RESUMO
BACKGROUND: Maternal overweight and obesity have been associated with an increased risk of atopic dermatitis (AD) in the offspring, but the underlying mechanisms are unclear. Vernix caseosa (VC) is a proteolipid material covering the fetus produced during skin development. However, whether maternal prepregnancy weight excess influences fetal skin development is unknown. Characterizing the VC of newborns from mothers with prepregnancy overweight and obesity might reveal AD-prone alterations during fetal skin development. OBJECTIVE: We sought to explore AD biomarkers and staphylococcal loads in VC from the offspring of mothers who were overweight/obese (O/O) before pregnancy versus in those from offspring of normal weight mothers. METHODS: The VC of newborns of 14 O/O and 12 normal weight mothers were collected immediately after birth. Biomarkers were determined by ELISA and staphylococcal species by quantitative PCR. RESULTS: The VC from the O/O group showed decreased expression of skin barrier proteins (filaggrin and loricrin) and increased levels of proinflammatory biomarkers (IgA, thymic stromal lymphopoietin [TSLP], S100A8, IL-25, and IL-33). No differences in concentrations of antimicrobial peptides and enzymes were detected. The VC from the O/O group had a lower Staphylococcus epidermidis and Staphylococcus hominis commensal bacterial load, whereas Staphylococcus aureus bacterial load was not significantly different between the 2 groups. Maternal body mass index was negatively correlated with VC filaggrin expression and S epidermidis load and was positively associated with TSLP concentration. One-year follow-up established that the offspring of O/O mothers had a higher incidence of AD that was specifically linked with decreased VC filaggrin expression and lower S epidermidis load. CONCLUSIONS: VC from neonates of mothers with prepregnancy overweight and obesity exhibit skin barrier molecular alterations and staphylococcal dysbiosis that suggest early mechanistic clues to this population's increased risk of AD.
Assuntos
Dermatite Atópica , Obesidade Materna , Verniz Caseoso , Humanos , Recém-Nascido , Feminino , Gravidez , Dermatite Atópica/patologia , Proteínas Filagrinas , Obesidade Materna/metabolismo , Obesidade Materna/patologia , Verniz Caseoso/metabolismo , Sobrepeso , Pele/patologia , Citocinas/metabolismo , Linfopoietina do Estroma do Timo , Obesidade/patologia , Biomarcadores/metabolismoRESUMO
Vernix caseosa peritonitis (VCP) is a complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity during a cesarean section.The physiopathology mechanisms are still incompletely understood. However, keratina granulomas could be induced by the squamous cells inside the vernix.In spite of its infrequent condition this entity should be included in the differential diagnosis of abdominal pain and acute abdomen in the post-partum after cesarean section.In this article, we present a case of VCP, and we discuss the clinical and histopathologic findings that allow its prompt recognition as well as to guide us towards the correct surgical and therapeutic technique.
Assuntos
Peritonite/etiologia , Transtornos Puerperais/etiologia , Verniz Caseoso , Adulto , Feminino , HumanosRESUMO
The relationship between ultrasonographic detection of fetal vernix and visual assessment of amniotic fluid (AF) and fetal pulmonary maturity evaluated by the "shake test" was studied in 73 high-risk patients undergoing amniocentesis for obstetrical indications. The AF was classified as type I, type II, and type III, depending on the subjective amount of vernix detected. Ultrasound predicted correctly 7 out of 11 cases of type I AF (64%), 14 out of 22 cases of type II AF (64%), and 38 out of 40 cases of type III AF (95%). When ultrasonography detected type I AF the "shake test" was negative in all cases, whereas if type II or type III were found, the "shake test" was positive in 40% and 86%, respectively. Our results suggest that sonographic detection of type I AF is associated with immaturity, thus amniocentesis should be avoided in such cases. Conversely, if a type III AF is detected a mature fetus is found in almost 90% of the cases. The observation of AF detecting fetal vernix during third trimester sonography is a simple manoeuver that can help to avoid the use of amniocentesis, an invasive procedure associated with some serious fetal and maternal complications.
Assuntos
Líquido Amniótico , Maturidade dos Órgãos Fetais , Ultrassonografia Pré-Natal , Verniz Caseoso , Feminino , Idade Gestacional , Humanos , Pulmão/embriologia , GravidezRESUMO
Se estudió la correlación entre la detección ultrasonográfica de vérnix y el aspecto macroscópico del líquido amniótico (LA) y la madurez pulmonar fetal (MPF) en 73 pacientes de la Unidad de Alto Riesgo del Servicio de Obstetricia y Ginecología del Hospital "Guillermo Grant Benavente" de Concepción. La concordancia entre el aspecto macroscópico del LA obtenido por amniocentesis y la ultrasonografía fue correcta en 59 de los 73 casos (80,8%). En 4 casos (5,5%) la ultrasonografía informó un tipo menor y en 10 casos (13,7%) informó un tipo mayor al que correspondía según el aspecto macroscópico. La ultrasonografía detectó correctamente el 95%de los LA macroscópicamente tipo III (38 de 40) y el 64%de los LA tipo II o tipo I (14 de 22 y 7 de 11, respectivamente). En todos los casos de tipo I por ultrasonografía la prueba de Clements fue negativa (n = 9; MPF = 0%), en cambio fue positiva en 8 de los 20 casos de LA tipo II (MPF = 40%) y en 38 de los 44 casos de LA tipo III (MPF = 86,4%). Nuestro estudio permite concluir que la detección ultrasonográfica de vérnix abundante (LA tipo III) permite asegurar MPF y la ausencia o la presencia de escaso vérnix (LA tipo I) permite suponer inmadurez pulmonar, con lo cual pareciera innecesario realizar estudio de LA para MPF, lo que permite evitar el empleo de amniocentesis, procedimiento invasivo que no está exento de complicaciones tanto maternas como fetales
Assuntos
Maturidade dos Órgãos Fetais , Líquido Amniótico/análise , Verniz Caseoso/análise , Diagnóstico Pré-Natal , UltrassonografiaRESUMO
Se estudian 320 madres embarazadas sanas que presentan una FUR segura. Todos los recien nacidos fueron examinados en el parto. Se decribe la distribucion del unto sebaceo que presentan y se lo relaciona con la edad gestacional obtenida por la FUR. Se presenta un esquema, en el que se senala la correspondencia habida entre la distribucion del unto y la edad gestacional. La concordancia de ambos parametros oscilo entre un 70% a las 40 semanas y un 90,9% a las 42. Se senala la sistematizada aparicion y desaparicion del unto a medida que cursa el embarazo: se inicia en la zona ventral, se continua en la dorsal y termina en los pliegues axiloinguinales.Se destaca la importancia del vernix en la individualizacion de las semanas 36 a la 41 inclusive. Particular valor se da a la presencia del signo de Nikolsky en el diagnostico de la semana 41. Se insiste en precisar la madurez gestacional como base para el manejo del recien nacido, ya que no siempre coincide con la edad gestacional
Assuntos
Recém-Nascido , Humanos , Idade Gestacional , Verniz CaseosoRESUMO
Dysmaturity, diagnosed according to the Clifford criteria, was studied for the first time in a black population. The infants and matched control subjects were participants in the Collaborative Perinatal Study in Philadelphia from birth to 7 years of age. The incidence of dysmaturity was 25/1,000 live births; more boys than girls were born dysmature, reversing the normal male/female ratio found among black infants in the Collaborative Study as a whole. The condition was more common among post-term infants but did occur in earlier gestational weeks. The overall characteristics of the condition among this black population did not differ from those previously reported among white populations of various races. Surviving infants developed mentally and physically as well as control subjects. No prenatal or environmental characteristics were found that distinguished mothers of dysmature infants from those of nondysmature infants.