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221: Changes in the immune system as measured by cytokines are associated with levels of maternal depression during pregnancy
Poster Session I
Clinical Obstetrics, Neonatology, Physiology-Endocrinology www.AJOG.org
hypoxemia. Fetal cardiac function and pulmonary hemodynamics were assessed by Doppler ultrasonography. RESULTS: Maternal norepinephrine infusion had no significant effect on fetal hemodynamics. Pindolol infusion decreased fetal heart rate and weight-indexed left ventricular cardiac output (LVCO) and increased pulmonary arterial and pulmonary venous vascular impedances, while labetalol had no effect on these parameters. During hypoxemia, fetal heart rate increased to the baseline level in the pindolol group and pulmonary vascular impedances increased in the labetalol group, with no significant changes in fetal cardiac outputs. CONCLUSIONS: The administration of pindolol for maternal hypertension decreased fetal LVCO and induced vasoconstriction in the pulmonary vasculature. However, neither labetalol nor pindolol appeared to significantly modify fetal cardiac and pulmonary hemodynamic responses to acute hypoxemia.
220 Electrical uterine activity: does BMI play a role? Karen Playforth1, Oded Langer1 1
St. Luke’s-Roosevelt Hospital Center, New York, NY
OBJECTIVE: To evaluate the effect of body mass index on electrical
uterine activity during labor. STUDY DESIGN: Eighty-four patients admitted to Labor & Delivery at RooseveltHospital, who met study criteria, were recruited to join a prospective, blinded, IRB-approved study. Electrical activity of the uterine myometrium was measured with electromyography as previously described. The EUM-100 electromyogram (EMG) machine (OB Tools) employed used 9-electrodes, a multi-channel signal amplifier with high and low-pass filters, and a 3-dimensional position sensor to measure the electrical depolarization of the uterine myometrium. In addition, the EUM-100 is designed to control for the different thickness of the abdominal wall during measurement of uterine electrical activity. EUM data were recorded and sent offsite to an analyst blinded to clinical data.This measurement was converted via computer algorithm into Peak Root Mean Square (pRMS). Maternal demographic and pregnancy outcome data were obtained from medical records. BMI information was available for comparison with 144 electromyography measurements. Student’s t test and Pearson’s correlations were used to test for statistical significance. RESULTS: The study revealed: (1) There was a negative linear correlation between BMI and electrical uterine activity (r⫽ -0.40); (2) When BMI was separated into WHO categories, there were statistically significant differences in the mean pRMS for normal-weight versus overweight and obese individuals (513 vs. 428; p⫽0.0026 and 513 vs. 437; p⫽0.0048); and, (3) There were no statistically significant differences in the mean pRMS of underweight versus normal-weight individuals (509 vs. 513; p⫽0.83) or in the mean pRMS of overweight versus obese individuals (428 vs. 437; p⫽0.36). CONCLUSIONS: Our data suggests that electrical uterine activity decreases as body mass index increases. This difference is most notable between normal weight and overweight individuals.
221 Changes in the immune system as measured by cytokines are associated with levels of maternal depression during pregnancy Kimberly D’Anna1, Camille Hoffman1, Mary Coussons-Read2, Randy Ross2 1 University of Colorado, Denver Health and Hospital Authority, Denver, CO, 2University of Colorado Denver, Denver, CO
OBJECTIVE: Maternal depression is associated with various negative maternal/child outcomes, including perinatal complications and disruptions in the mother-infant bond. Despite evidence that maternal depression begins during pregnancy, little is known regarding the underlying physiological changes associated with maternal depression during pregnancy. Alterations in inflammatory immune responses are associated with major depressive disorder, however, how the immune system relates to depression in the perinatal period is less understood. This study tested the hypothesis that immune signals in-
S96
volved in inflammation (as measured by the pro-inflammatory cytokines IL-6 and TNF-␣, and the anti-inflammatory IL-10) will vary with maternal depression. STUDY DESIGN: Blood was collected to determine plasma levels of immune-related cytokines (IL-6, IL-10 and TNF-␣) from 60 pregnant women during early pregnancy (15-19 weeks gestation), mid pregnancy (26-29 gestational weeks) and late pregnancy (32⫹weeks). Perinatal mood symptoms were assessed with the Edinburgh postnatal depression scale at these same time points and once additionally in the postpartum period (4-12 weeks). RESULTS: Plasma levels of the pro-inflammatory cytokine TNF-␣ in early and late pregnancy were positively correlated with levels of reported depressive symptoms in late pregnancy (p⫽0.08 and p⫽0.37, respectively). In addition, plasma levels of the anti-inflammatory cytokine IL-10 in early pregnancy were negatively correlated with depressive symptoms at this same time point (p⫽0.027). No significant correlations were found between IL-6 and perinatal depression nor were any prenatal plasma cytokine levels associated with depression in the postpartum period. CONCLUSIONS: This information suggests that changes in the immune system during pregnancy may be related to depressive symptoms. Specifically high levels of TNF-␣ and low levels of IL-10 were both associated with high levels of depressive symptoms. Cytokines may be a useful biomarker in which to gain further information in those women at risk for developing perinatal depression.
222 Pomegranate juice reduces oxidative stress in term human placenta Methodius Tuuli1, D. Michael Nelson1, Mark Longtine1 1
Washington University in St. Louis, St. Louis, MO
OBJECTIVE: Oxidative stress is implicated in several complications of
pregnancy. Pomegranate juice (PJ), a rich natural source of polyphenols, reduces oxidative stress and apoptosis in a murine model of ischemic-reperfusion injury (Loren, D.J. et al, 2005, West, T. et al., 2007). Labor induces placental oxidative stress (Cindrova-Davies, T., et al., 2007), providing a convenient model to test the ability of PJ to moderate oxidative stress during pregnancy.We tested the hypothesis that PJ reduces oxidative stress in term human placenta. STUDY DESIGN: Proteins were extracted from placentas of women with normal term pregnancies administered 8oz per day of commercially available PJ (POM Wonderful, Los Angeles, CA) in the last two weeks of pregnancy who underwent long labor (⬎5hrs, n⫽4) and from women with normal term pregnancies not administered PJ who underwent short (⬍5hrs, n⫽4) or long (⬎5hrs, n⫽4) labors. Proteins were also extracted from placental explants (n⫽4) cultured under 8% or ⬍1% oxygen for 8 hours and from primary human syncytiotrophoblasts (PHTs, n⫽4) cultured under 8% or ⬍1% oxygen for 24 hours, with and without PJ at a concentration of 1:300. Proteins were separated by SDS-PAGE and levels of heat shock protein 90 (HSP 90) determined by immunoblot analysis. RESULTS: Median levels of HSP 90 were elevated in both short and long labored placentas, and in explants and PHTs cultured under hypoxia. PJ significantly reduced placental HSP 90 in women who underwent labor (p ⫽ 0.03) (Figure 1). PJ also reduced HSP 90 in explants and PHTs cultured under hypoxia in media with PJ compared to those without PJ. These findings were confirmed on immunohistochemistry. CONCLUSIONS: PJ reduces oxidative stress in labored placentas in vivo and in placental explants and trophoblasts cultured under hypoxia in vitro. We speculate that prenatally administered PJ may reduce hypoxia-related perinatal complications.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
Clinical Obstetrics, Neonatology, Physiology-Endocrinology www.AJOG.org
hypoxemia. Fetal cardiac function and pulmonary hemodynamics were assessed by Doppler ultrasonography. RESULTS: Maternal norepinephrine infusion had no significant effect on fetal hemodynamics. Pindolol infusion decreased fetal heart rate and weight-indexed left ventricular cardiac output (LVCO) and increased pulmonary arterial and pulmonary venous vascular impedances, while labetalol had no effect on these parameters. During hypoxemia, fetal heart rate increased to the baseline level in the pindolol group and pulmonary vascular impedances increased in the labetalol group, with no significant changes in fetal cardiac outputs. CONCLUSIONS: The administration of pindolol for maternal hypertension decreased fetal LVCO and induced vasoconstriction in the pulmonary vasculature. However, neither labetalol nor pindolol appeared to significantly modify fetal cardiac and pulmonary hemodynamic responses to acute hypoxemia.
220 Electrical uterine activity: does BMI play a role? Karen Playforth1, Oded Langer1 1
St. Luke’s-Roosevelt Hospital Center, New York, NY
OBJECTIVE: To evaluate the effect of body mass index on electrical
uterine activity during labor. STUDY DESIGN: Eighty-four patients admitted to Labor & Delivery at RooseveltHospital, who met study criteria, were recruited to join a prospective, blinded, IRB-approved study. Electrical activity of the uterine myometrium was measured with electromyography as previously described. The EUM-100 electromyogram (EMG) machine (OB Tools) employed used 9-electrodes, a multi-channel signal amplifier with high and low-pass filters, and a 3-dimensional position sensor to measure the electrical depolarization of the uterine myometrium. In addition, the EUM-100 is designed to control for the different thickness of the abdominal wall during measurement of uterine electrical activity. EUM data were recorded and sent offsite to an analyst blinded to clinical data.This measurement was converted via computer algorithm into Peak Root Mean Square (pRMS). Maternal demographic and pregnancy outcome data were obtained from medical records. BMI information was available for comparison with 144 electromyography measurements. Student’s t test and Pearson’s correlations were used to test for statistical significance. RESULTS: The study revealed: (1) There was a negative linear correlation between BMI and electrical uterine activity (r⫽ -0.40); (2) When BMI was separated into WHO categories, there were statistically significant differences in the mean pRMS for normal-weight versus overweight and obese individuals (513 vs. 428; p⫽0.0026 and 513 vs. 437; p⫽0.0048); and, (3) There were no statistically significant differences in the mean pRMS of underweight versus normal-weight individuals (509 vs. 513; p⫽0.83) or in the mean pRMS of overweight versus obese individuals (428 vs. 437; p⫽0.36). CONCLUSIONS: Our data suggests that electrical uterine activity decreases as body mass index increases. This difference is most notable between normal weight and overweight individuals.
221 Changes in the immune system as measured by cytokines are associated with levels of maternal depression during pregnancy Kimberly D’Anna1, Camille Hoffman1, Mary Coussons-Read2, Randy Ross2 1 University of Colorado, Denver Health and Hospital Authority, Denver, CO, 2University of Colorado Denver, Denver, CO
OBJECTIVE: Maternal depression is associated with various negative maternal/child outcomes, including perinatal complications and disruptions in the mother-infant bond. Despite evidence that maternal depression begins during pregnancy, little is known regarding the underlying physiological changes associated with maternal depression during pregnancy. Alterations in inflammatory immune responses are associated with major depressive disorder, however, how the immune system relates to depression in the perinatal period is less understood. This study tested the hypothesis that immune signals in-
S96
volved in inflammation (as measured by the pro-inflammatory cytokines IL-6 and TNF-␣, and the anti-inflammatory IL-10) will vary with maternal depression. STUDY DESIGN: Blood was collected to determine plasma levels of immune-related cytokines (IL-6, IL-10 and TNF-␣) from 60 pregnant women during early pregnancy (15-19 weeks gestation), mid pregnancy (26-29 gestational weeks) and late pregnancy (32⫹weeks). Perinatal mood symptoms were assessed with the Edinburgh postnatal depression scale at these same time points and once additionally in the postpartum period (4-12 weeks). RESULTS: Plasma levels of the pro-inflammatory cytokine TNF-␣ in early and late pregnancy were positively correlated with levels of reported depressive symptoms in late pregnancy (p⫽0.08 and p⫽0.37, respectively). In addition, plasma levels of the anti-inflammatory cytokine IL-10 in early pregnancy were negatively correlated with depressive symptoms at this same time point (p⫽0.027). No significant correlations were found between IL-6 and perinatal depression nor were any prenatal plasma cytokine levels associated with depression in the postpartum period. CONCLUSIONS: This information suggests that changes in the immune system during pregnancy may be related to depressive symptoms. Specifically high levels of TNF-␣ and low levels of IL-10 were both associated with high levels of depressive symptoms. Cytokines may be a useful biomarker in which to gain further information in those women at risk for developing perinatal depression.
222 Pomegranate juice reduces oxidative stress in term human placenta Methodius Tuuli1, D. Michael Nelson1, Mark Longtine1 1
Washington University in St. Louis, St. Louis, MO
OBJECTIVE: Oxidative stress is implicated in several complications of
pregnancy. Pomegranate juice (PJ), a rich natural source of polyphenols, reduces oxidative stress and apoptosis in a murine model of ischemic-reperfusion injury (Loren, D.J. et al, 2005, West, T. et al., 2007). Labor induces placental oxidative stress (Cindrova-Davies, T., et al., 2007), providing a convenient model to test the ability of PJ to moderate oxidative stress during pregnancy.We tested the hypothesis that PJ reduces oxidative stress in term human placenta. STUDY DESIGN: Proteins were extracted from placentas of women with normal term pregnancies administered 8oz per day of commercially available PJ (POM Wonderful, Los Angeles, CA) in the last two weeks of pregnancy who underwent long labor (⬎5hrs, n⫽4) and from women with normal term pregnancies not administered PJ who underwent short (⬍5hrs, n⫽4) or long (⬎5hrs, n⫽4) labors. Proteins were also extracted from placental explants (n⫽4) cultured under 8% or ⬍1% oxygen for 8 hours and from primary human syncytiotrophoblasts (PHTs, n⫽4) cultured under 8% or ⬍1% oxygen for 24 hours, with and without PJ at a concentration of 1:300. Proteins were separated by SDS-PAGE and levels of heat shock protein 90 (HSP 90) determined by immunoblot analysis. RESULTS: Median levels of HSP 90 were elevated in both short and long labored placentas, and in explants and PHTs cultured under hypoxia. PJ significantly reduced placental HSP 90 in women who underwent labor (p ⫽ 0.03) (Figure 1). PJ also reduced HSP 90 in explants and PHTs cultured under hypoxia in media with PJ compared to those without PJ. These findings were confirmed on immunohistochemistry. CONCLUSIONS: PJ reduces oxidative stress in labored placentas in vivo and in placental explants and trophoblasts cultured under hypoxia in vitro. We speculate that prenatally administered PJ may reduce hypoxia-related perinatal complications.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011