Effects of head-down tilt on atrial natriuretic peptide and the renin system in pregnancy

We studied the effects of head-down tilt to 10 degrees for 30 minutes on plasma atrial natriuretic peptide and the renin-aldosterone system in 8 preeclamptic pregnant women, 8 healthy pregnant women, and 11 nonpregnant women of fertile age. Mean arterial blood pressure did not change in the pregnant groups but increased significantly in the nonpregnant control subjects. Heart rate decreased significantly in preeclamptic women but remained unchanged in both control groups. Baseline atrial natriuretic peptide concentration was significantly higher in both preeclamptic (66 +/- 4 pmol/L) and pregnant (54 +/- 6 pmol/L) control subjects compared with nonpregnant subjects (40 +/- 2 pmol/L), but the difference between the pregnant groups was not significant. Head-down tilting induced a significant increase in atrial natriuretic peptide only in healthy pregnant women. Baseline plasma renin activity and aldosterone concentrations were significantly higher in pregnant control subjects compared with both the preeclamptic and nonpregnant groups. The differences between the preeclamptic and nonpregnant control groups were nonsignificant. After head-down tilting, plasma renin activity decreased significantly only in nonpregnant control subjects, whereas aldosterone decreased significantly in preeclamptic and nonpregnant control subjects. In preeclampsia, atrial natriuretic peptide release followed blood pressure and not changes in cardiac output. When all 27 women were studied, a correlation between atrial natriuretic peptide and mean arterial pressure was found in the left lateral supine position. The results suggest that pregnant women developing preeclampsia lose their usual hemodynamic control and show reactions resembling the nonpregnant state when subjected to head-down tilt.     

Epidemiology, appropriateness, and cost of vancomycin use

OBJECTIVE: Our purpose was to compare the estimated maternal cerebral perfusion pressure and an index of vascular resistance, the resistance area product, in nonpregnant women with hypertensive pregnant women. STUDY DESIGN: The maternal middle cerebral artery was evaluated by transcranial Doppler ultrasonography in 17 nonpregnant women, 17 pregnant normotensive patients, 20 pregnant patients with chronic hypertension, and 21 pregnant patients with pre-eclampsia (defined by The American College of Obstetricians and Gynecologists criteria) and cerebral blood flow velocities were determined. We calculated estimated cerebral perfusion pressure as [Estimated cerebral perfusion pressure = V mean/(V mean = V diastolic) (Mean blood pressure - Diastolic blood pressure)] modified from Aaslid et al, 1986. Because the diameter of the vessels could not be measured directly, an index of resistance, the resistance area product, was calculated. Resistance area product = Mean blood pressure/mean velocity (Evans et al, 1988). We calculated an index of cerebral blood flow (Cerebral blood flow index) = Estimated cerebral perfusion pressure/resistance area product. RESULTS: Women who were chronically hypertensive and those with pre-eclampsia showed a significant increase in estimated cerebral perfusion pressure and resistance area product compared with nonpregnant and pregnant normotensive women. An estimate of cerebral blood flow (cerebral blood flow index) in nonpregnant women showed that pregnancy resulted in a nonsignificant 18% increase in cerebral blood flow. CONCLUSIONS: Women with chronic hypertension and pre-eclampsia behave similarly by demonstrating significant increases in cerebral perfusion pressure (estimated cerebral perfusion pressure) and cerebrovascular resistance (resistance area product) compared with normotensive and nonpregnant women. Pregnant patients have a minimal increase in cerebral blood flow (18%).     

Folate status response to controlled folate intake in pregnant women

A metabolic study (84-d) was conducted to investigate the folate status response of pregnant subjects (n = 12) during their second trimester and nonpregnant controls (n = 12) to folate intakes approximating the current (400 microg/d) and former (800 microg/d) recommended dietary allowance (RDA). The overall goal of the study was to provide metabolic data to assist in the interpretation of the current RDA for folate. Subjects were fed a controlled diet containing 120 +/- 15 microg/d (mean +/- SD) folate and either 330 or 730 microg/d synthetic folic acid. Outcome variables between and within supplementation groups were compared at steady state. Serum folate was higher (P 0.05) were detected in serum folate between pregnant and nonpregnant women within the same supplementation group. Urinary 5-methyl-tetrahydrofolate excretion was greater (P 0.05) in 5-methyl-tetrahydrofolate excretion were detected between pregnant and nonpregnant women within supplementation groups. Differences (P 相似文献   

Quinine pharmacokinetics in young children with severe malaria

In this study, we determined selenium concentrations in serum samples of healthy women (146 pregnant and 74 nonpregnant) living in the Mediterranean area of the coast of Granada (southeast Spain). The subjects were distributed in two groups: group A (pregnant women), divided into three categories according to the trimester of pregnancy, and group B (nonpregnant women). No significant differences were observed in the selenium levels either among pregnant women according to the trimester of pregnancy or in the group of nonpregnant women. No other significant differences were determined as regards the age of pregnant women (P > 0.05). Serum selenium levels are slightly lower during pregnancy. Considering that serum selenium levels affect the body selenium status, the concentrations determined establish the non-existence of selenium problems in the daily dietary intake with respect to maternal and fetal necessities during pregnancy.     

Mobilization of hepatic cadmium in pregnant rats

Mobilization of hepatic cadmium (Cd) in pregnant rats was investigated. Female Sprague-Dawley rats (200-250 g) were injected subcutaneously, daily with 1.0 mg Cd/kg body weight as CdCl2 for 8 days. A group of these rats was made pregnant. Copper (Cu), zinc (Zn), Cd, and metallothionein (MT) concentrations in the liver, kidney, and plasma of the control and Cd-injected, pregnant and nonpregnant rats, were compared. The hepatic Cd concentration of the Cd-injected rats decreased by 40% during pregnancy and became significantly lower than that of the nonpregnant Cd-injected rats. On the other hand, there was a concomitant increase (60%) of Cd concentrations in the kidney of the Cd-injected pregnant rats. MT in the Cd-injected rats also showed a similar pattern of decrease in hepatic concentrations and increase in renal concentrations during pregnancy. Both Cd and MT contents in the placenta of the Cd-injected rats were higher than those of the control and there was a significant increase over the gestational period. Plasma Cd and MT concentrations of the Cd-injected pregnant rats were higher than those of Cd-injected nonpregnant rats. These results suggest that pregnancy can mobilize the hepatic Cd which can be transferred to the kidney and placenta through the blood plasma. Moreover, the blood urea nitrogen levels of the pregnant Cd-injected rats were increased on Gestation Day 21 and 7 days after delivery, indicating signs of Cd nephropathy. The hepatic Cd, Cu, Zn, and MT concentrations of the newborn rats, however, were unaltered by Cd injections. Therefore, it is possible that pregnancy may induce a high risk of Cd nephrotoxicity in women with chronic Cd exposure.     

The procoagulant activity of red blood cells from patients with severe preeclampsia

OBJECTIVE: Our purpose was to determine whether red blood cells from patients with severe preeclampsia may exhibit increased membrane exposure of procoagulant phospholipids (i.e., phosphatidylserine), which may initiate intravascular clotting and platelet activation. STUDY DESIGN: The study group comprised 28 women: 9 with severe preeclampsia in the third trimester of pregnancy, 10 normotensive with uncomplicated pregnancies, and 9 age-matched, nonpregnant, healthy women. The exposure of phosphatidylserine on the outer membrane phospholipid layer was analyzed with use of isolated, washed red blood cells that were added as a source of phospholipids to a "prothrombinase" coagulation complex. RESULTS: The resultant thrombin formed was measured by an amidolytic assay. Thrombin generation significantly increased on the addition of red blood cells from women with preeclampsia (741 +/- 132 mU/ml/min) compared with red blood cells from normotensive pregnant (422 +/- 228 mU/ml/min) and nonpregnant women (316 +/- 268 mU/ml/min, p = 0.0008). CONCLUSION: This study indicates that in patients with preeclampsia the red blood cells exhibit a significant procoagulant surface that may trigger thrombin formation, thereby playing a role in the hypercoagulable state.     

Effect of the vascular endothelium on norepinephrine-induced contractions in uterine radial arteries from the nonpregnant and pregnant human uterus

OBJECTIVE: Our purpose was to investigate the role of the endothelium in the human uterine arterial response to norepinephrine in the nonpregnant and pregnant states. STUDY DESIGN: Tissue was obtained from six pregnant and six nonpregnant women undergoing cesarean section or hysterectomy. Uterine radial arteries were isolated and subjected to norepinephrine dose-response curves with and without intact endothelium. RESULTS: Responses were obtained over a dose range of 10(-8) to 10(-4) norepinephrine. Initially there was no difference between vessels from pregnant and nonpregnant patients, but removal of the endothelium significantly increased the response in vessels from pregnant women. Addition of nitro-L-arginine methyl ester when the endothelium was intact did not alter the dose-response curves. CONCLUSIONS: In pregnancy human uterine radial arteries are more sensitive to norepinephrine than during the nonpregnant state. This increase is countered by an endothelium-derived relaxing factor. The factor is unlikely to be nitric oxide.     

Blood lead concentration in the Danish population after introduction of lead-free gasoline

Blood lead concentrations in a Danish reference population were related to information from an extensive questionnaire on work, environment and life style. The mean concentration of lead in blood was 0.167 mumol/L, i.e. significantly lower than in previous studies. This finding is in accordance with the fact that less than 10% of petrol used in Denmark contained lead additives (up to 0.15 g/L). An important finding was that the well-documented predictors for lead in blood at higher concentration levels, such as age, gender, menopausal status, and intake of alcohol, are still valid in a low-level exposure situation. In addition, a strong and negative correlation was found between blood lead concentrations and dietary supplementation with vitamins and minerals. The present data indicate that lead exposure may still constitute a health risk in a small proportion of adult males and postmenopausal women.     

Admissions to a radiation oncology inpatient service

Lead exposure and its deleterious effects continue to be a problem in many countries. The lack of effective and safe treatments for low-level intoxication has promoted environmental interventions to control different sources of lead. In this study we evaluated the effect of milk consumption in 1849 mother-and-child pairs participating in the lead surveillance program in Mexico City. The mean lead levels were 11.2 micrograms/dL for maternal blood lead (MBL) and 10.8 micrograms/dL in umbilical cord. The correlation between blood lead and umbilical cord lead was r = 0.74. Forty-eight percent of the MBL exceeded 10 micrograms/dL and 9.5% exceeded 20 micrograms/dL. Maternal blood lead was positively related to the use of lead-glazed ceramic were and to traffic exposure and was inversely related to the consumption of milk and orange juice. Women who reported the consumption of more than 7 glasses of milk per week had a blood lead level of 8.7 micrograms/dL; in comparison, those women who reported a consumption of less than 7 glasses per week had a blood lead level of 11.1 micrograms/dL. Similar findings were observed for lead measured in umbilical cord. The association between lead levels and milk intake remained unchanged after taking in consideration other predictors of blood lead. This study suggests that a simple intervention could reduce lead burden among women and their newborns.     

Natural cytotoxicity of CD16+ lymphocytes in women with selected states of pregnancy pathology

The natural cytotoxic activity of lymphocytes CD16+ (NK) was studied in healthy nonpregnant and pregnant women and in patients with threatened spontaneous abortion, preterm delivery and preeclampsia. We have shown no differences in the proportion of NK cells between all studied patients and controls. The possibility of previous contact with embryonic antigens was excluded since no differences were noted between cytotoxic activity of NK cells obtained from multiparous women and those who never gave a birth. The natural cytotoxic activity of NK cells from patients with threatened abortion or preterm delivery was found to be significantly higher (p < 0.01) than from cells of healthy pregnant women. However in preeclamptic patients activity of NK cells was very low as comparing to pregnant women and more than three lower than in nonpregnant ones. This indicates that though the amount of NK cells does not different between normal and pathological pregnancies, there is marked difference in their biological activity.     

Pregnancy smoking cessation: a case of mistaken identity

This study examined the process of change in pregnancy smoking cessation, using the stages and processes of change from the Transtheoretical Model, to compare women who stopped smoking during pregnancy with women who were in the process of smoking cessation, but were not pregnant. Differences in smoking cessation process activity and abstinence self-efficacy were hypothesized between the pregnant and nonpregnant groups of women. Study participants were 89 pregnant women who quit smoking, 28 nonpregnant women in the action stage of smoking cessation, and 92 nonpregnant women in the preparation stage. The Smoking Cessation Processes of Change Scale and the Smoking Abstinence Self-Efficacy Scale served as dependent measures. One-way MANOVA and follow-up Newman-Keuls comparisons indicated significant differences between pregnant and nonpregnant women in their levels of process activity and self-efficacy. Pregnancy smoking cessation differed dramatically from the process of nonpregnancy smoking cessation. Pregnant quitters were not engaging in experiential and behavioral processes at levels associated with the action stage of change. Low levels of process use and high efficacy indicated an externally (for the baby) motivated stopping rather than an internal, intentional process of change, which may account for high relapse rates postpartum.     

Nitric oxide-mediated changes in vascular reactivity in pregnancy in spontaneously hypertensive rats

1. To examine the mechanisms which may account for pregnancy-induced vasodilatation in spontaneously hypertensive rats (SHR), we have investigated the changes in vascular reactivity and the effects of endothelial nitric oxide (NO) inhibition in the in situ blood-perfused, mesenteric resistance vessels of 18-20 day pregnant SHR. The effects of NG-nitro-L-arginine (L-NOARG) were compared in pregnant and nonpregnant SHR and gestation matched normotensive Wistar-Kyoto (WKY) rats. 2. Intra-arterial mean blood pressures (MBP) were similar in pregnant and nonpregnant SHR. Basal perfusion pressures (BPP) were decreased in pregnant compared with nonpregnant SHR. Pregnant WKY had lower MBP and BPP than either pregnant or nonpregnant SHR. 3. Vasoconstrictor responses to electrical stimulation (ES) and intra-arterial noradrenaline (NA) were decreased in pregnant compared with nonpregnant SHR. These responses were still greater in pregnant SHR when compared with pregnant WKY. Vascular reactivity to angiotensin II (AII) in pregnant SHR was reduced to a similar level to that in pregnant WKY. 4. L-NOARG (5 mg kg-1, i.v.), an inhibitor of nitric oxide synthase, increased MBP and BPP in all groups. After L-NOARG, BPP were equalized between pregnant and nonpregnant SHR. Pregnant WKY still showed lower MBP and BPP than SHR groups. 5. L-NOARG potentiated vascular responses to ES, NA and AII in all groups. The blunted vascular responses to NA and ES were normalized and the reactivity to AII was only partially reversed in pregnant SHR compared with nonpregnant SHR. Pregnant WKY still had much lower vascular responses to ES and NA than either pregnant or nonpregnant SHR. L-NOARG enhanced vascular responses to All to a greater extent in pregnant SHR than in pregnant WKY.6. These results demonstrate that blunted responses to NA and ES were NO-dependent, while diminished reactivity to AII was only partially dependent on NO in the in situ blood perfused mesenteric resistance vessels of pregnant SHR.7. The present results in pregnant SHR differ from our previous finding with pregnant normotensive WKY, in which blunted responses to NA, but not to ES, were equalized by L-NOARG. Pregnancy induced vasodilatation in hypertensive rats appears to be more dependent on endothelial NO than in normotensive WKY. A defect of the endothelial NO generating pathway which promotes vasodilatation in pregnancy may contribute to the predisposition of women with essential hypertension to develop pre-eclampsia.     

Umbilical cord blood transplantation: acceptance of umbilical cord blood donation by pregnant patients

BACKGROUND/OBJECTIVE: Umbilical cord blood is an alternative source for allogeneic transplantation of hematopoietic stem cells from related and unrelated donors. It can easily be collected, cryopreserved and stored in cord blood banks for later use. In Switzerland, cord blood banks for related and unrelated stem cell transplantation are being established. The aim of the study was to evaluate previous knowledge of the possible medical use of cord blood and acceptance of cord blood banking in pregnant women. METHODS: We performed a prospective open study using a structured, anonymous questionnaire at the University of Basel Women's Hospital pregnancy outpatient clinic. After concise information on the use of cord blood for transplantation, questions were asked concerning previous knowledge of the use of placenta and cord blood in general, concerning the attitude to donation of cord blood for transplantation, and the respondent's willingness to donate cord blood of her own child. Women of different ethnic background were compared. RESULTS: From 300 questionnaires handed out to pregnant women of different ethnic background attending our outpatient clinic, 250 (83%) were returned, and 245 could be evaluated for final analysis. Only 40% indicated that they did know what usually happens to the placenta after birth. In contrast, the vast majority (95%) supported the idea of umbilical cord blood for banking and later use for stem cell transplantation. Similarly, 93% stated that they would agree to donate the cord blood from their own child for this purpose, while no statistically significant differences could be identified either between women with or without previous knowledge or of different ethnic background. CONCLUSIONS: This study shows the high acceptance of umbilical cord blood donation for banking and stem cell transplantation purposes in pregnant women, irrespective of previous knowledge. As there are no major differences between women of different ethnic background, a high degree of diversity of HLA-types of donated cord blood samples can be expected and may offset the underrepresentation of ethnic minorities in bone marrow donor registries.     

Incidence and consequences of pregnancy in women with known duration of HIV infection. Italian Seroconversion Study Group

BACKGROUND: The increasing incidence of human immunodeficiency virus (HIV) infection in women of childbearing age led us to evaluate whether pregnancy affects the natural history of this disease. OBJECTIVES: To conduct a prospective study of women with known dates of HIV seroconversion to describe the incidence and outcome of pregnancy and to assess differences according to age and exposure group. To compare the rate of disease progression between pregnant and nonpregnant women. PATIENTS: All participants, recruited from 14 clinical centers in Italy, had documented HIV-seronegative test results followed by confirmed positive test results within 2 years. RESULTS: A total of 331 women, who had seroconversion between 1981 and 1994, were followed up for a median of 5.5 years from seroconversion; 94 developed HIV-related diseases, 47 developed acquired immunodeficiency syndrome, and 53 had at least 1 CD4 cell count lower than 0.10 x 10(9)/L (< 100 cells/mm3). Thirty-eight women (11.5%) were pregnant at the time of HIV seroconversion and 31 (9.4%) became pregnant after HIV seroconversion (cumulative incidence of pregnancy within 8 years of seroconversion, 28.9%; 95% confidence interval, 21.6%-36.2%). Forty-five (65.2%) of the 69 pregnancies were carried to term. There were no discernible differences in these findings by age or exposure group. Pregnant women did not experience a more rapid rate of progression of disease, even when adjusting for age, exposure group, CD4 cell count, or use of treatment (adjusted relative hazards: HIV-related diseases, 0.72; acquired immunodeficiency syndrome, 0.69; CD4 cell count <0.10 x 10(9)/L, 1.24). CONCLUSION: Women infected with HIV continue to become pregnant after seroconversion, yet pregnancy does not appear to influence the rate of progression of HIV disease.     

The direct action of 17 beta-estradiol in isolated omental artery from nonpregnant and pregnant women is related to calcium antagonism

OBJECTIVE: Our purpose was to study the mechanism by which 17 beta-estradiol modulates contractile activity in isolated rings of omental artery from nonpregnant and pregnant patients. STUDY DESIGN: Rings of omental artery with intact endothelium from nonpregnant and pregnant women were mounted in organ chambers for isometric tension recording. The concentration-relaxation relationship to 17 beta-estradiol (10(-7) mol/L to 3 x 10(-5) mol/L) was studied in rings contracted with 60 mmol/L potassium chloride (in both the absence and the presence of tamoxifen, 10(-6) mol/L). The effect of 17 beta-estradiol (10(-5) mol/L) on the contraction induced by 60 mmol/L potassium chloride and on the concentration-contraction relationships to both norepinephrine (10(-9) mol/L to 10(-5) mol/L) and calcium ion (0.05 mmol/L to 2.5 mmol/L in calcium-free depolarizing solution) were studied in the presence and absence of tamoxifen (10(-6) mol/L). The maximal contraction, negative logarithm of the concentration producing 50% relaxation or 50% contraction to the reference 60 mmol/L potassium chloride contraction, and the area under the curve were calculated. Data analysis was by one-way analysis of variance, Newman-Keuls test, and two-sample tests as appropriate. Probability values less than 0.05 in a two-tailed test were considered statistically significant. RESULTS: 17 beta-Estradiol relaxed omental arteries contracted with 60 mmol/L potassium chloride, and this effect was potentiated by tamoxifen in both groups. Incubation of the omental arteries with 17 beta-estradiol inhibited contractions induced by 60 mmol/L potassium chloride in rings from both groups of patients, and tamoxifen did not antagonize this effect in either group. Rings of omental artery from the nonpregnant patients (expressed as percentage of the reference potassium chloride contraction) showed greater contraction than rings from the pregnant women when exposed to norepinephrine, a statistically significant difference. 17 beta-Estradiol decreased the norepinephrine-induced contraction in omental arteries from nonpregnant but not pregnant women in a statistically significant way. Tamoxifen did not influence the effect of norepinephrine for either group. 17 beta-Estradiol inhibited calcium ion-induced contraction similarly in rings of omental artery from both nonpregnant and pregnant patients. Tamoxifen potentiated estradiol-induced inhibition in arteries from pregnant patients. CONCLUSIONS: 17 beta-Estradiol inhibits norepinephrine-induced contractions in omental arteries from nonpregnant but no pregnant patients. The inhibition of the ter sion developed after exposure to potassium chloride, norepinephrine, and calcium ion is caused by a calcium channel blocking action.     

Impact of pregnancy on maternal AIDS

OBJECTIVE: To assess the impact of pregnancy on maternal acquired immunodeficiency syndrome (AIDS) among tribal women in India. STUDY DESIGN: From February 1992 to February 1996, 71 tribal women from Manipur, India, with AIDS (Centers for Disease Control stage iii/iv), matched for age, parity, CD4 lymphocyte count and demographic characteristics, were recruited into a prospective study. Thirty-two (49%) of these women were pregnant (8-10 weeks) (group A) and 38 (51%) nonpregnant (group B). RESULTS: Pneumocystis carinii pneumonia followed by miliary tuberculosis and wasting disease were the most common AIDS-defining illness and cause of maternal death in both groups. A total of 28 (39%) women died as a direct result of their AIDS-defining illness; 10 (27%) of them were among the nonpregnant women as compared to 18 (56%) deaths among the pregnant women (P = .17, odds ratio 3.7285, 95% confidence interval 1.23, 11.58). Three (16%) of these 18 deaths occurred within 14 weeks of an uneventful first-trimester medical termination of pregnancy. Thirteen women (41%) died undelivered at 30-34 weeks' gestation, and two died within 3 weeks of delivery. Fourteen (44%) women vaginally delivered 14 preterm infants, between 28 and 35 weeks' gestation. Eleven of these infants died within six weeks; nine deaths were a direct result of prematurity and clinical diagnosis of an AIDS-defining illness. The mean survival time was 9.72 months for the pregnant women and 22.6 months for the nonpregnant women (P = .066). CONCLUSION: Pregnancy increased maternal and fetal mortality in these AIDS-infected women.     

Hostile and benevolent reactions toward pregnant women: Complementary interpersonal punishments and rewards that maintain traditional roles.

A naturalistic field study investigated behavior toward pregnant (vs. nonpregnant) women in nontraditional (job applicant) and traditional (store customer) roles. Female confederates, who sometimes wore a pregnancy prosthesis, posed as job applicants or customers at retail stores. Store employees exhibited more hostile behavior (e.g., rudeness) toward pregnant (vs. nonpregnant) applicants and more benevolent behavior (e.g., touching, overfriendliness) toward pregnant (vs. nonpregnant) customers. A second experiment revealed that pregnant women are especially likely to encounter hostility (from both men and women) when applying for masculine as compared with feminine jobs. The combination of benevolence toward pregnant women in traditional roles and hostility toward those who seek nontraditional roles suggests a system of complementary interpersonal rewards and punishments that may discourage pregnant women from pursuing work that violates gender norms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome of differentiated thyroid cancer diagnosed in pregnant women

The clinical features and outcome of thyroid cancer in 61 pregnant women (mean age, 26.0 +/- 5.9 SD yr) and in 528 female, age-matched controls who were not pregnant (mean age, 26.3 +/- 5.9 SD yr) were compared. Median follow-up was 22.4 and 19.5 yr [P = not significant (NS)] in the two groups, respectively. The thyroid nodule was asymptomatic and discovered on routine examination more often in the pregnant women (74%) than in controls (43%, P < 0.001); other clinical and tumor features were similar in the two groups. Most of the pregnant women underwent thyroidectomy after delivery (77%) or during the second trimester of pregnancy (20%). Near-total thyroidectomy was done in 43 (73%) of the pregnant women and 265 (59%) of the controls (P = NS), and nearly the same proportion of both groups (30% and 25%, respectively) were treated with 131I postoperatively. Outcome in the pregnant women and controls, respectively, was: cancer recurrence 9 (15%) and 107 (23%, P = NS); distant recurrences 1 (2%) and 12 (3%, P = NS), and cancer deaths 0 and 6 (1.2%, P = NS). Outcomes were similar when surgery was done during or after pregnancy, despite a longer delay in treatment of the latter (1.1 +/- 1.0 vs. 16.1 +/- 19.7 months, P < 0.001). This study suggests that the prognosis of differentiated thyroid cancer is the same in pregnant women and nonpregnant women of the same age, and that the diagnosis and treatment of thyroid cancer occurring during pregnancy can be delayed until after delivery in most patients.     

Adrenomedullin, a new vasoactive peptide, is increased in preeclampsia

Adrenomedullin is a novel peptide that elicits a long-lasting vasorelaxant activity. Recently, we found high concentrations of adrenomedullin in maternal and umbilical cord plasma and in amniotic fluid in full-term human pregnancy, indicating a role of this peptide during gestation. To investigate the possibility that adrenomedullin is involved in the pathophysiology of preeclampsia, we measured its concentration in maternal and fetoplacental compartments. We studied 12 normotensive nonpregnant women, 13 hypertensive nonpregnant subjects, 29 patients with preeclampsia, and 30 normotensive pregnant women. In all patients, plasma was collected from the cubital vein, and amniotic fluid samples were obtained by transabdominal amniocentesis or at elective cesarean section. Plasma samples from umbilical vein and placental tissues were collected at delivery. Adrenomedullin was assayed on plasma and amniotic fluid samples using a specific radioimmunoassay, and its localization and distribution on placental sections was determined by immunohistochemistry. Adrenomedullin concentrations were higher in hypertensive than in normotensive nonpregnant patients. Pregnant women had higher adrenomedullin levels than nonpregnant subjects, although maternal plasma adrenomedullin concentrations did not differ between normal pregnant and preeclamptic women. Preeclamptic patients showed higher concentrations (P<0.01) than normotensive pregnant women of adrenomedullin in amniotic fluid (252+/-29 versus 112+/-10 fmol/ micromol creatinine) and umbilical vein plasma (18.1+/-2.1 versus 8. 5+/-1.1 fmol/mL). Increased local production of adrenomedullin is associated with preeclampsia. The fetus seems to be responsible for the higher levels of this hormone. Increased adrenomedullin concentrations may be necessary to maintain placental vascular resistance and/or fetal circulation at a physiological level.     

Corticotropin-releasing hormone and proopiomelanocortin-derived peptides are present in human myometrium

CRH and POMC-derived peptides are produced at a number of intrauterine sites in both the nonpregnant and pregnant states. It is hypothesized that CRH and POMC-derived peptides may be produced locally by the uterus to modulate myometrial contractility. This study has examined the distribution of these peptides in human uterine tissue during the ovulatory cycle and pregnancy. The immunoperoxidase staining method was used to localize CRH and POMC-derived peptides: ACTH, beta-endorphin, and alphaMSH. Immunoreactive (IR-) CRH and IR-POMC-derived peptides, beta-endorphin and alphaMSH, were observed in the myometrial smooth muscle, vascular smooth muscle, endometrial glandular epithelium, and luminal epithelium of the nonpregnant uterus (n = 17). Staining for IR-CRH did not change during the cycle from the proliferative (n = 8) to the secretory phases (n = 9). Conversely, staining for IR-beta-endorphin and IR-alphaMSH was only observed during the secretory phase of the cycle (n = 9). In uterine tissue obtained from pregnant women (n = 20) IR-CRH was present in the myometrial smooth muscle, vascular smooth muscle, decidua, and glandular epithelium. IR-POMC-derived peptides were not detectable at any uterine site during pregnancy (n = 20). IR-CRH was measurable in myometrial extracts collected from pregnant women undergoing cesarean section (20.9+/-3.8 ng/g wet wt; n = 7) and from nonpregnant premenopausal women undergoing hysterectomy (7.7+/-2.1 ng/g wet wt; n = 6). IR-CRH concentrations significantly increased with pregnancy. Levels of messenger ribonucleic acid encoding for CRH were examined in nonpregnant (n = 4) and pregnant (n = 10) myometrial smooth muscle and were also significantly increased with pregnancy. This study has demonstrated that levels of CRH and POMC peptide in human uterine tissue change with pregnancy and that CRH is produced locally by myometrial smooth muscle cells. These studies are consistent with the possibility that the CRH peptide has an autocrine/paracrine activity during pregnancy and labor that may be related to the modulation of myometrial contractility.