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Current
Women's Health Reviews
ISSN: 1573-4048
Current Women’s Health
Reviews
Volume 5, Number 2, May 2009
Contents
Editorial: Pp . 55
Soy Isoflavones and Exercise: Possible Benefits for Postmenopausal
Women’s Cardiovascular Health Pp.
56-62
Stéphane Choquette, David-Alexandre
Lalancette and Isabelle J. Dionne
[Abstract] [Purchase
Article]
Trophoblast Invasion: A Possible Link
Between Implantation Deficiencies and Preeclampsia Pp.
63-87
Maria L. Ribeiro, Micaela S. Sordelli, Mariana
G. Farina and Ana M. Franchi
[Abstract] [Purchase
Article]
The Psychological Pain of Perinatal Loss
and Subsequent Parenting Risks: Could Induced Abortion be
more Problematic than Other Forms of Loss Pp.
88-99
Priscilla K. Coleman
[Abstract] [Purchase
Article]
Atypical Antipsychotic Drugs During Pregnancy.
Their Effects on the Mother and Offspring Pp.
100-108
María Florencia Iveli, Alejandro
Rebolledo and Verónica Milesi
[Abstract] [Purchase
Article]
Preconception Care for the Type 2 Diabetic
Mother: A Review on Current Care Guidelines Pp.
109-116
Batul K. Valika and Randall J.
Urban
[Abstract] [Purchase
Article]
Aneuploidy in Human Oocytes: Some Facts
and Questions Pp. 117-122
Bernd Rosenbusch
[Abstract] [Purchase
Article]
Abstracts
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Editorial: Preeclampsia-Eclampsia, Time to Act and Time to
Deepen Research
Preeclampsia-eclampsia is one of the leading causes
of maternal death in low and middle income countries (LMICs)
accounting for more than seventy-five thousands maternal deaths
every year. In high income countries, where treatment is more
readily available, few women die of this disease, but complications-
including rupture of liver, kidney failure, hemorrhage, and
stroke – can cause lasting health problems. In addition,
preeclampsia is among the most common causes of preterm births
in high income countries.
Preeclampsia-eclampsia is one of the pregnancy complications
which has gained great attention in the research field and
there are a number of international and national scientific
societies as well as journals dealing exclusively with it.
There are two major foci of research, those looking for the
etiology of the disease and those looking for the prevention
and treatment.
Regardless that the disease has been observed for more than
two thousand years still the etiology is unknown. Preeclampsia
is known as the disease of theories and the history of research
is prolific about big amounts of theories. Many years ago
a researcher discovered a parasite in the placentas of women
with preeclampsia, and the findings were published in a relevant
journal, but a great disappointment came afterwards since
the results showed that pieces of cotton swabs had become
mixed in with the placentas; and under the microscope they
looked like parasites. In contrast with this failure many
relevant studies have provided clues that are approaching
to solve this subject.
In this issue a comprehensive and detailed review about the
role that implantation and trophoblast invasion have in the
genesis of preeclampsia was given by Ribeiro and coworkers.
A promising area requiring more support is the role of angiogenic
agents in the development of preeclampsia. Many ongoing studies
are looking for modifications in maternal homeostasis previous
to the development of preeclampsia that could contribute to
better identify changes that can be associated with this disease.
The possibility to perform genes studies could give information
to assess the role of the genetic constitution of mother,
the father and even the fetus on the genesis of preeclampsia.
Studies about the etiology of preeclampsia will give a clue
about approaches that could prevent this disease, but we are
still far from obtaining such approaches and meanwhile many
women in LMICs are dying as a consequence of this disease.
Studies focused on the prevention and treatment of preeclampsia
has given some relevant interventions and the challenge to
make available such interventions to women living in LMICs.
Antiplatelet agents, largely low-dose aspirin, have moderate
benefits when used for prevention of pre-eclampsia and its
consequences. There is a 17% reduction in the risk of pre-eclampsia
associated with the use of antiplatelet agents (relative risk
(RR) 0.83, 95% confidence interval (CI) 0.77 to 0.89), and
72 (CI 52 to 119) women need to receive such therapy to avoid
one women with preeclampsia [1].
Disappointing results have been obtained with antioxidants
since trials with supplements of vitamin C and E did not show
any effects on preeclampsia prevention [2].
Several studies have shown that women having a low basal calcium
intake supplemented with extra calcium at around 1 gram daily,
showed a significant reduction of preeclampsia (RR 0.36, 95%
CI 0.18 to 0.70). Also, calcium supplementation has shown
a reduction on the rare occurrence of the composite outcome
'death or serious morbidity' [3].
Conclusive evidence has shown that magnesium sulphate is the
treatment of excellence for women with severe preeclampsia
and eclampsia and the severe complications of its use are
negligible [4-6].
We have then interventions that can prevent and treat preeclampsia
and eclampsia, but the current situation of incidence and
maternal mortality due to this disease has shown no changes
in LMICs. The great challenge is how we can make available
to women in LMICs preventive and curative interventions. Low-dose
aspirin is a low cost medicine. Calcium is a natural mineral
easy to be delivered trough a variety of foods and also of
low cost as a supplement. Magnesium sulphate is a medicine
of low cost, and stable at different temperatures. In summary,
there are not major limitations of cost, availability, storage,
side effects of preventive and curative interventions to reduce
the consequences of preeclampsia and eclampsia. Relevant research
trials have already provided interventions effective to prevent
and treat preeclampsia and now it is mandatory to deliver
such interventions to women in LMICs.
REFERENCES
[1] Duley L, Henderson-Smart DJ, Meher S, King JF.
Antiplatelet agents for preventing pre-eclampsia and its complications
(Cochrane Review). In: The Cochrane Library, Issue 4, 2008.
Oxford: Update Software.
[2] Rumbold Alice, Duley Lelia, Crowther Caroline A, Haslam
Ross R. Antioxidants for preventing pre-eclampsia (Cochrane
Review). In: The Cochrane Library, Issue 4, 2008. Oxford:
Update Software.
[3] Hofmeyr GJ, Atallah AN, Duley L. Calcium supplementation
during pregnancy for preventing hypertensive disorders and
related problems (Cochrane Review). In: The Cochrane Library,
Issue 4, 2008. Oxford: Update Software.
[4] Duley L, Gülmezoglu AM, Henderson-Smart DJ. Magnesium
sulphate and other anticonvulsants for women with pre-eclampsia
(Cochrane Review). In: The Cochrane Library, Issue 4, 2008.
Oxford: Update Software.
[5] Duley L, Henderson-Smart D. Magnesium sulphate versus
phenytoin for eclampsia (Cochrane Review). In: The Cochrane
Library, Issue 4, 2008. Oxford: Update Software.
[6] Duley L, Henderson-Smart David J. Magnesium sulphate versus
diazepam for eclampsia (Cochrane Review). In: The Cochrane
Library, Issue 4, 2008. Oxford: Update Software.
José M. Belizán
(Editor-in-Chief)
Department of Mother &
Child Health Research
Institute for Clinical Effectiveness and Health Policy (IECS)
Viamonte 2146 (3er Piso)
(C1056ABH) Buenos Aires
Argentina
Tel/Fax: (+54-11) 49534058
E-mail: belizanj@allstat.org
[Back to top] [Purchase
Article]
Soy Isoflavones and Exercise: Possible Benefits for Postmenopausal
Women’s Cardiovascular Health
Stéphane Choquette, David-Alexandre
Lalancette and Isabelle J. Dionne
Menopause is characterized by a decrease of estrogen
and progesterone levels. It is also associated with deleterious
changes in body composition and blood lipids that increase
the risks of type 2 diabetes and cardiovascular diseases (CVD).
Physical activity and hormone-replacement therapy (HRT) have
been suggested to act in synergy on important risk factors.
However, HRT has recently been associated with a greater risk
of CVD in older women, which has lead to an acute interest
in alternative therapies. Soy isoflavones, a class of phytoestrogens,
have shown beneficial effects on body composition of peri-
and postmenopausal Japanese women. Recently, some studies
combining isoflavones and exercise have suggested potential
actions on risk factors of CVD.
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Article]
Trophoblast Invasion: A Possible Link Between Implantation
Deficiencies and Preeclampsia
Maria L. Ribeiro, Micaela S. Sordelli, Mariana
G. Farina and Ana M. Franchi
Trophoblast invasion during implantation and placentation
is critical for successful gestation and it is thought that
invasion insufficiencies during placentation contribute to
a number of obstetrical complications. However, relatively
little is known regarding the regulation of this process and
its link with the formation of new vascular beds during early
pregnancy. Here, we review literature concerning the potential
significance of inadequate uterine invasion as a contributor
to the obstetrical complications of spontaneous abortion and
preeclampsia. Studies have shown that both extrinsic and intrinsic
factors involved in trophoblast invasion modulation seemed
to be involved in some common obstetrical complications as
early pregnancy loss and preeclampsia. Lipid molecules (i.e.
prostaglandins, lysophosphatidic acid, anandamide), nitric
oxide, metalloproteases and uterine natural killer cells,
which are involved in implantation deficiencies, are also
reported to be part of vascular abnormalities observed during
preeclampsia. Trophoblast invasion together with placental
vascularization reflects a complex interaction of regulatory
factors. Understanding the regulation of trophoblast growth
in the uterine matrix will provide much needed insight into
implantation failure and placenta-related vascular insufficiencies.
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Article]
The Psychological Pain of Perinatal Loss and Subsequent Parenting
Risks: Could Induced Abortion be more Problematic than Other
Forms of Loss
Priscilla K. Coleman
This dual purpose of this review was to organize and
synthesize what is known about women’s psychological
and behavioral responses to perinatal loss and examine perinatal
loss as a predictor of compromised parenting. The conditions
surrounding distinct losses (miscarriage, relinquishment of
a child for adoption, and abortion) are highly variable necessitating
examination of the differential impact of the various forms
of loss on women’s mental health and parenting. Preliminary
assessment of relevant literature suggests the psychological
experience and the cultural context of abortion may render
this form of perinatal loss particularly damaging to the parenting
process.
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Article]
Atypical Antipsychotic Drugs During Pregnancy. Their Effects
on the Mother and Offspring
María Florencia Iveli, Alejandro
Rebolledo and Verónica Milesi
Risk-benefit analysis of medication used for psychiatric
disorders is in general a challenge for medical doctors and
a detailed analysis is required, which takes into account
the age of the patient. Furthermore, it is even more difficult
to find a suitable treatment for women who are planning to
or become pregnant, because in this case it is also necessary
to evaluate the potential risks of the drugs on the offspring,
since some of them can pass the placental membranes reaching
the fetal circulation. Atypical antipsychotic drugs including
risperidone, quetiapine, clozapine and olanzapine are commonly
used in patients with schizophrenia and other psychiatric
disorders, but there are few studies of their effects during
pregnancy. This is a subject which merits further investigation,
especially taking into account that this group of drugs reaches
in higher concentration values in fetal blood than in the
maternal circulation. In this article we review the literature
related to the effects of atypical antipsychotics during pregnancy
and the neonatal period, focusing both on the mother and the
fetus.
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Article]
Preconception Care for the Type 2 Diabetic Mother: A Review
on Current Care Guidelines
Batul K. Valika and Randall J.
Urban
Preconception counseling has been a public health dilemma
for many years as industrialized nations try to reconcile
their fortitude in medicine with their poor pregnancy outcomes.
Prior to the Center for Disease Control’s (CDC) national
recommendations in 2006, survey data showed that many providers
were not addressing this stage in a women’s life. Only
1 of 6 Primary Care Providers in the United States provided
preconception care for women prior to their prenatal care.
This problem is further complicated by chronic diseases that
are now appearing in women of reproductive age.
Globally, diabetes will increase by more than 50% in the next
10 years. This has translated into a 76% increase in prevalence
among women in the last 25 years. However, this proportional
increase has not translated into better care. This paper will
summarize the need for preconception care for the Type 2 diabetic
woman, look at challenges in the first trimester, and offer
a literature review of the clinical guidelines for the primary
care provider, obstetrician, and the endocrinologist.
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Article]
Aneuploidy in Human Oocytes: Some Facts and Questions
Bernd Rosenbusch
Studies on the origin of aneuploid conceptions have indicated
that many chromosomal abnormalities arise during maternal
meiosis. Therefore, the direct cytogenetic analysis of female
gametes is of interest to evaluate underlying mechanisms.
Human oocytes failing to fertilize after the application of
assisted reproductive technologies have predominantly been
used for this purpose. In addition, indirect data can be obtained
from the examination of the first polar body that reflects
the chromosomal constitution of the oocyte. Both approaches
have been conducted with different methods and provided substantial
information on the incidence of aneuploidy originating from
errors during first meiotic division. However, the results
reported so far display great variability, most probably due
to technical problems and heterogeneity of the study population.
Notwithstanding these limitations, it was unequivocally shown
that two aneuploidy-causing mechanisms exist: non-disjunction,
resulting in the loss or gain of whole chromosomes, and predivision,
resulting in the loss or gain of single chromatids in mature
oocytes. All chromosome groups are affected by aneuploidy
but abnormalities in groups D, E, and G exceed the expected
values. Considering only abnormal complements with one extra
or missing chromosome/chromatid reveals a slight increase
in predivision compared with non-disjunction. Chromosome and
chromatid abnormalities are positively correlated to maternal
age. The simultaneous analysis of oocytes and first polar
bodies suggests that some cases of aneuploidy are caused by
gonadal mosaicism instead of meiotic errors.
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