RESUMEN
Polybrominated diphenyl ethers (PBDEs) are pollutants that may increase the risk of preterm birth. In previous studies, we found that a mixture of PBDEs altered the expression of biomarkers for preterm birth by the placenta. However, there are 209 different PBDE congeners with different tissue distributions. How these different congeners may alter the production of immunomodulators by the placenta that help to maintain the survival of the fetal allograft is unclear. Therefore, we compared the effects 5 common congeners on basal and bacteria-stimulated cytokine production by the placenta. Placental explant cultures were incubated with 20⯵M of PBDE congeners 47, 99, 100, 153, 209 or vehicle in the presence and absence of Escherichia coli for 20â¯h. Conditioned medium was harvested and concentrations of IL-1ß, TNF-α, IL-6, sgp130, HO-1, IL-10, BDNF, and 8-IsoP quantified. For unstimulated cultures, all congeners, except for PBDE-47, reduced the production of IL-1ß and IL-6 production was enhanced by PBDE-153. BDNF concentrations tended to be reduced by most PBDE congeners and IL-10 production was enhanced by PBDE-99, -153, and -209. 8-IsoP production was enhanced by PBDE-153, but not the other congeners. For bacteria-stimulated cultures, PBDE-47 increased IL-1ß production and PBDE-47, -153, and -209 tended to reduce TNF-α production. IL-6 production was enhanced by all PBDEs except 153. IL-10 production was enhanced by all congeners except for PBDE-47. All congeners significantly enhanced BDNF and 8-IsoP. These results suggest that PBDEs can alter the expression of placental biomarkers in a congener and infection-dependent manner.
Asunto(s)
Citocinas/metabolismo , Contaminantes Ambientales/toxicidad , Retardadores de Llama/toxicidad , Éteres Difenilos Halogenados/toxicidad , Placenta/efectos de los fármacos , Biomarcadores/metabolismo , Cesárea , Medios de Cultivo Condicionados/análisis , Medios de Cultivo Condicionados/metabolismo , Citocinas/análisis , Citocinas/inmunología , Escherichia coli/inmunología , Escherichia coli/patogenicidad , Femenino , Humanos , Placenta/inmunología , Placenta/metabolismo , Embarazo , Nacimiento Prematuro/inducido químicamente , Nacimiento Prematuro/inmunología , Nacimiento Prematuro/microbiología , Técnicas de Cultivo de TejidosRESUMEN
Ischemic placental disease can have long-term maternal health implications. In this article, we discuss the three conditions of ischemic placental disease (preeclampsia, fetal growth restriction, and abruption placenta) and its associated long-term maternal morbidity. Retrospective observational studies comparing pregnancies complicated by ischemic placental disease to uncomplicated pregnancies suggest an increased long-term risk of hypertension, cardiovascular death, metabolic syndrome, and cerebrovascular disease. This association is much stronger in women who had an indicated-preterm delivery due to ischemic placental disease. It is important to adequately counsel women who are diagnosed with these conditions about their future health risks. Increased awareness of the potential health risks and multidisciplinary collaboration remains paramount to instituting the appropriate screening and preventative strategies (i.e., behavior modification) for affected women.
Asunto(s)
Isquemia/complicaciones , Isquemia/fisiopatología , Mortalidad Materna , Madres/estadística & datos numéricos , Enfermedades Placentarias/fisiopatología , Placenta/irrigación sanguínea , Desprendimiento Prematuro de la Placenta/fisiopatología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/mortalidad , Enfermedad Crónica , Femenino , Retardo del Crecimiento Fetal/fisiopatología , Humanos , Hipertensión/etiología , Hipertensión/mortalidad , Isquemia/mortalidad , Síndrome Metabólico/etiología , Síndrome Metabólico/mortalidad , Enfermedades Placentarias/mortalidad , Preeclampsia/fisiopatología , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate factors associated with patient acceptance of noninvasive prenatal testing for trisomy 21, 18 and 13 via cell-free fetal DNA. METHODS: This was a retrospective study of all patients who were offered noninvasive prenatal testing at a single institution from 1 March 2012 to 2 July 2012. Patients were identified through our perinatal ultrasound database; demographic information, testing indication and insurance coverage were compared between patients who accepted the test and those who declined. Parametric and nonparametric tests were used as appropriate. Significant variables were assessed using multivariate logistic regression. The value p < 0.05 was considered significant. RESULTS: Two hundred thirty-five patients were offered noninvasive prenatal testing. Ninety-three patients (40%) accepted testing and 142 (60%) declined. Women who accepted noninvasive prenatal testing were more commonly white, had private insurance and had more than one testing indication. There was no statistical difference in the number or the type of testing indications. Multivariable logistic regression analysis was then used to assess individual variables. After controlling for race, patients with public insurance were 83% less likely to accept noninvasive prenatal testing than those with private insurance (3% vs. 97%, adjusted RR 0.17, 95% CI 0.05-0.62). CONCLUSION: In our population, having public insurance was the factor most strongly associated with declining noninvasive prenatal testing.