RESUMO
Pregnancy in women with sickle cell disease (SCD) is associated with increased maternal and fetal morbidity and mortality. Outcomes vary widely owing to methodological limitations of clinical studies, but overall, hypertensive disorders of pregnancy, venothromboembolism, poor fetal growth, and maternal and perinatal mortality are increased globally. Few therapeutic interventions have been explored other than prophylactic and selective transfusion therapy. Unfortunately, existing data are limited, and it remains unclear whether prophylactic use of chronic transfusions will improve pregnancy outcomes. Management of pregnant women with SCD is best accomplished with a multidisciplinary team that includes a sickle cell expert and an obstetrician familiar with high-risk pregnancies. Women with SCD should have individualized care plans that outline management of acute pain and guidelines for transfusion therapy. Neonates require close monitoring for neonatal abstinence syndrome and hemolytic disease of the newborn. Ideally all young women with SCD will have a "reproductive life plan" developed as a component of preconception counseling and health promotion. Research leading to improved pregnancy management focused on diminishing adverse maternal and neonatal outcomes is overdue. International collaborations should be considered to improve subject recruitment and foster timely completion of clinical trials. Additional therapeutic interventions outside of transfusion therapy should be explored.
Assuntos
Anemia Falciforme , Transfusão de Sangue , Eritroblastose Fetal , Retardo do Crescimento Fetal , Síndrome de Abstinência Neonatal , Complicações Hematológicas na Gravidez , Tromboembolia Venosa , Adulto , Anemia Falciforme/metabolismo , Anemia Falciforme/patologia , Anemia Falciforme/terapia , Eritroblastose Fetal/metabolismo , Eritroblastose Fetal/patologia , Eritroblastose Fetal/prevenção & controle , Feminino , Retardo do Crescimento Fetal/metabolismo , Retardo do Crescimento Fetal/terapia , Humanos , Síndrome de Abstinência Neonatal/metabolismo , Síndrome de Abstinência Neonatal/patologia , Síndrome de Abstinência Neonatal/prevenção & controle , Gravidez , Complicações Hematológicas na Gravidez/metabolismo , Complicações Hematológicas na Gravidez/patologia , Complicações Hematológicas na Gravidez/terapia , Tromboembolia Venosa/metabolismo , Tromboembolia Venosa/patologia , Tromboembolia Venosa/terapiaRESUMO
OBJECTIVE: To examine the expression of hypoxia-inducible factor-1α (HIF-1α), TfR1, and TfR1-attached terminal monosaccharides in placentas of women with IDAP and severe preeclampsia. METHODS: TfR1 and HIF-1α were detected by western blot. Immunoadsorption of TfR1 was performed to characterize the terminal monosaccharides by specific lectin binding. RESULTS: There was no difference in the expression of TfR1 and HIF-1α between groups. Lectin blot analysis pointed out an overexpression of galactose ß1-4 N-acetylglucosamine (Gal-GlcNAc) and mannose in severe preeclampsia. CONCLUSION: The increase in Gal-GlcNAc may be due to the increased presence of antennary structures and the mannose glycans of TfR1 may indicate the presence of misfolded or incomplete proteins. These findings may be associated with the low expression of placental TfR1 in women with preeclampsia.
Assuntos
Acetilglucosamina/genética , Acetilglucosamina/metabolismo , Anemia Ferropriva/genética , Anemia Ferropriva/metabolismo , Antígenos CD/genética , Antígenos CD/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Placenta/metabolismo , Pré-Eclâmpsia/genética , Pré-Eclâmpsia/metabolismo , Complicações Hematológicas na Gravidez/genética , Complicações Hematológicas na Gravidez/metabolismo , Receptores da Transferrina/genética , Receptores da Transferrina/metabolismo , Adolescente , Adulto , Feminino , Expressão Gênica , Glicosilação , Humanos , Manose/genética , Manose/metabolismo , Monossacarídeos/genética , Monossacarídeos/metabolismo , Gravidez , Adulto JovemRESUMO
Pregnancy in sickle cell disease (SCD) has been associated with increased complications such as vaso-occlusive crises, severe anemia and foetal loss. It has been proposed that the sickling of red blood cells (RBCs) inside the placenta circulation could participate to these complications. The present study investigated the adhesion of sickle RBCs on human trophoblast-derived cell and its extracellular matrix. Results demonstrated 1) similar adhesion of sickle RBCs and healthy RBCs to trophoblast but 2) a greater adhesion of sickle RBCs to the extracellular matrix of trophoblasts as compared with healthy RBCs. This greater adhesion could partly involve the Lu/BCAM glycoproteins and could participate to the complications reported in SCD pregnant women.
Assuntos
Anemia Falciforme/complicações , Eritrócitos/patologia , Placenta/irrigação sanguínea , Complicações Hematológicas na Gravidez/sangue , Trofoblastos/citologia , Adulto , Adesão Celular , Linhagem Celular , Deformação Eritrocítica , Matriz Extracelular/metabolismo , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez/metabolismo , Complicações Hematológicas na Gravidez/patologiaRESUMO
OBJECTIVE: Iron deficiency anemia (IDA) can severely impair the outcome of pregnancy. IDA has been shown to cause oxidative stress, which may be exacerbated by oral iron therapy. In this study, the effects of IDA and its treatment with iron polymaltose complex/folic acid (IPC/FA) were examined in anemic pregnant rats, their fetuses and placentas. STUDY DESIGN: Hematological variables and oxidative stress markers in the liver, heart and kidney were evaluated in non-anemic, anemic and IPC/FA-treated pregnant rats and their fetuses. Markers for oxidative stress, inflammation and hypoxia were assessed in the placentas of all groups. RESULTS: IDA was shown to increase oxidative stress levels in all the studied organs and in placenta as well as hypoxia and inflammation in placenta. IPC/FA treatment corrected IDA measured by the hemoglobin level, serum iron level and transferrin saturation. The oxidative stress levels in all the studied organs and in placentas of the IPC/FA-treated group were comparable to those of the non-anemic group. The number of fetuses and the neonatal and placental weight were lower in the anemic group compared to the non-anemic and IPC/FA-treated groups. CONCLUSIONS: The current study shows that IDA in pregnant rats impaired pregnancy outcome, increased the expression of hypoxia and inflammatory markers in the placenta, and increased oxidative stress in dams, fetuses and placentas. Treatment with oral IPC/FA corrected the IDA as well as reduced the levels of oxidative stress and inflammatory markers close to non-anemic control values in all the studied organs.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/uso terapêutico , Hematínicos/uso terapêutico , Estresse Oxidativo/efeitos dos fármacos , Placenta/efeitos dos fármacos , Complicações Hematológicas na Gravidez/tratamento farmacológico , Anemia Ferropriva/metabolismo , Animais , Feminino , Compostos Férricos/farmacologia , Glutationa/metabolismo , Hematínicos/farmacologia , Masculino , Malondialdeído/metabolismo , Placenta/metabolismo , Gravidez , Complicações Hematológicas na Gravidez/metabolismo , Resultado da Gravidez , Ratos , Ratos Sprague-DawleyRESUMO
In an effort to define the varied expression of three vasoactive markers in the clinical models of normal placenta/ normal invasion (n = 11), preeclampsia/restricted trophoblast invasion (n = 15), and placenta accreta/exaggerated invasion (n = 6), we performed semiquantitative immunohistochemistry for kallikrein, bradykinin B2 receptor, and endothelial nitric oxide synthase (eNOS). In the floating villi, the syncytiotrophoblast expressed more kallikrein in placenta accreta (p < 0.05), than in normal and preeclamptic placentas, while the bradykinin B2 receptor and eNOS were similarly expressed in all groups; in the fetal endothelium, the bradykinin B2 receptor was enhanced in placenta accreta (p < 0.005), but kallikrein and eNOS were similarly expressed in the other two groups. In the extravillous trophoblast, both kallikrein and eNOS expression were higher in placenta accreta (p < 0.001), while the bradykinin B2 receptor signal was only enhanced in preeclampsia (p < 0.05). The presence and localization of kallikrein, the bradykinin B2 receptor, and eNOS in the fetomaternal interface in the three study conditions supports a local role for interrelated vasodilatory/antiaggregating systems. This first report of the variations observed in kallikrein and eNOS in a condition of exaggerated trophoblast invasion supports the participation of vasodilatation in trophoblast migration.
Assuntos
Calicreínas/metabolismo , Óxido Nítrico Sintase Tipo III/metabolismo , Placenta Acreta/metabolismo , Placenta/metabolismo , Pré-Eclâmpsia/metabolismo , Receptor B2 da Bradicinina/metabolismo , Vilosidades Coriônicas/metabolismo , Células Endoteliais/metabolismo , Feminino , Feto/metabolismo , Expressão Gênica , Idade Gestacional , Humanos , Calicreínas/urina , Troca Materno-Fetal , Modelos Biológicos , Placenta/irrigação sanguínea , Gravidez , Complicações Hematológicas na Gravidez/metabolismo , Resultado da Gravidez , Trofoblastos/metabolismoRESUMO
Essential hypertension is associated with insulin resistance and hyperinsulinemia. To assess whether hyperinsulinemia is also present in hypertensive disease induced by pregnancy, we studied the plasma glucose and insulin responses to 50 g of oral glucose in 10 women with definite, severe preeclampsia but normal glucose tolerance, and compared them with the responses observed in a well-matched control group of healthy pregnant women. Fasting plasma glucose concentrations were similar in healthy and preeclamptic pregnant mothers (4.1 +/- 0.4 mmol/L v 4.5 +/- 0.4 mmol/L, respectively, P = NS). Similar plasma glucose levels were also observed after glucose ingestion (5.5 +/- 0.3 mmol/L v 6.2 +/- 0.3 mmol/L in healthy and preeclamptic women, respectively P = NS). In contrast, fasting plasma insulin concentrations in the preeclamptic women were significantly higher than in normal pregnant mothers (175 +/- 29 pmol/L v 101 +/- 11 pmol/L, P < .05). Postload plasma insulin concentrations were nearly fourfold higher in the preeclamptic group as compared with the control group (1162 +/- 70 pmol/L v 366 +/- 39 pmol/L, P < .01). We conclude that preeclampsia is associated with marked hyperinsulinemia both in the fasting state and after oral glucose ingestion, suggesting that insulin resistance may play a role in pregnancy-induced hypertension.
Assuntos
Glicemia/fisiologia , Hiperinsulinismo/complicações , Pré-Eclâmpsia/complicações , Complicações Hematológicas na Gravidez/metabolismo , Adulto , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperinsulinismo/sangue , Insulina/sangue , Pré-Eclâmpsia/sangue , Gravidez , Complicações Hematológicas na Gravidez/sangueRESUMO
Severe genital hemorrhage in women is almost always present during puerperal pregnancy status. Thus, bearing in mind the hemodynamic and metabolic changes which appear physiologically during gestation: hypovolimia, hemodilution, tachycardia, and modification showing in blood coagulation factors and in electrocardiogram, is of paramount importance. In this article, a four-type genital bleeding classification based on the extent of blood loss is presented. Out of the four types. Class III and class IV correspond to hypovolemic shock and call for intensive care. The need for the availability of all necessary material resources and the participation of a multidisciplinary team are emphasized. The author also emphasized the preservation of the fetus' life-while inside the uterus-whenever this be feasible.
Assuntos
Hemorragia Pós-Parto/complicações , Complicações Hematológicas na Gravidez/metabolismo , Hemorragia Uterina/classificação , Catecolaminas/metabolismo , Cuidados Críticos , Feminino , Humanos , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/terapia , Gravidez , Terceiro Trimestre da Gravidez , Choque/etiologia , Choque/terapia , Hemorragia Uterina/complicações , Hemorragia Uterina/etiologiaRESUMO
OBJECTIVE: The hypothesis of our study was that both the systemic and uteroplacental circulations would adapt to chronic maternal anemia to ensure that oxygen supply to maternal tissues would be adequate. STUDY DESIGN: We measured cardiac output and uteroplacental blood flow and calculated systemic and uteroplacental oxygen delivery, extraction, and consumption in pregnant sheep that were anemic for 6 days (hematocrit 14%) and in normal sheep (hematocrit 28%). RESULTS: When compared with normal pregnant sheep, anemic pregnant sheep had increases in cardiac output and uteroplacental blood flow, neither of which was sufficient to prevent systemic or uteroplacental oxygen delivery from decreasing. In spite of decreases in oxygen delivery, systemic and uteroplacental oxygen consumptions were maintained at normal levels because of increases in oxygen extraction. CONCLUSION: Maternal systemic and uteroplacental circulations are capable of adapting well to chronic maternal anemia.