DEFB-1 genetic polymorphism screening in HIV-1 positive pregnant women and their children

Objective. In our study we evaluated the frequency of three SNPs (?52 G/A, ?44 C/G; ?20 G/A) in the 5′ UTR of DEFB-1 gene, in a cohort of 130 HIV-1 infected mothers and their children, collected by the Italian group SIGO in Obstetrics and Gynecology.

Methods. The three SNPs (?52 G/A, ?44 C/G; ?20 G/A) in the 5′ UTR of DEFB-1 gene were genotyped by direct sequencing of PCR products.

Results. The C allele at position ?44 was shown to be significantly different in both HIV-1 positive mothers and their children when compared to the healthy controls. The odds ratio for ?44 C allele in children born to HIV-1 infected mothers is 7.09 (confidence interval 3.38–15.3) while the odds ratio for this allele in HIV-1 infected mothers is 6.42 (confidence interval 3.14–13.4).

Conclusions. Our results evidence a high frequency of the ?44 CC allele in HIV-1 infected mothers and their children with augmented potential risk of maternal fetal transmission. This potential vertical transmission risk has been successfully prevented by antiretroviral drug treatment and cesarian section of the HIV-1 positive mothers.     

Italian multicentric pilot study on MBL2 genetic polymorphisms in HIV positive pregnant women and their children.

OBJECTIVE: We investigated genetic polymorphisms of MBL2 gene, in a cohort of 90 Italian HIV-1 pregnant seropositive women and their children in order to understand whether the MBL2 genotype of HIV-1 positive mothers might be related to their ability to transmit the virus to their children. MATERIALS AND METHODS: DNA was extracted from Iso Code Stix cards, and MBL2 genotyping was performed by Melting Temperature Assay. RESULTS: The frequency of the MBL2 0/0 homozygotes was higher in HIV-1 positive mothers than in healthy controls, the MBL2 0/0 genotype was more frequent in children born from HIV positive mothers than healthy subjects. CONCLUSIONS: We have confirmed the association of polymorphisms involving a gene of the innate immunity with an increased risk of being infected by HIV. These polymorphisms were also evidenced in children born from HIV+ mothers, but the risk of infection was strongly reduced by cesarean delivery and by antiretroviral treatment.     

Design of antiretroviral clinical trials for HIV-1 infected pregnant women and their newborn infants.

Antiretroviral therapy has been highly successful in reducing mother to child transmission of human immunodeficiency virus-1 infection in pregnant women. However, the treatment regimens are intensive, difficult to deliver in less developed countries, and there are limited pharmacology studies addressing critical questions regarding maternal safety and fetal risk. There are currently 3 pharmacologically diverse classes of antiretroviral agents with inadequate information available to define drug disposition necessary to determine appropriate dose regimens and limited data on long-term adverse events. This article summarizes representative clinical studies for selected antiretrovirals that provide a framework for continuing the necessary clinical research to extend successful outcomes in developed countries to human immunodeficiency virus-1 infected pregnant women and infants world-wide and minimize the risk of long-term adverse effects.     

Midtrimester screening for microalbuminuria in healthy pregnant women.

To ascertain the effectiveness and feasibility of testing for microalbuminuria and the albumin/creatinine ratio as an early indication of hypertensive disorders of pregnancy, we measured albumin and creatinine excretion in 95 healthy pregnant women between 16 and 20 weeks of pregnancy. Nine women developed hypertensive complications; one of them became pre-eclamptic. There were no statistically significant differences in urine albumin and creatinine concentrations nor in the albumin/creatinine ratio between those women who developed pregnancy-induced hypertension and those who did not. Microalbuminuria testing had a specificity of 0.95 (95% CI: 0.88 - 0.99) and a sensitivity of 0.11 (95% CI: 0.03 - 0.48). The albumin/creatinine ratio had a specificity of 0.98 (95% CI: 0.92 - 1.0) and a sensitivity of 0.22 (95% CI: 0.03 - 0.6). The albumin/creatinine ratio was significantly lower in women who delivered prematurely. We conclude that mid-trimester testing for microalbuminuria and the measurement of the urinary albumin/creatinine ratio are not effective tools for the early recognition of pregnancy-induced hypertension in healthy pregnant women.     

Plasma HIV-1 RNA viral load and serum vitamin A and E levels in HIV-1 infected pregnant women

The aim of this study was to assess the correlation between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio in HIV-1 infected pregnant women not receiving antiretroviral therapy There were no significant correlations between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio. However, the presence of underlying vitamin A deficiency in these pregnant women was common.     

162 HIV-1 infected pregnant women and vertical transmission. Results of a prospective study

BACKGROUND: Aim of this paper is to describe the changes over a 16-year period of the characteristics and management of HIV infected pregnant women. METHODS: Prospective study: analysis of data obtained from 162 women and 176 infants. Factors evaluated included: maternal socio-demographic level, immunological and virological parameters, antiretroviral therapy, mode of delivery, pregnancy outcome and babies follow-up. RESULTS: The proportion of women with heterosexual acquisition of infection has increased significantly from 13.5% in 1985-1989 to 47.1% in 1996-2001 (p<0.0005, Fisher's exact test), while the proportion acquiring HIV through injecting drugs has declined. Mean CD4 cell count at delivery was 535 x 106/l (+/-522.3 x 106/l). In 1990, 50% of mothers received antiretroviral therapy, rising significantly to 87.5% in 2000. The elective cesarean section was introduced in 1998 and its rate has increased to 75% in 2000. The vertical transmission rate changed from 9.5% in 1985-1989 to 14.3% in 1996-2000 (this difference was not statistically significant, Fisher's exact test). CONCLUSIONS: Social characteristics of the HIV-infected women have changed since the mid-1980s: in recent times women are having children at increasingly older ages and are more likely to know that they are HIV infected when they become pregnant. Antiretroviral therapy, elective caesarean delivery and avoidance of breastfeeding can reduce transmission of HIV, but the vertical transmission rate was unaffected by their use in our study and it remains high in comparison with rates reported from other studies.     

Hepatitis B screening in pregnant patients and their children. A Greifswald perinatology-pediatric study. II. Pediatric findings

Hepatitis B virus carriers were identified by a systematic screening of women during the last trimester of pregnancy. With 0.5% the HBV carrier incidence was found to be constant over years. 25 children of HBsAg positive women were followed after 2-4 years in order to define the risk of vertical transmission. One infant died due to the sequelae of a congenital malformation. In 12 of the remaining infants HBV markers were found after different intervals, in 10 of them also clinical and paraclinical symptoms of HBV infection could be diagnosed. The results are discussed in relation to the maternal serologic status and with regard to different preventive measures. Summarizing our results the following recommendations can be given: A mass screening for HBV during pregnancy is the only safe method of diagnosing HBsAg positive carriers. All newborns of HBsAg positive pregnants should be vaccinated immediately after birth, both actively and passively.     

Drug screening and criminal prosecution of pregnant women

According to the U.S. Supreme Court, the Fourth Amendment rights of 10 women were violated by a hospital that provided them prenatal care. The incidence of prenatal drug testing for criminal prosecution with or without a woman's knowledge is increasing. Concurrently, funding and availability of drug treatment programs for pregnant women are declining. Nurses and physicians who act as advocates for the state rather than the patient damage the patient-provider relationship and breach their ethical responsibility to the patient.     

Gynaecological morbidity among HIV positive pregnant women in Cameroon

Objective  

To compare the prevalence of gynaecological conditions among HIV infected and non-infected pregnant women.     

Hypovolemic pregnant women and their risk determinants

Among hypovolemic pregnant women there is a high risk of premature labor, fetal growth retardation, and/or hypertension. Arterial wave velocity was determined and Evan's blue disappearance rates measured in hypovolemic gravidas with complications. It appeared that those hypovolemic gravidas without increased cardiac performance are more likely to give birth prematurely, while those with increased cardiac performance and delayed in vivo mixing of Evan's blue dye develop hypertension.     

高龄孕妇的血糖筛查和管理

随着社会工业化程度提高和全面二孩政策实施,高龄妊娠孕妇数量逐年增加。高龄为孕前及妊娠期糖尿病的独立危险因素,可导致母儿不良妊娠结局和近远期并发症发生。本文仅就高龄孕妇的血糖筛查和干预管理问题进行分析讨论。     

Group B Streptococcus carriers among HIV-1 infected pregnant women: prevalence and risk factors

OBJECTIVE: The objective was to determine the frequency and risk factors of anogenital colonization by Streptococcus agalactiae (GBS) in pregnant women infected with human immunodeficiency virus type 1 (HIV-1). STUDY DESIGN: A prospective study was conducted on 207 pregnant women divided into two groups: HIV group (n=101) and a control group consisting of HIV-uninfected pregnant women (n=106) to assess regional colonization by GBS. Anal and vaginal swabs were collected and cultured in Todd-Hewitt broth, followed by a confirmatory test. For a control group with an anticipated proportion based on literature research of 10-30% and alpha=0.05, a sample size of 100 would have a power of 80% to detect a difference of 15% or greater with a study group. The mothers were studied in terms of frequency of anogenital colonization by GBS, maternal epidemiological data, and TCD4 lymphocyte counts. The results were analyzed using the chi(2)-test, Fisher's exact test and the Student's t-test, with the level of significance set at p<0.05. RESULTS: Twenty (19.8%) HIV-1-infected pregnant women were found to be colonized by GBS at between 35 and 37 weeks' gestation. In the control group, the prevalence of GBS was 14.1%. CONCLUSION: No significant increase in GBS colonization was observed in HIV-1-infected pregnant women. Maternal colonization of GBS in HIV-infected pregnant women was not found to be associated with their immunological status. Sexual contact does not seem to be the principal way of transmitting GBS.     

The impact of protease inhibitors on maternal serum screening analyte levels in pregnant women who are HIV positive

OBJECTIVE: The purpose of this study was to compare alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol levels in women who take protease inhibitors and those women who do not. STUDY DESIGN: This retrospective review from August 2000 to May 2003 was performed for maternal serum screen results, medication use, pregnancy, and perinatal outcomes. RESULTS: Thirty-nine women met study criteria. Sixteen women were treated with protease inhibitors, and 23 women were not treated with protease inhibitors. There was no difference in initial viral load or initial CD4 count between the groups. No difference was found for human chorionic gonadotropin and estriol levels; significantly lower alpha-fetoprotein multiples of the median were found for the women who were treated with protease inhibitors compared with the women who were not (0.97 +/- 0.32 [SD] MoM vs 1.2 +/- 0.4 MoM, respectively; P = .04). Six of 39 women (15%) had positive maternal serum screens. All the babies were normal at birth, and there were no cases of perinatal transmission of human immunodeficiency virus. CONCLUSION: Protease inhibitors are associated with lower alpha-fetoprotein levels in women who are infected with human immunodeficiency virus.     

Malarial immunity in pregnant Nigerian women and their newborn

The levels of malarial fluorescent antibody titers (MFAT) were estimated throughout pregnancy and at delivery in 20 urban Nigerian primigravidas who received malarial chemoprophylaxis. There was a statistically significant (p < 0.001) fall in the MFAT levels as pregnancy progressed. The mean logarithmic MFAT levels were 2.8664 +/- 0.3326 and 2.2794 +/- 0.1656 in the first and last trimesters of pregnancy, respectively. The MFAT level in the newborn was positively correlated to the maternal MFAT level at delivery (r = 0.9468; p < 0.001). If malarial prophylactics are used for a prolonged period, the maternal MFAT level will fall, leaving newborns with lowered immunity to malaria.     

The relation between plasma homocysteine concentration and methylenetetrahydrofolate reductase gene polymorphism in pregnant women.

OBJECTIVE: Our purpose was to clarify the influence of methylenetetrahydrofolate reductase (MTHFR) gene polymorphism on plasma homocysteine (Hcy) concentrations during early pregnancy. METHODS: Between 1996 and 1998, Hcy concentration and MTHFR gene polymorphism were studied in 840 pregnant women between 6 to 12 weeks' gestation. Hcy concentration was measured by amino acid autoanalyzer (DLC-300, Nihon Denshi), and MTHFR genotypes were determined by the PCR/RFLP methods. Pregnancy outcomes were compared in association with Hcy concentration and MTHFR genotypes. RESULTS: A total of 816 of the 840 women were enrolled into the study because MTHFR genotypes were not available in 24 women. Genotypes of C677T in the MTHFR gene were CC: CT: TT (%) = 280 (34.3): 400 (49.0): 136 (16.7). Plasma Hcy concentration was significantly (p < 0.0001) higher in women with TT genotype than other genotypes [CC: CT: TT = 5.67 (2.8-10.6): 5.80 (2.5-20.1): 6.91 (3.5-20.9) nmol/ml, median (range)]. Women with hyperhomocysteinemia had severe preeclampsia (2 of 35 vs 5 of 714, p < 0.01) and stillbirth (2 of 35 vs 10 of 714, p < 0.05) more frequently than normohomocysteinemia. CONCLUSIONS: Plasma Hcy concentration during early pregnancy was higher in women with homozygote for the T677 allele in the MTHFR gene than other genotypes.     

Obstructive sleep apnea screening and perinatal outcomes in Korean pregnant women

Purpose

This study was intended to evaluate the attributable risk of obstructive sleep apnea (OSA) by a sleep questionnaire to adverse pregnancy outcomes.

Methods

This was a prospective, cohort study in Korean pregnant women. Berlin questionnaire was employed for symptom-based OSA screening during the third trimester and obstetric outcome data were obtained in 276 deliveries. The relationship between symptom-based OSA and outcomes were explored using SPSS version 18.0 and stratified by obesity (BMI strata <30 and ≥30). Our primary outcome was the compound occurrence of SGA (fetal) or preeclampsia (maternal). Multivariate models were applied in controlling for potential confounders.

Results

The overall prevalence of OSA was 32.2 % and it was significantly related with the higher maternal BMI, more body weight at delivery, and weight gain during pregnancy (p = 0.007, p = 0.003, p = 0.005, respectively). There were no significant differences in the primary outcomes according to the positivity of OSA by screening, regardless of the stratification by obesity. The cesarean delivery rate was significantly higher in the OSA positive group (36.0 vs 22.5 %, p = 0.018), but it was not significant in the each strata of obesity. In multivariate analysis, the outcomes of birth weight, preeclampsia, cesarean delivery, and small for gestational age were also not different according to the positivity of OSA.

Conclusions

It seems that the prevalence of OSA by a sleep questionnaire is overestimating OSA in Korean pregnant women. Polysomnography might be needed to diagnose OSA and to evaluate the relationship between OSA and the occurrence of SGA or preeclampsia.