Prevalence of anemia during pregnancy: results of Valencia (Venezuela) anemia during pregnancy study

To determine the prevalence of anemia during pregnancy in Venezuelan pregnant women. By using a cross-sectional study, 630 Venezuelan pregnant women in their third trimester at labor from the Valencia Anemia during Pregnancy Study were studied. Anemia during pregnancy was defined according to WHO guidelines (Hb < 11 g/dl), iron deficiency was considered when serum ferritin level was < 12 ng/ml, and when serum folate level was < 3 ng/ml, it was considered as folate deficiency. 630 pregnant women (mean [+/- SD] age, 24 +/- 6.4 years) having an average of Hb 11.38 +/- 1.47 g/dl [95%CI = 11.27 to 11.50] were studied. No patient had hemolytic anemia nor clinical infections. Almost all patients were from low or very low socioeconomic status. Prevalence of anemia was 34.44% (severe: 1.8%, moderate: 15.2%, and mild: 83%). Iron deficiency anemia (IDA) was present in 39.2% (95%CI = 32.7 to 45.7), prevalence of folate deficiency anemia (FDA) was 11.98% (95%CI = 7.6% to 16.3%). Combined anemia (IDA and FDA) occurred in 11.52% (95%CI = 7.27% to 15.7%). Multivariate analysis showed that multiparous (odds ratio -OR-: 1.95, 95%CI = 1.28 to 2.97, p = .002) and supplement use of iron (OR: .55 (95%CI = .33 to .91, p = .02) are associated with IDA. The factors associated with FDA were: supplement use of folic acid (OR: .37 (95%CI = .19 to .71, p = .003) and appropriate prenatal control (OR: .51 95%CI = .27 to .96, p = .04). Prevalence of anemia during pregnancy was found to be high. Educational efforts should be stressed in order to encourage improvements in the prenatal care visits.     

Serum levels and urinary excretion of magnesium in pregnancy. Effect of milk intake

Magnesium levels in serum, as well as 24-hr urine and 2-hr post-fasting urine levels, were studied in 107 pregnant women, who were later separated into two groups. One group was advised to follow their usual intake, and the other, to supplement the diet with 750 cc of milk. The control group (30 healthy non-pregnant women) underwent the same protocol. Magnesium intake in pregnant women was much lower than that recommended for gestation. In both groups of pregnant women, serum magnesium levels were lower than those of the controls, in the second and third trimester of pregnancy. Urinary magnesium in 24-hr urine was higher in each trimester of pregnancy than the controls. Hypomagnesemia and hypermagnesuria not influenced by milk intake was observed.     

Serum vitamin A during pregnancy and effects on obstetrics and perinatal outcomes in HIV infected pregnant women

To evaluate serum vitamin levels and its association with obstetrics and perinatal results in HIV infected pregnant women. Observational and prospective study carried out at Division of Infectious-Contagious Diseases in Gynecology and Obstetrics of the University Hospital, Medicine School of Ribeir?o Preto, University of S?o Paulo, involving 57 pregnant women divided into 3 groups: Group 1, with 12 normal pregnant women, it was the control group; Group 2, with 20 HIV infected pregnant women, using ZDV; and Group 3, with 25 HIV infected pregnant women, using therapy I contend ZDV, 3TC and nelfinavir. The evaluation of the serum vitamin level was obtained three times during pregnancy at equidistant time intervals and in the immediate period after birth. We also evaluated the levels of this vitamin and the hemoglobin in the blood of the umbilical cord. We obtained maternal and newborn infant anthropometric data, as well as the counting of lymphocyte TCD4 and viral load of the HIV during the pregnancy. Reduced serum vitamin levels were observed in the Group 1(25%), the Group 2(29,4%) and the Group 3(28,6%). Association was not observed between serum levels of maternal retinol and the duration of the gestation in groups 2 and 3. In groups 1 and 3, an association was observed between the maternal concentration of retinol and the newborn hemoglobin (p=0.05). In distinct way to the Control group, association was not observed between the retinol levels of the umbilical cord and the weight of the newborn in gestations of Group 2, while a trend to this association was observed in gestations of Group 3 (p=0.06). We observed high prevalence of hipovitaminosis A in the population of this study, regardless of antiretroviral scheme used.     

The nutritional and health status of the Latin American woman

Latin America is a region where countries have various levels of socioeconomic development. Thus, the living standards and health status of its people differ significantly in the midst of a mosaic of social, ethnic, cultural and economic realities. Social inequalities and extreme poverty determine significant differences, not only in the magnitude of health indicators, but also in the type of pathology prevalent. People in the high socioeconomic levels are affected by nutritional diseases characterized by excessive food intake, while people from the low socioeconomic levels are affected by undernutrition and its associated pathology. Undernutrition occurs fundamentally among the age groups at higher risk in the population segments with low income, low food intake, illiteracy and poor access to the health care and preventive medicine centers. Among families exposed to undernutrition, women are usually in worse condition than men. This is due to the long working hours and the increased nutritional requirements caused by frequent gestations and prolonged lactation. It is estimated that one fourth of newborns in Latin America are affected by low birth weight, which has been associated to adolescent mothers, their excessive physical work, anemia, low maternal pregestational weight, low weight gain during gestation, and frequent maternal infections. Nutritional anemia due to iron deficiency is highly prevalent among pregnant women in Latin America. In some countries, the prevalence of folate deficiency during pregnancy appears to have increased significantly in the past 15 years and is becoming a nutritional problem that needs preferential attention. Diets generally are inadequate and, in the case of pregnant and lactating women, usually deficient in calories, protein, iron and folic acid. It is urgent that the health and nutritional status of Latin American women of low socioeconomic condition be given special attention, particularly mothers during gestation and lactation. Otherwise, women will not be able to altogether fulfill their important role in the home and within the family, nor will they successfully participate in the economic development of their countries.     

Iron deficiency and anemia in pregnant women from Chaco,Argentina

Aiming at their prevention, to determine the prevalence of gestational iron deficiency and anemia, considering access to health care and associations with social and biological variables in the Province of el Chaco, Argentina. Three hundred and sixty four, randomly selected pregnant women from the whole province participated. Mean Hemoglobin (Hb) +/- SD dropped progressively from 118.4 +/- 11.0 to 112.1 +/- 11.5 g/L (p = 0.015) between the 1st and the 3rd gestational trimesters. Anemia prevalence (Hb < 110 g/L) was 17.4, 26.5 and 35.8%. From the 1st to the 3rd trimesters. Second trimester prevalence was 14.1% using Hb < 105 g/L as recently suggested. The ferritin geometric mean during the progressive gestational trimesters were 28.9; 16.0 and 11.1 micrograms/L. 21.7, 40.5 and 60.5% had ferritins < 12 micrograms/L, and 39.1, 58.9 and 83.2% had ferritins < 20 micrograms/L in these respective trimesters (p < 0.004 between trimesters in both cases). Both iron deficiency and anemia were significantly greater in women with unfinished primary education and with interpregnancy interval < 1 year. Seventy five percent of women had adequate number of antenatal visits but only 23% were taking iron supplements and 10% had stopped taking them. The prevention and correction of gestational iron deficiency and anemia must focus on the preconceptional period (inter-pregnancy spacing and increasing iron intake using all available means) as well as during pregnancy improving adherence to iron supplements by means of motivation of health workers and community.     

Requirements of nutrients which participate in erythropoiesis

Proteins, some minerals and vitamins, play important roles in erythropoiesis and the survival of the red blood cell. This article deals specifically with the physiological requirements and recommended intakes of iron, folate and vitamin B12. A comparison of the physiologic iron requirements according to age and sex, and the amount of iron which is actually absorbed from the diets consumed by the lower socioeconomic strata of the Venezuelan population; indicates that these diets do not satisfy the requirements at all ages. Such disparity is most marked in children below three years of age, in adolescents and in women during their reproductive age. Failure to do so leads to varying degrees of iron deficiency. This low bioavailability of the Venezuelan diet is also observed in other Latin American diets consumed by the same low socioeconomic strata, which explains the high prevalence of iron-deficiency anemia in the vulnerable groups. The low intake of fruits and vegetables by the lower socioeconomic strata of the Latin American population prevents these sectors from consuming an adequate intake of folate, failing to fulfill the daily recommended intake (3.3 - 3.6 micrograms/kg body weight). This situation is aggravated in pregnant and lactating women who require an additional intake of 300 micrograms and 100 micrograms, respectively. Prevalence of folate deficiency in the first stage may be in the order of 30% in some regions. In the second stage of deficiency, characterized by megaloblastic changes in the bone marrow and an erythrocyte folate concentration of less than 50 micrograms/lt, it could be as high as 40% in pregnant women. Nutritional vitamin B12 deficiency does not constitute a health problem in Latin America. Various surveys in the lower socioeconomic strata have reported normal or higher than normal serum B12 concentrations, compared to well-nourished populations.     

Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease

Maternal hormones are essential for the normal fetal development during pregnancy. Autoimmune thyroid disease is a frequent pathology in our iodine replete region. The aim of this study is to evaluate the occurrence of subclinical hypothyroidism (SCH) in cases with known autoimmune thyroid disease, which were in a euthyroid state prior to pregnancy, and to assess the association between supplemental treatments administered and the outcome of the pregnancy. The study is a prospective interventional controlled study. The two cohorts comprise the interventional group, consisting of 109 pregnant women with known autoimmune asymptomatic thyroid disease, without any levothyroxine (LT4) treatment and an aged-matched control group, with an unknown thyroid disease. After the pregnancy, a monthly evaluation of TSH, FT3, and FT4 was performed. Offspring evaluation was made at birth time. 88.8% of the women developed SCH in the first four weeks of pregnancy. Average LT4 doses increased as the pregnancy progressed. The monthly adjustment was 12.5 or 25 μg. All SCH cases developed in the first trimester of pregnancy. There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy. Premature birth was described in one case in the interventional group.     

Total Long-Chain n-3 Fatty Acid Intake and Food Sources in the United States Compared to Recommended Intakes: NHANES 2003–2008

The American Heart Association recommends consuming fish (particularly oily fish) at least two times per week, which would provide ≈ 0.5 g/day of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) for cardiovascular disease risk reduction. Previous analyses indicate that this recommendation is not being met; however, few studies have assessed different ethnicities, subpopulations requiring additional n-3 fatty acid intake (i.e., children and pregnant and/or lactating women), or deciles of intake. Data from the National Health and Nutrition Examination Survey 2003–2008 was used to assess n-3 fatty acid intake from foods and supplements in the US population, according to age, sex, and ethnicity. A unique “EPA equivalents” factor, which accounts for potential conversion of shorter-chain n-3 fatty acids, was used to calculate total long-chain n-3 fatty acid intake. Data are reported for 24,621 individuals. More than 90% consumed less than the recommended 0.5 g/day from food sources (median = 0.11 g/day; mean = 0.17 g/day). Among the top 15% of n-3 fatty acid consumers, fish was the largest dietary contributor (71.2%). Intake was highest in men aged 20 years or more, and lowest in children and women who are or may become pregnant and/or are lactating. Among ethnicities, intake was lowest in Mexican-Americans. Only 6.2% of the total population reported n-3 fatty acid supplement use, and this did not alter median daily intake. Additional strategies are needed to increase awareness of health benefits (particularly among Mexican-Americans and women of childbearing age) and promote consumption of oily fish or alternative dietary sources to meet current recommendations.     

Plasma Ceramides and Triglycerides Are Elevated during Pregnancy in Association with Markers of Insulin Resistance in Hutterite Women

Changes in maternal insulin sensitivity and circulating lipids typically occur during the metabolic transitions of pregnancy and lactation. Although ceramides can cause insulin resistance in mammals, their potential roles during pregnancy and lactation are unknown. We hypothesized that changes in lipids like ceramide and triglycerides could occur across different reproductive states and relate to insulin resistance. Our objectives were to comprehensively characterize lipids in the plasma of pregnant, lactating, and nonpregnant and nonlactating (NPNL) women, and to evaluate the relationship between ceramides and the triglyceride index, a proxy of insulin resistance. Middle-aged Hutterite women from the South Dakota Rural Bone Health Study were classified by reproductive status as nonpregnant and nonlactating (NPNL; 19 observations), pregnant (14 observations), or lactating (31 observations). Several plasma lipids were elevated in pregnancy such as ceramides, triglycerides, and total- and high-density lipoprotein cholesterol. The triglyceride index was highest during pregnancy and was positively associated with long- and very long-chain ceramides. Lipidomics revealed lipid signatures specific to reproductive state, including triglycerides, phosphatidylcholines, sphingomyelins, and cholesteryl esters, which were also related to the triglyceride index. Our data support the possibility that ceramides contribute to the development of insulin resistance during pregnancy, and reveal distinct lipid signatures associated with pregnancy and lactation.     

Differences and Commonalities in Physical,Chemical and Mineralogical Properties of Zanzibari Geophagic Soils

The function of human geophagy has long been questioned. We sought to test hypotheses concerning its potential physiological effects through analysis of soils and patterns in geophagy behavior. Eleven samples of geophagic soils consumed by pregnant women on Pemba Island, Zanzibar, Tanzania, were characterized according to their color, texture, major element chemistry, trace element chemistry, bulk mineralogy, and clay mineralogy. An epidemiological study (N = 2367) and ethnographic interviews (N = 57) on Pemba yielded information about geophagic behaviors and socio-demographic and biological characteristics of those who consumed earth. The soils varied widely in color, ranging from light red to white through various shades of brown and yellow, and texture ranged from clay to sand. Major element chemistry of the soils also varied greatly; most were low in Fe and Ca. Trace elements, whether of biological or non-biological significance, were uniformly low when compared with normal ranges of mineral soils. The sole commonality among the samples is that all clay fractions were dominated by a kaolin mineral: kaolinite, halloysite, or a mixture of both. Geophagy behavior also varied greatly, with one major exception: a greater proportion of pregnant women (7.1%) and young children (4.5%) consumed earth than non-pregnant women (0.2%) or men (0%). The presence of kaolin mineral in all samples, its palliative and detoxifying properties, and the highest prevalence of geophagy among those most biologically vulnerable suggest that geophagy may be a protective behavior.     

Docosahexaenoic Acid Supplementation during Pregnancy: A Potential Tool to Prevent Membrane Rupture and Preterm Labor

Polyunsaturated fatty acids (PUFAs) are required to maintain the fluidity, permeability and integrity of cell membranes. Maternal dietary supplementation with ω-3 PUFAs during pregnancy has beneficial effects, including increased gestational length and reduced risk of pregnancy complications. Significant amounts of ω-3 docosahexaenoic acid (DHA) are transferred from maternal to fetal blood, hence ensuring high levels of DHA in the placenta and fetal bloodstream and tissues. Fetal DHA demand increases exponentially with gestational age, especially in the third trimester, due to fetal development. According to the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), a daily intake of DHA is recommended during pregnancy. Omega-3 PUFAs are involved in several anti-inflammatory, pro-resolving and anti-oxidative pathways. Several placental disorders, such as intrauterine growth restriction, premature rupture of membranes (PROM) and preterm-PROM (pPROM), are associated with placental inflammation and oxidative stress. This pilot study reports on a preliminary evaluation of the significance of the daily DHA administration on PROM and pPROM events in healthy pregnant women. Further extensive clinical trials will be necessary to fully elucidate the correlation between DHA administration during pregnancy and PROM/pPROM occurrence, which is related in turn to gestational duration and overall fetal health.     

Alcohol Consumption during Pregnancy: Analysis of Two Direct Metabolites of Ethanol in Meconium

Alcohol consumption in young women is a widespread habit that may continue during pregnancy and induce alterations in the fetus. We aimed to characterize prevalence of alcohol consumption in parturient women and to assess fetal ethanol exposure in their newborns by analyzing two direct metabolites of ethanol in meconium. This is a cross-sectional study performed in September 2011 and March 2012 in a series of women admitted to an obstetric unit following childbirth. During admission, socio-demographic and substance use (alcohol, tobacco, cannabis, cocaine, and opiates) during pregnancy were assessed using a structured questionnaire and clinical charts. We also recorded the characteristics of pregnancy, childbirth, and neonates. The meconium analysis was performed by liquid chromatography—tandem mass spectrometry (LC-MS/MS) to detect the presence of ethyl glucuronide (EtG) and ethyl sulfate (EtS). Fifty-one parturient and 52 neonates were included and 48 meconium samples were suitable for EtG and EtS detection. The median age of women was 30 years (interquartile range (IQR): 26–34 years); EtG was present in all meconium samples and median concentration of EtG was 67.9 ng/g (IQR: 36.0–110.6 ng/g). With respect to EtS, it was undetectable (<0.01 ng/g) in the majority of samples (79.1%). Only three (6%) women reported alcohol consumption during pregnancy in face-to-face interviews. However, prevalence of fetal exposure to alcohol through the detection of EtG and EtS was 4.2% and 16.7%, respectively. Prevention of alcohol consumption during pregnancy and the detection of substance use with markers of fetal exposure are essential components of maternal and child health.     

Maternal anemia in Concepción province, Chile: association with maternal nutritional status and fetal growth

Previous studies in Santiago, Chile have established that anemia in the earliest stages of pregnancy is a public health issue. The situation in other parts of the country is unknown. The purpose of this study is to establish the prevalence of anemia in pregnant women in the province of Concepcion and evaluate its association with maternal nutricional status and fetal growth. The study included 1782 women with singleton pregnancies who began prenatal check-ups in 2004 at the public primary health care centers. Anemia was established using the following criteria: from WHO (Hb < 11 g / dl) and from the USA Center for Disease Control (CDC) (Hb < percentile 5 for each gestational week). Anemia prevalence was compared in relation to independent study variables: maternal age, parity, morbidity and smoking habit, and mother and child anthropometry. A multivariable logistic regression model studied the possible effect of anemia on fetal growth. The prevalence of anemia was 10.9% and 14.5% using the WHO and CDC criteria, respectively. The mother's nutritional status was significantly associated with anemia. However, anemia according to WHO and CDC criteria at the beginning of pregnancy was not significantly associated to fetal growth in the univariate and multivariate analyses. The prevalence of anemia in the province of Concepcion constitutes a public health problem that needs to be addressed and it is slightly higher to that recently observed in the county of Puente Alto, Santiago.     

The Associations of SCFA with Anthropometric Parameters and Carbohydrate Metabolism in Pregnant Women

Short-chain fatty acids (SCFAs) mediate the transmission of signals between the microbiome and the immune system and are responsible for maintaining balance in the anti-inflammatory reaction. Pregnancy stages alter the gut microbiota community structure, which also synthesizes SCFAs. The study involved 90 pregnant women, divided into two groups: 48 overweight/obese pregnant women (OW) and 42 pregnant women with normal BMI (CG). The blood samples for glucose, insulin, and HBA1c were analyzed as well as stool samples for SCFA isolation (C2:0; C3:0; C4:0i; C4:0n; C5:0i; C5:0n; C6:0i; C6:0n) using gas chromatography. The SCFA profile in the analyzed groups differed significantly. A significant positive correlation between C2:0, C3:0, C4:0n and anthropometric measurements, and between C2:0, C3:0, C4:0n, and C5:0n and parameters of carbohydrate metabolism was found. SCFA levels fluctuate during pregnancy and the course of pregnancy and participate in the change in carbohydrate metabolism as well. The influence of C2:0 during pregnancy on anthropometric parameters was visible in both groups (normal weight and obese). Butyrate and propionate regulate glucose metabolism by stimulating the process of intestinal gluconeogenesis. The level of propionic acid decreases with the course of pregnancy, while its increase is characteristic of obese women, which is associated with many metabolic adaptations. Propionic and linear caproic acid levels can be an important critical point in maintaining lower anthropometric parameters during pregnancy.     

Dietary protein level during pregnancy. Its influence on maternal-fetal exchange of substrates

It is well known that the dietary protein level influences both the pregnancy process and development of the offspring. Therefore, a study was carried out to determine the effect that different protein percentages: 10%, 4% and 20% in diets administered to rats during pregnancy, had on food efficiency and on the substrates partition between rat dams and their neonates. Experimentation was thus carried out over a period of 21 days (pregnancy) and comparisons were made with well-nourished rats receiving 10% protein (controls) and between one and other group. Moreover, the effect on pregnancy was observed by comparing pregnant rats with non pregnant rats within each dietary situation. Food intake, weight parameters and food efficiency ratio were recorded in adult rats. Weight parameters were also evaluated in newborns. As results revealed, the highest the protein level in the diet, the highest the food efficiency ratio, both in the pregnant group and in the non pregnant group. Weight changes were determined in rat dams and their neonates, as a consequence of the different protein intakes. These also involved alterations in the substrates partition between the mothers and their offspring. Such findings might lead to the retention of substrates by the maternal tissues and, hence, to impairment of neonatal development.     

Development and validation of a quantitative choline food frequency questionnaire for use with drinking and non-drinking pregnant women in Cape Town,South Africa

Background

Although animal and human studies have demonstrated interactions between dietary choline and fetal alcohol spectrum disorders, dietary choline deficiency in pregnancy is common in the US and worldwide. We sought to develop and validate a quantitative food frequency questionnaire (QFFQ) to estimate usual daily choline intake in pregnant mothers.

Methods

A panel of nutrition experts developed a Choline-QFFQ food item list, including sources with high choline content and the most commonly consumed choline-containing foods in the target population. A data base for choline content of each item was compiled. For reliability and validity testing in a prospective longitudinal cohort, 123 heavy drinking Cape Coloured pregnant women and 83 abstaining/light-drinking controls were recruited at their first antenatal clinic visit. At 3 prenatal study visits, each gravida was interviewed about alcohol, smoking, and drug use, and administered a 24-hour recall interview and the Choline-QFFQ.

Results

Across all visits and assessments, > 78% of heavy drinkers and controls reported choline intake below the Dietary Reference Intakes adequate intake level (450 mg/day). Women reported a decrease in choline intake over time on the QFFQ. Reliability of the QFFQ across visits was good-to-acceptable for 2 of 4 group-level tests and 4 of 5 individual-level tests for both drinkers and controls. When compared with 24-hr recall data, validity of the QFFQ was good-to-acceptable for 3 of 4 individual-level tests and 3 of 5 group-level tests. For controls, validity was good-to-acceptable for all 4 individual-level tests and all 5 group-level tests.

Conclusions

To our knowledge, this is the first quantitative choline food frequency screening questionnaire to be developed and validated for use with both heavy and non-drinking pregnant women and the first to be used in the Cape Coloured community in South Africa. Given the high prevalence of inadequate choline intake and the growing evidence that maternal choline supplementation can mitigate some of the adverse effects of prenatal alcohol exposure, this tool may be useful for both research and future clinical outreach programs.

     

A Docosahexaenoic Acid-Functional Food During Pregnancy Benefits Infant Visual Acuity at Four but not Six Months of Age

Within the visual system, docosahexaenoic acid (DHA, 22:6n−3) is an important structural component for retinal photoreceptors and cortical gray matter. There is a marked decrease in neural DHA accumulation in the face of DHA deficiency. DHA is accumulated at an accelerated rate during pregnancy, especially in the third trimester. However, pregnant women in the US and Canada have dietary DHA intakes that are significantly below the optimal level. The main objective of this study was to determine whether a DHA-functional food during pregnancy would benefit infant visual acuity at four and six months of age measured behaviorally using the acuity card procedure (ACP). In a randomized, longitudinal, double-blinded, and placebo-controlled trial, 30 pregnant women received either the DHA-functional food (n = 16) or the placebo (n = 14). There were significant main effects for visual acuity at four months of age (P = 0.018). The mean acuity scores were 3.8 ± 1.1 cycles/degree in the DHA group versus 3.2 ± 0.7 cycles/degree in the placebo group. At six months there were no group differences. Based on our results, we conclude that DHA supplemented during pregnancy plays a role in the maturation of the visual system.     

The Risk of Congenital Heart Anomalies Following Prenatal Exposure to Serotonin Reuptake Inhibitors—Is Pharmacogenetics the Key?

Serotonin reuptake inhibitors (SRIs) are often prescribed during pregnancy. Previous studies that found an increased risk of congenital anomalies, particularly congenital heart anomalies (CHA), with SRI use during pregnancy have created concern among pregnant women and healthcare professionals about the safety of these drugs. However, subsequent studies have reported conflicting results on the association between CHA and SRI use during pregnancy. These discrepancies in the risk estimates can potentially be explained by genetic differences among exposed individuals. In this review, we explore the potential pharmacogenetic predictors involved in the pharmacokinetics and mechanism of action of SRIs, and their relation to the risk of CHA. In general, the risk is dependent on the maternal concentration of SRIs and the foetal serotonin level/effect, which can be modulated by the alteration in the expression and/or function of the metabolic enzymes, transporter proteins and serotonin receptors involved in the serotonin signalling of the foetal heart development. Pharmacogenetics might be the key to understanding why some children exposed to SRIs develop a congenital heart anomaly and others do not.     

Pregnancy-Induced High Plasma Levels of Soluble Endoglin in Mice Lead to Preeclampsia Symptoms and Placental Abnormalities

Preeclampsia is a pregnancy-specific disease of high prevalence characterized by the onset of hypertension, among other maternal or fetal signs. Its etiopathogenesis remains elusive, but it is widely accepted that abnormal placentation results in the release of soluble factors that cause the clinical manifestations of the disease. An increased level of soluble endoglin (sEng) in plasma has been proposed to be an early diagnostic and prognostic biomarker of this disease. A pathogenic function of sEng involving hypertension has also been reported in several animal models with high levels of plasma sEng not directly dependent on pregnancy. The aim of this work was to study the functional effect of high plasma levels of sEng in the pathophysiology of preeclampsia in a model of pregnant mice, in which the levels of sEng in the maternal blood during pregnancy replicate the conditions of human preeclampsia. Our results show that wild type pregnant mice carrying human sEng-expressing transgenic fetuses (fWT(hsEng⁺)) present high plasma levels of sEng with a timing profile similar to that of human preeclampsia. High plasma levels of human sEng (hsEng) are associated with hypertension, proteinuria, fetal growth restriction, and the release of soluble factors to maternal plasma. In addition, fWT(hsEng⁺) mice also present placental alterations comparable to those caused by the poor remodeling of the spiral arteries characteristic of preeclampsia. In vitro and ex vivo experiments, performed in a human trophoblast cell line and human placental explants, show that sEng interferes with trophoblast invasion and the associated pseudovasculogenesis, a process by which cytotrophoblasts switch from an epithelial to an endothelial phenotype, both events being related to remodeling of the spiral arteries. Our findings provide a novel and useful animal model for future research in preeclampsia and reveal a much more relevant role of sEng in preeclampsia than initially proposed.