternal-Fetal Medicine, Units Network.

OBJECTIVE: The aim of this study was to prospectively determine the relationship between occupational fatigue and spontaneous preterm delivery segregated into the etiologically distinct categories of spontaneous preterm labor, preterm premature rupture of membranes, and indicated preterm delivery. STUDY DESIGN: A total of 2929 women with singleton pregnancies at 22 to 24 weeks' gestation were enrolled in a multicenter (10 sites) Preterm Prediction Study. Patients reported the number of hours worked per week and answered specific questions designed to determine the following 5 sources of occupational fatigue described by Mamelle et al: posture, work with industrial machines, physical exertion, mental stress, and environmental stress. Fatigue was quantified (0-5 index) according to the number of these sources positively reported. Simple and Mantel-Haenszel chi2 tests were used to test the univariate association and hypothesis of a linear trend between sources of occupational fatigue and spontaneous preterm delivery. Covariables were considered by multivariate logistic regression analysis. Women who did not work outside the home were considered separately from those who worked but did not report any sources of occupational fatigue. RESULTS: Each source of occupational fatigue was independently associated with a significantly increased risk of preterm premature rupture of membranes among nulliparous women but not among multiparous women. The risk of preterm premature rupture of membranes increased (P = .002) with an increasing number of sources of occupational fatigue-not working outside the home, 2.1%; working but not reporting fatigue, 3.7%; working with 1 source of fatigue, 3.2%; working with 2 sources of fatigue, 5.2%; working with 3 sources of fatigue, 5.1%; and working with 4 or 5 sources of fatigue, 7.4%. There was also a significant relationship (P = .01) between preterm premature rupture of membranes and an increasing number of hours worked per week among nulliparous women. Neither spontaneous preterm labor nor indicated preterm delivery was significantly associated with occupational fatigue among either nulliparous or multiparous women. CONCLUSION: The occupational fatigue index of Mamelle et al discriminated a group of nulliparous women at increased risk for preterm premature rupture of membranes. The relationship between preterm premature rupture of membranes and occupational fatigue or hours worked may provide guidelines according to which nulliparous women and their employers can be advised.

Adolescent↗
PubMed2001

The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes.

OBJECTIVE: To determine the risk of neonatal and maternal disease associated with the sequential use of vacuum and forceps compared with spontaneous vaginal delivery. STUDY DESIGN: Using Washington state birth certificate data linked to hospital discharge records, we compared 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, and 3741 forceps deliveries to 11,223 spontaneous vaginal deliveries. RESULTS: Compared with spontaneous vaginal deliveries, deliveries by sequential use of vacuum and forceps had significantly higher rates of intracranial hemorrhage (relative risk [RR], 3.9; 95% confidence interval [CI], 1.5 to 10.1), brachial plexus (RR, 3.2; 95% CI, 1.6 to 6.4), facial nerve injury (RR, 13.3; 95% CI, 4.7 to 37.7), seizure (RR, 13.7; 95% CI, 2.1 to 88.0), depressed 5-minute Apgar score (RR, 3.0; 95% CI, 2.2 to 4.0), assisted ventilation (RR, 4.8; 95% CI, 2.1 to 11.0), fourth-degree (RR, 11.4; 95% CI, 6.4 to 20.1 among multiparous women) and other lacerations, hematoma (RR, 6.2; 95% CI, 2.1 to 18.1 among multiparous women), and postpartum hemorrhage (RR, 1.6; 95% CI, 1.3 to 2.0). The relative risk of sequential vacuum and forceps use was greater than the sum of the individual relative risks of each instrument for intracranial hemorrhage, facial nerve injury, seizure, hematoma, and perineal and vaginal lacerations. CONCLUSION: Sequential use of vacuum and forceps is associated with increased risk of both neonatal and maternal injury.

Adult↗
PubMed2001

Relationship of twin zygosity and risk of preeclampsia.

OBJECTIVE: Twin gestations are known to be at higher risk for preeclampsia. One theory suggests that maternal recognition of fetal and trophoblastic tissues as foreign may be a factor. If that hypothesis is true, mothers carrying monozygous (MZ) gestations (ie a single fetal graft) might be predicted to have a lower rate of preeclampsia than those carrying dizygous (DZ) gestations. To evaluate this hypothesis, we compared the rate of preeclampsia in mothers with MZ and DZ twin gestations. STUDY DESIGN: Seven hundred sixty-eight twin deliveries from 1994 to 1999 were reviewed. Placental pathology reports were reviewed to determine the chorionic state of each placenta. Monochorionic placentas were assumed to be MZ. Dichorionic placentas were categorized as DZ if the neonates were of different sexes or different blood types. Maternal and fetal data were abstracted from the medical records. Preeclampsia was defined by standard criteria of the National Institutes of Health Working Group on High Blood Pressure. Our analysis was limited to women with pregnancies reaching at least 30 weeks of gestation where zygosity could be determined. RESULTS: Our analysis included 464 twin pregnancies, 154 MZ and 310 DZ. Among nulliparous women, the rate of preeclampsia was 15% (25/170) for DZ twins versus 20% (15/75) for MZ twins (P =.3). Among multiparous women, the rate was 8% (11/140) for DZ twins and 5% (4/79) for MZ twins (P =.4). In a logistic regression performed to control for confounding by maternal age, gestational age at delivery, assisted reproduction, and male sex, dizygotic state was associated with an odds ratio of 1.4 (95% CI = 0.5-3.9) for developing preeclampsia in nulliparous women and 1.2 in multiparous women (95% CI = 0.3-5.0). CONCLUSIONS: : These results do not support the hypothesis that zygosity affects the rate of preeclampsia in twin gestations, though the number of subjects in our study was too small to allow definitive conclusions. Larger studies are needed to evaluate this finding.

Adult↗
PubMed2002

Total and individual triplet birth weights as a function of gestational age.

OBJECTIVE: Our purpose was to determine the relationship between gestational age and both the total and individual triplet birth weights. STUDY DESIGN: A 1988-2000 prospective cohort of 3238 live-born triplets in the United States was evaluated. The mean individual (heaviest, middle, and lightest) and total triplet birth weights were correlated with gestational age in nulliparous and multiparous patients. RESULTS: The mean total triplet birth weights significantly correlated with gestational age for both nulliparous women and multiparous women, but the respective regression lines were significantly different (P =.0018). The respective regression lines for individual triplets showed a significant linear correlation (R(2) = 0.996-0.998). Interparity and intraparity differences of the individual triplets' regression lines were also significantly different. CONCLUSIONS: The relationships support a model of two distinct growth periods for triplets: an age- and growth-promoting period until 33 weeks and an age-promoting growth-restricting period thereafter.

Adult↗
PubMed2004

Timing of nutrient restriction and programming of fetal adipose tissue development.

It is apparent from epidemiological studies that the timing of maternal nutrient restriction has a major influence on outcome in terms of predisposing the resulting offspring to adult obesity. The present review will consider the extent to which maternal age, parity and nutritional restriction at defined stages of gestation can have important effects on fat deposition and endocrine sensitivity of adipose tissue in the offspring. For example, in 1-year-old sheep the offspring of juvenile mothers have substantially reduced fat deposition compared with those born to adult mothers. Offspring of primiparous adult mothers, however, show increased adiposity compared with those born to multiparous mothers. These offspring of multiparous ewes show retained abundance of the brown adipose tissue-specific uncoupling protein 1 at 1 month of age. A stimulated rate of metabolism in brown fat of these offspring may act to reduce adipose tissue deposition in later life. In terms of defined windows of development that can programme adipose tissue growth, maternal nutrient restriction targetted over the period of maximal placental growth results in increased adiposity at term in conjunction with enhanced abundance of mRNA for the insulin-like growth factor-I and -II receptors. In contrast, nutrient restriction in late gestation, coincident with the period of maximal fetal growth, has no major effect on adiposity but results in greater abundance of specific mitochondrial proteins, i.e. voltage-dependent anion channel and/or uncoupling protein 2. These adaptations may increase the predisposal of these offspring to adult obesity. Increasing maternal nutrition in late gestation, however, can result in proportionately less fetal adipose tissue deposition in conjunction with enhanced abundance of uncoupling protein 1.

Adipose Tissue↗
PubMed2001

Mid-trimester termination of pregnancy by dilatation and evacuation.

The object of this study was to evaluate the feasibility and safety of Dilatation and Evacuation (D&E) as a method of termination of pregnancy in the second trimester. We conducted a retrospective analysis of 61 cases. The mean age of women was 25.6 years (range 1545) and the majority of terminations were performed for social reasons. Twelve women (20%) had at least one previous termination of pregnancy. The median gestational age was 16 weeks (range 1322). Except for three multiparous women, they all had Cervagem vaginal pessaries preoperatively and the mean operative time was 26.6 minutes. Most of the operations were performed under ultrasound guidance, but there was no increased risk of complications in the rest of the group. One multiparous woman suffered uterine perforation and severe haemorrhage, for which she underwent hysterectomy. One in four women tested positive for chlamydia infection. Evacuation of retained products of conception (ERPC) was required in four cases. No postoperative analgesia was required in 43% of women and most of the rest required only mild non-opiate analgesia. Except for two women, all were discharged from the hospital either on the same or the day after the operation. This retrospective study shows that surgical evacuation in the second trimester of pregnancy is a quick and well tolerated method of termination, although there is a risk of perforation and hysterectomy.

Journal Article↗
PubMed2002

Ultrasound assessment of the effect of parity on postpartum uterine involution.

A longitudinal study of 300 women in the puerperium was undertaken in an African population. The aim was to determine the influence of parity on postpartum uterine diameters during involution. The patients were divided into two groups, nulliparous and multiparous based on parity. The uterine diameters were larger in the multiparous group when compared with the nulliparous group. Further analysis revealed positive (Pearson's) correlation between parity and uterine diameters and uterine volume. There was no significant correlation between parity and uterine volume on the 42nd puerperal day. In conclusion, Negroid patients have large uteri, which correlate in size positively with parity.

Adult↗
PubMed2005

Trends in uterine rupture in Enugu, Nigeria.

Our objective was to determine the trend of rupture of the gravid uterus at Enugu, Nigeria and to determine any change in pattern of presentation, management and outcome of such patients. The birth register of 4,333 deliveries at the University of Nigeria Teaching Hospital Enugu from January 1997 and December 2000 were reviewed. Forty-one cases of ruptured uterus were identified and analysed. The incidence of uterine rupture was 1 in 106 deliveries with a mean maternal age of 31.2 years. The majority (75.6%) of the patients were multiparous and had some form of antenatal care (61%) with 19.5% of the total booked at the Teaching Hospital. Many (78.1%) of the patients were in labour for 24?hours or less and 22.0% had oxytocin to augment or induce labour. The majority (68.3%) had a previously scarred uterus and many (53.6%) had lower segment ruptures. At laparotomy 31.7% had repair alone, 29.2% had repair with tubal ligation, 22.0% subtotal hysterectomy and 17.1% total hysterectomy. Perinatal mortality was high (87.8%) and maternal mortality rate 48.8 per 1,000 deliveries. Labour in a previously scarred uterus was the most common aetiological factor followed by obstructed labour in a multiparous woman. The incidence of ruptured uterus is still rising at Enugu, Nigeria but maternal mortality, due to uterine rupture continues to fall. The most commonly performed surgery is repair with or without sterilisation rather than hysterectomy.

Adult↗
PubMed2005

Eight years' experience of uterine rupture cases.

Ruptured uterus is a serious obstetric emergency with a high maternal and perinatal mortality. It is a preventable and common obstetric problem in developing countries. The objective of this study was to review the incidence, methods of diagnosis and maternal and perinatal morbidity and mortality associated with uterine rupture. Case notes were reviewed for all patients with a ruptured uterus at Yüzüncü Yil University Medical Faculty Department of Obstetrics and Gynaecology from January 1995 to August 2003. Relevant data relating to the clinical characteristics of labour, operative procedures, maternal and perinatal outcome were assessed. There were 20 cases of ruptured uteri. The incidence was 0.40%. When patients referred from other hospitals were excluded, the revised ratio was 0.12%. There were 13 (65%) complete and seven (35%) incomplete ruptures. Nine (45%) cases occurred in patients with scarred uteri. Ten (50%) cases were grand multiparous. Subtotal abdominal hysterectomy was performed in five (25%) cases, total abdominal hysterectomy was performed in two (10%) cases and the remaining 13 (65%) cases had uterine rupture repair. There were two (10%) maternal deaths. Both of them were referred from other hospitals. There were seven (35%) perinatal deaths attributable to uterine rupture. Occurrence of uterine rupture is significantly associated with grand multiparity, scarred uterus, lack of antenatal care, unsupervised labour at home and low socioeconomic status of the patients. These factors are largely preventable.

Adult↗
PubMed2006

Comparison between subjective and objective assessments of the cervix before induction of labour.

The aim of the study was to compare the pre-induction cervical assessment by Bishop's score with the transvaginal ultrasound cervical length as predictors of the induction-delivery interval (IDI) and the success of induction. This prospective study included 104 women with singleton pregnancies who were booked for induction of labour at term over a period of 3 years. Transvaginal ultrasound measurement of the cervical length and Bishop's Score were performed by different operators. Data were collected on parity, gestational age, methods of induction, Bishop's score, ultrasound cervical length measurements, IDI and mode of delivery. A total of 87 women (83.7%) delivered vaginally and 17 (16.3%) delivered by caesarean section. Linear regression models demonstrated that ultrasound cervical length was a better indicator of IDI than Bishop's score. The adjusted R2 for the regression including ultrasound cervical length was 0.87 compared with a value of 0.67 for the model including Bishop's score. Although logistic regression analysis confirmed that cervical effacement was the best component of Bishop's score to predict the mode of delivery, ultrasound cervical length assessment provided better prediction. Receiver operating characteristic curve showed that the optimised cut-off value for prediction of vaginal delivery was < or =3.4 cm for the cervical length and >5 for the Bishop's score. At those optimised cut-off values the cervical length predicted vaginal delivery with sensitivity of 62.1% (95% CI [51%, 72.3%]) and specificity of 100% (95% CI [80.5%, 100%]) while the Bishop's score predicted vaginal delivery with a sensitivity of 23% (95% CI [14.6%, 33.2%]) and specificity of 88.2% (95% CI [63.5%, 98.5%]). Further analysis showed that ultrasound cervical length has a higher sensitivity in prediction of vaginal delivery in multiparous than nulliparous women (85.1% compared with 35%) at a cut-off value of < or =3.4 cm. On the other hand, it has a higher sensitivity in nulliparous comparable with multiparous women (85.3% compared with 30%) in prediction of IDI at a cut-off value of >3.5 cm. In conclusion, transvaginal ultrasound cervical length assessment is better than Bishop's score in predicting the IDI and the success of induction of labour.

Adolescent↗
PubMed2005

Patterns of pregnancy-related hypertension in black and white women.

OBJECTIVE: To determine whether the higher rate of preeclampsia previously reported in Black women is attributable to a higher rate of chronic hypertension in that group. METHODS: Rates and severity of pregnancy-related hypertensive disease in Black and White women with and without chronic hypertension were reviewed from the medical records of our institution. RESULTS: Of 1,355 records reviewed, evidence of hypertensive disease was noted in 101 singleton pregnancies. Hypertension during pregnancy occurred in 7.4% of Black and 7.4% of White women. Among women with hypertension in pregnancy but no chronic hypertension, Blacks were more likely to be diagnosed with preeclampsia (78 vs. 53%, p=0.04) and more likely to have had systolic blood pressures >160 mmHg (43 vs. 17%, p=0.01). However, the rates of severe preeclampsia were similar in Black and White women since Whites were more likely to be diagnosed with severe preeclampsia in the absence of very high systolic blood pressures. Black multiparous patients with hypertension were three times more likely than White multiparous patients to be diagnosed with preeclampsia (80 vs. 27%, p=0.01). Conclusions. In our population, Black women with hypertension in pregnancy in the absence of chronic hypertension were more likely to be diagnosed with preeclampsia than were White women. This finding suggests that the higher rate of preeclampsia among Black women is not completely explained by higher rates of chronic hypertension in that group.

Adult↗
PubMed2000

Primary tuberculosis of the breast in Qatar: ten year experience and review of the literature.

OBJECTIVE: To present our experience of isolated tuberculosis of the breast, 1988-98. DESIGN: Retrospective study of case notes and radiographs. SETTING: Hamad General Hospital, Qatar. SUBJECTS: 13 multiparous women with tuberculosis of the breast. MAIN OUTCOME MEASURES: Objective confirmation of diagnosis and adequacy of treatment. RESULTS: We found an overall incidence of histologically confirmed tuberculosis to be 0.4%/year. All patients presented with a lump, 2 had nipple discharge and one had a palpable axillary node on the same side. 7 were treated by excision biopsy, 3 by incision and drainage, and 3 had fine needle aspiration (FNA) as their only procedure. All diagnoses were confirmed histologically. 2 patients developed recurrences during treatment but these were successfully treated. CONCLUSION: Although the incidence of the disease is low, the diagnosis should be suspected in young multiparous women with a breast lump in whom malignancy has been excluded. The minimum of surgical intervention (incision or excision biopsy) together with antituberculous drugs seems to be the most successful treatment.

Adult↗
PubMed2000

Pregnancy and miscarriage rates in 3978 donor insemination cycles: effect of age, parity and partner's infertility status on pregnancy outcome.

The effects of age, parity and male infertility status on pregnancy outcome were studied in a cohort of 720 women receiving donor insemination (DI) treatment. Twenty-two percent of women failed to complete the treatment, leaving 562 women receiving 3202 cycles of DI for assessment. Of the 321 of pregnancies achieved, 57 (17.8%) ended in a miscarriage. After further DI treatments, 64.7% of mothers who had miscarried succeeded in giving birth. There was some evidence to indicate a trend of decreasing pregnancy rate with increasing maternal age, although this result was not significant (log rank trend statistics = 3.44, P > 0.05). The pregnancy rates of multiparous and primiparous women were significantly different, irrespective of their partner's infertility status (azoospermia: log rank statistics = 3.74, P less-than-or-eq, slant 0.05; oligozoospermia: log rank statistics = 4.71, P < 0.03). Furthermore, multiparous women were more likely to become pregnant than primiparous women (azoospermia: hazard ratio = 1.29; oligozoospermia: hazard ratio = 1.50). There was no significant association between miscarriage rate and maternal age (log rank trend statistics = 0.99, P > 0.05). The small number of older women (> 35 years) may confound this result. The mean (plus minus SD) sperm donor age was 23.6 years (plus minus 3.5 years). The implications of these observations are discussed.

Journal Article↗
PubMed1985

Bioavailability of soil-borne polybrominated biphenyls ingested by farm animals.

Concentrations of polybrominated biphenyl (PBB) were measured in the fat of livestock on several farms on which soil-borne PBB in confinement areas was the only source of residue. Ratios of concentrations in fat to concentrations in soil were 0.37 for dairy heifers, 0.27 for primaparous dairy cows, 0.10 for multiparous dairy cows, 0.27 for beef cows, 0.39 for beef calves, 0.37 for ewes, and 1.86 for swine. Multiparous dairy cows had lower ratios because of the excretion of PBB in milk during long-term lactation, and swine had higher ratios because they ingest greater amounts of soil than other species. Diets containing 5% PBB-contaminated soil, or 5% contaminated soil amended with activated carbon, were fed to lambs for 56 d. Accumulation of soil-borne PBB in fat, when adjusted for intake, did not differ significantly from accumulation of PBB from a diet in which PBB was added to cornmeal. Amending soil with activated carbon had no effect on residue accumulation. About 70% of PBB in a control diet with PBB added to cornmeal was absorbed, as measured by using titanium as an unabsorbed marker. Absorption of soil-borne PBB was 65% from unamended soil, 57% from soil amended with 0.3% activated carbon, and 56% from soil amended with 0.6% activated carbon. The differences were not great enough to be of practical importance. These results with PBB may be useful in assessing and managing risks of other soil-borne contaminants that have chemical characteristics similar to those of PBB.

Adipose Tissue↗
PubMed1993

Cadmium-109 metabolism in mice. IV. Diet versus maternal stores as a source of cadmium transfer to mouse fetuses and pups during gestation and lactation.

The transfer of 109Cd from dam to offspring during gestation and lactation was studied in uniparous mice. From 70 to 210 d of age and during the subsequent reproductive period, young adult female mice received drinking water containing tracer amounts of 109Cd (8 ppb total Cd) and nutrient-sufficient or -deficient solid diet containing stable Cd (5 ppm Cd). The nutrient quality of the deficient diet was patterned after that consumed by Japanese women who contracted itai-itai disease. To evaluate established maternal stores as a potential source of cadmium transfer to pups, some dams were switched to water with no 109Cd and diet with an environmental or control level of cadmium (0.25 ppm Cd) during the reproductive period. The resulting pups were analyzed for 109Cd at birth and at 7-d intervals throughout the lactation period. Pup 109Cd content at birth, representative of the amount transferred via the placenta during gestation, accounted for less than 1% of the total 109Cd transferred during the full reproductive period. During lactation, 109Cd levels in pups from dams with current 109Cd exposure approximately tripled with each 7-d interval; no significant differences occurred due to nutrient quality of the dams' diet. For 21-d-old pups, 98% of the 109Cd burden came from the diet of the dam, while only 2% came from her tissue stores, primarily the hepatic one. Such fractions represented a transfer per pup of about 0.01% of the oral 109Cd dose ingested by the dam during the reproductive period and about 0.05% of the 109Cd in her tissue stores. Overall, transfer per litter amounted to about 7% of the dietary 109Cd dose absorbed and retained by the dam during that interval and about 0.2% of the 109Cd from tissue stores. On lactation d 21, 90% of the total 109Cd in pups was sequestered in the gastrointestinal tract. Cadmium transfer was additionally examined in multiparous mice that began a repetitive breeding program at 70 d of age at the time of introduction to the same diet/water regimens already described. Overall, females consuming nutrient-sufficient diet experienced 5 consecutive 42-d rounds of gestation/lactation, while their deficient diet counterparts experienced 3 nonconsecutive rounds during an equivalent period. Transfer was examined during their last gestation/lactation experience. Throughout the lactation interval, 109Cd transfer to pups was about 30% increased for multiparous versus uniparous females; however, transfer again was not significantly affected by nutrient quality of the dams' diet.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗
PubMed2005

Circadian blood pressure variability in normotensive pregnant women as a function of parity, maternal age, and stage of gestation.

Studies based on conventional office blood pressure (BP) measurements concluded that both maternal age and parity have significant effects on BP during pregnancy. Previous results have also indicated predictable trends of BP variability with gestational age. Accordingly, we have evaluated possible differences in the circadian pattern of ambulatory BP as a function of parity, maternal age, and stage of gestation in normotensive women who were systematically studied by ambulatory BP monitoring during their pregnancies. We analyzed 1408 BP profiles obtained from 126 nulliparous and 109 multiparous pregnant women sampled for 48 consecutive h every 4 weeks from the first obstetric visit (usually within the first trimester of pregnancy) until delivery. Data were divided for comparative analysis according to parity (nulliparous versus multiparous), age (< or = 25, 26-30, 31-35, and > or = 36 yrs), and trimester of gestation. Circadian BP parameters established by population multiple-components analysis were compared between groups using a nonparametric test. A highly statistically significant circadian pattern described by a model that includes components with periods of 24 and 12h is demonstrated for systolic and diastolic BP for all groups of pregnant women in all trimesters (always p < 0.001). There was no significant difference in the 24h mean among groups divided by parity at any age or stage of pregnancy. A trend of increasing BP with age was found for diastolic but not for systolic BP. Although statistically significant, differences in the 24h mean of diastolic BP among groups divided by age were always less than 2 mm Hg. Data obtained from systematic ambulatory monitoring in normotensive pregnant women indicate the lack of differences in BP according to parity. The small, although significant, increase in diastolic BP with age may have scarce influence in the proper identification of women with gestational hypertension. Reference thresholds for BP to be used in the early identification of hypertensive complications in pregnancy could thus be developed as a function of the rest-activity cycle and gestational age only, and independently of parity or maternal age.

Adult↗
PubMed2004

Preeclampsia and Chlamydia pneumoniae: is there a link?

Several parallels exist between preeclampsia and atherosclerosis. Both are multifactorial diseases that share risk factors such as obesity, insulin resistance, lipid abnormalities, and elevated serum homocysteine. There are also similarities in the biochemical changes seen in both diseases, including elevated serum triglycerides, decreased HDL cholesterol and enhanced formation of small, dense LDL particles as well as vascular atherosclerotic lesions. Chronic infection with Chlamydia pneumoniae has been linked to coronary artery disease. This study evaluated a possible link between the incidence of preeclampsia and infection with C. pneumoniae by examining the rate of seropositivity in 81 women with preeclampsia, and 206 women with normal pregnancies. Although our data confirmed well-known risk factors for preeclampsia such as obesity, diabetes, and hypertension, we found no difference in the rate of seropositivity between preeclampsia and normal pregnancy. On the contrary, the presence of chlamydial antibodies was lower in preeclampsia. Multiparous women with preeclampsia showed a significantly lower rate of seropositivity than multiparous normal women and nulliparous preeclamptics. In addition, women with a history of preeclampsia who developed preeclampsia in the current pregnancy also had a significantly lower rate of seropositivity.

Adolescent↗
PubMed2004

Depressed natural killer cell cytotoxicity against Plasmodium falciparum-infected erythrocytes during first pregnancies.

We measured natural killer (NK) cell cytotoxicity and cortisol and prolactin concentrations in peripheral venous blood samples obtained from pregnant Gabonese women at the time of delivery. The NK cell-mediated cytotoxicity against Plasmodium falciparum-infected erythrocytes in vitro was lower in samples obtained from primiparous women than in samples obtained from multiparous women; cortisol concentrations were significantly higher in primiparous women than in multiparous women, and prolactin concentrations were significantly lower. The highest cortisol concentrations were found in the plasma of P. falciparum-infected primiparous women. A positive correlation was found between cortisol concentration and parasite load; an inverse correlation was found between the magnitude of the NK cell cytolytic effect and cortisol production. A positive correlation was found between this effect and prolactin production. Thus, depressed NK cell cytotoxicity against P. falciparum-infected erythrocytes is correlated with high cortisol concentrations and may contribute to increased susceptibility to malaria during pregnancy.

Adult↗