Normal Physiological Changes Research Articles

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy.

Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.

Association between higher serum uric acid levels within the normal physiological range and changes of lumbar spine bone mineral density in healthy Chinese postmenopausal women: a longitudinal follow-up study.

The aim of this study was to investigate whether higher serum uric acid (SUA) levels within the physiological range were associated with changes in lumbar spine bone mineral density (LBMD) in postmenopausal women without existing lumbar spine osteoporosis after a longitudinal follow-up of 3.09 years, and to further confirm the relationship between SUA and bone mineral density (BMD) in other sites such as femoral neck, total hip, and trochanter at follow-up. A longitudinal study of 175 healthy postmenopausal women without osteoporosis was conducted in Shenyang, China. BMD of the lumbar spine, femoral neck, total hip, and trochanter were measured using dual-energy x-ray absorptiometry at each visit. Pearson's correlation analysis and regression analyses were performed to determine any associations. There were positive correlations between baseline SUA and BMD of the lumbar spine (P = 0.03), total hip (P = 0.04), and trochanter (P = 0.04). Moreover, higher baseline SUA levels were independently associated with LBMD decline and the odds ratio of the baseline SUA of the third quartile group was 0.12 (95% confidence interval, 0.02-0.70, P < 0.05), with P = 0.23 for the trend in baseline SUA when compared with participants in the lowest, first quartile group after adjustment for many potential confounding variables. Higher SUA levels within the normal physiological range were independently associated with decreased LBMD, and SUA levels were positively related to the BMD of the lumbar spine, total hip, and trochanter in healthy Chinese postmenopausal women.

Peripartum Cardiomyopathy.

Peripartum cardiomyopathy is a rare form of heart failure due to left ventricular systolic dysfunction that affects women late in pregnancy and the postpartum period. A diagnosis of exclusion, peripartum cardiomyopathy can be difficult to diagnose in the context of the normal physiologic changes of pregnancy and requires a high index of suspicion. Original research articles, review articles, and guidelines on peripartum cardiomyopathy were reviewed. The etiology of peripartum cardiomyopathy remains poorly defined, but theories include genetic predisposition, as well as myocardial inflammation and angiogenic dysregulation. Risk factors for this condition include hypertensive disorders of pregnancy, Black race, and maternal age older than 30 years. Patients with peripartum cardiomyopathy are at increased risk of acute clinical decompensation, cardiac arrhythmias, thromboembolic complications, and death. Primary treatment modalities include initiation of a medication regimen aimed at the optimization of preload and reduction of afterload. Maternal clinical status is the primary determinant for timing of delivery. Prompt diagnosis and medical management by an interdisciplinary care team are vital for improving outcomes in patients with peripartum cardiomyopathy.

Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis.

Maternal sepsis is an obstetric emergency and a leading cause of maternal morbidity and mortality. Early recognition in a pregnant or postpartum patient can be a challenge as the normal physiologic changes of pregnancy may mask the signs and symptoms of sepsis. Bedside assessment tools may aid in the detection of maternal sepsis. Timely and targeted antibiotic therapy and fluid resuscitation are critical for survival in patients with suspected sepsis. Once diagnosed, a search for etiologies and early application of source control measures will further reduce harms. If the patient is in septic shock or not responding to initial treatment, multidisciplinary consultation and escalation of care is necessary. Health care professionals should be aware of the unique complications of sepsis in critically ill pregnant and postpartum patients, and measures to prevent poor outcomes in this population. Adverse pregnancy outcomes may occur in association with sepsis, and should be anticipated and prevented when possible, or managed appropriately when they occur. Using a standardized approach to the patient with suspected sepsis may reduce maternal morbidity and mortality.

Association Between Food Choices Motivators and Physical Activity in Body Image (dis)Satisfaction in Portuguese Adolescents.

Concerns about weight and body image are common among adolescents since they are particularly vulnerable to body-image dissatisfaction due to the normal physiological, social, and psychological changes they are going through. This study aims to analyse the relationship between food choice motivations and physical activity in body-image perception among adolescents. Twelve to sixteen years old adolescents were recruited from three school districts. The Portuguese version of the Food Choices Questionnaire (FCQ) was used to assess food choice motivators, and the Quantification de l'Activité Physique en Altitude Chez les Enfants was used to assess physical activity and to calculate daily energy expenditure (DEE). Body image perception was measured using Collins' sequence of seven silhouettes. Body image (dis)satisfaction was estimated by the present body shape minus the desired body shape. ANOVA and Kruskal-Wallis tests were performed to compare groups, and the post-hoc Bonferroni test was used to compare target groups. A multinominal logistic regression was performed to analyse the association between gender, age, hours of sport's competition, FCQ, and body dissatisfaction. All analyses were performed in IBM SPSS Statistics 26.0. The sample comprised 286 adolescents (51.4% females). Means of FCQ categories varied between 0.33 and 0.97 (range: −2 to 2). Regarding the categories of FCQ, statistically significant differences were found in the category of body satisfaction and weight control among the three groups (p = 0.004). A preventive effect was found of choosing food regarding body satisfaction and weight control, on body-image dissatisfaction.

Physiological changes during pregnancy: a mimic of medical disease and risk to existing ones

During pregnancy; multiple physiological adaptations are encountered. Their aim is to protect and nurture the developing fetus and prepare the mother for labor and delivery. They are mediated by an orchestra of maternal and placental hormones. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease. It is important to differentiate between normal physiological changes and disease pathology. The present review summarizes the changes in different systems of the body and its metabolism in an attempt to assist clinicians caring for pregnant women during health and disease.&#x0D; Keywords: adaptations, changes, hormones, metabolism, physiology, pregnancy.

Maternal sepsis update.

Maternal sepsis is the second leading cause of maternal death in the United States. A significant number of these deaths are preventable and the purpose of this review is to highlight causes such as delays in recognition and early treatment. Maternal sepsis can be difficult to diagnose due to significant overlap of symptoms and signs of normal physiological changes of pregnancy, and current screening tools perform poorly to identify sepsis in pregnant women. Surveillance should not only include during pregnancy, but also throughout the postpartum period, up to 42 days postpartum. Education and awareness to highlight this importance are not only vital for obstetric healthcare provides, but also for nonobstetric healthcare providers, patients, and support persons. Through education and continual review and analysis of evidence-based practice, a reduction in maternal morbidity and mortality secondary to maternal sepsis should be attainable with dedication from all disciplines that care for obstetric and postpartum patients. Education and vigilance also extend to patients and support persons who should be empowered to escalate care when needed.

Postpartum depression: How it differs from the “baby blues”

IntroductionDespite many signs and symptoms of depression get dismissed as normal physiologic changes associated with childbirth, depressive disorders are a common complication of pregnancy and postpartum period. The so-called “baby blues” have a minor functional impact and respond well to social support, whilst postpartum depression causes significant functional compromise, requiring more aggressive therapy. There is an extreme type of postpartum depressive disorder, postpartum psychosis, when patients present psychosis, mania, or thoughts of infanticide. It is imperative to promptly recognize and differentiate these entities, in order to minimize its impact on both mother and child. Antidepressant treatment may be necessary for some women, but risks and benefits should always be considered prior to institute pharmacotherapy.ObjectivesTo identify current approaches and evidence-based treatment options for postpartum depression.MethodsReview of the most recent literature regarding postpartum depression. The research was carried out through the Cochrane, UptoDate, PubMed, MedLine, LILACS and SciELO databases, using the terms “postpartum depression”, “baby blues” and “postpartum psychosis”, until December 2020.ResultsSince both depression and antidepressant medications confer risk upon the infant, when postpartum depression develops, psychotherapy is usually the first-line treatment. Antidepressant treatment may be necessary, but its use during pregnancy and postpartum must be weighed carefully.ConclusionsIn order to better prevent postpartum depression, recommendations include the use of screening instruments as a routine clinical practice during pregnancy and referral when necessary. Maternal depression has a severe impact on both mother and child, so mental health professionals have a very important role in reducing postnatal emotional complications.DisclosureNo significant relationships.

Management and Perspective of Coronavirus Disease 2019 (COVID-19), Pregnancy, and Hypercoagulability.

The modern-day pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread rapidly. There is limited data about the effects of the virus on pregnant women, even in women who were infected by other strains of coronavirus such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). After reviewing numerous articles published in the peer-reviewed journals and other authentic sources, in this mini-review, we evaluated various key clinical and laboratory aspects of coronavirus disease 2019 (COVID-19) in relation to pregnancy. Eligibility criteria included the patient being pregnant upon admission to the hospital, clinically diagnosed, and/or laboratory-confirmed COVID-19. Taking a comprehensive approach by reviewing numerous studies, it is safe to say that there is no concrete evidence of intrauterine transmission. With adequate infection control measures, breastfeeding in neonates of mothers with COVID-19 is safe postpartum. A disruption of Virchow’s triad by COVID-19 and the normal physiologic changes of pregnancy put the expectant mothers at great risk of arterial, venous, and placental thrombus formation, which can be managed by antithrombotic and related pharmacologic agents including antiviral and anti-inflammatory drugs.

MANAGEMENT OF SEVERE PREECLAMPSIA IN COMPLETE HEART BLOCK: A RARE COMBINATION

Complete heart block is rare during pregnancy. It may be congenital or acquired. There are no proper guidelines regarding its management, posing a great challenge for obstetricians .It is further compounded, if it is associated with severe preeclampsia. Normal physiological hemodynamics and cardiac changes pose challenges in the setting of cardiac lesions like congenital heart block .When it is associated with preeclampsia it has profound effects over the cardiac function. Pregnancy with rare combination of complete heart block and severe preeclampsia warrants cautious use of antihypertensive drugs and pacemaker implantation. Commonly used antihypertensives drugs like labetalol used as the rst line of treatment in preeclampsia is contraindicated in case of complete heart block. Here we present challenges faced and its management by a multidisciplinary team when a case of complete heart block associated with severe preeclampsia reported in emergency at term gestation

Cardiac-specific troponins in uncomplicated pregnancy and pre-eclampsia: A systematic review.

The risk of myocardial infarction (MI) increases during pregnancy, particularly in women with pre-eclampsia. MI is diagnosed by measuring high blood levels of cardiac-specific troponin (cTn), although this may be elevated in women with pre-eclampsia without MI, which increases diagnostic uncertainty. It is unclear how much cTn is elevated in uncomplicated and complicated pregnancy, which may affect whether the existing reference intervals can be used in pregnant women. Previous reviews have not investigated high-sensitivity troponin in pregnancy, compared to older, less sensitive methods. Electronic searches using the terms "troponin I" or "troponin T", and "pregnancy", "pregnancy complications" or "obstetrics". cTn levels were extracted from studies of women with uncomplicated pregnancies or pre-eclampsia. The search identified ten studies with 1581 women. Eight studies used contemporary methods that may be too insensitive to use reliably in this clinical setting. Two studies used high-sensitivity assays, with one reporting an elevation in troponin I (TnI) in pre-eclampsia compared to uncomplicated pregnancy, and the other only examining women with pre-eclampsia. Seven studies compared cTn between women with pre-eclampsia or uncomplicated pregnancy using any assay. Seven studies showed elevated TnI in pre-eclampsia compared to uncomplicated pregnancy or non-pregnant women. One study measured troponin T (TnT) in pregnancy but did not examine pre-eclampsia. TnI appears to be elevated in pre-eclampsia, irrespective of methodology, which may reflect the role of cardiac stress in this condition. TnI may be similar in healthy pregnant and non-pregnant women, but we found no literature reporting pregnancy-specific reference intervals using high-sensitivity tests. This limits broader application of cTn in pregnancy. There is a need to define reference intervals for cTn in pregnant women, which should involve serial sampling throughout pregnancy, with careful consideration for gestational age and body mass index, which cause dynamic changes in normal maternal physiology.

Sexual dimorphism in immunometabolism and autoimmunity: Impact on personalized medicine.

Immune cells play essential roles in metabolic homeostasis and thus, undergo analogous changes in normal physiology (e.g., puberty and pregnancy) and in various metabolic and immune diseases. An essential component of this close relationship between the two is sex differences. Many autoimmune diseases, such as systemic lupus erythematous and multiple sclerosis, feature strikingly increased prevalence in females, whereas in contrast, infectious diseases, such as Ebola and Middle East Respiratory Syndrome, affect more men than women. Therefore, there are fundamental aspects of metabolic homeostasis and immune functions that are regulated differently in males and females. This can be observed in sex hormone-immune interaction where androgens, such as testosterone, have shown immunosuppressive effects whilst estrogen is on the opposite side of the spectrum with immunoenhancing facilitation of mechanisms. In addition, the two sexes exhibit significant differences in metabolic regulation, with estrous cycles in females known to induce variability in traits and more pronounced metabolic disease phenotype exhibited by males. It is likely that these differences underlie both the development of metabolic and autoimmune diseases and the response to current treatment options. Sexual dimorphism in immunometabolism has emerged to become an area of intense research, aiming to uncover sex-biased effector molecules in the various metabolic tissues and immune cell types, identify sex-biased cell-type-specific functions of common effector molecules, and understand whether the sex differences in metabolic and immune functions influence each other during autoimmune pathogenesis. In this review, we will summarize recent findings that address these critical questions of sexual dimorphism in immunometabolism as well as their translational implications for the clinical management of autoimmune diseases.

924 Is the HScore predictive of mortality in obstetric patients admitted to the ICU with COVID-19?

With the continuing spread of the COVID-19 pandemic, much attention has been focused on the role of cytokine storm in patients most severely affected by the virus. The HScore was developed and validated for the diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH), a condition that shares a similar cytokine profile to severe COVID-19. However, no studies have been published that specifically look at the HScore in an obstetric COVID-19 population. Our goal for this study was to evaluate the utility of the HScore in predicting mortality in obstetric patients admitted to the intensive care unit (ICU) with COVID-19. Data were collected from women enrolled in a prospective observational study to assess the impact of COVID-19 on pregnancy. HScores for women admitted to the COVID-19 ICU between April 2020 and September 2020 were calculated. Student’s t test and Fisher’s exact test were used to assess data, p<0.05 was considered significant. Data are expressed as mean±standard deviation. 15 women qualified for this study with a median age of 28 years (range 19-42) and a mean BMI of 36 kg/m2 (range 21-64). Seventy three percent of these women were Black, 13.3% were American Indian, 6.6% were Hispanic and 6.6% were White. The mean HScore was 80.3±8.3. Sixty percent of women had HScores less than 90. Mortality was not associated with HScores90 were mortalities. The remaining 4 patients with HScore>90 were discharged from the hospital. Interestingly, the two mortalities did not have the highest HScores in our cohort. Our results show that an elevated HScore was not useful for predicting mortality in obstetric patients with COVID-19 who were admitted to the ICU. However, HScore<90 was associated with survival in our patient population. Further research is needed to evaluate the effects of the COVID-19 cytokine storm in the obstetric population. Application of the Hscore in the obstetric population may be misleading given the normal physiologic laboratory changes of pregnancy.

Role of centchroman versus danazol in treatment of benign breast disorders

Background: The breast is a dynamic structure that undergoes cyclical changes throughout the menstrual cycle. Any aberration from normal physiological changes in breast produces different problem in breast. Many drugs are used for treatment for these disorders like Danazol, Bromocriptine, Tamoxifen and LH-RH analogue but still no consensus for any drug is present.Methods: The aim of our study was to analyze the effectiveness of drug Centchroman and its comparison with Danazol in treatment of benign breast disorders in respect to symptoms relief, decrease in nodularity and lump size, recurrence, cost and side effects of drug. This prospective study was conducted on 250 patients of benign breast disorders attending surgical OPD between May 2018 to September 2019 in SMS medical college and Hospital, Jaipur.Results: Tolerance and improvements in symptoms in centchroman group was more than danazol (100% vs 92.8%) with less recurrence in former group. While side effects varied between the two groups with menstrual irregularities more common in centchroman group.Conclusions: The study shows that centchroman is safe, more effective and less expensive to Danazol for the treatment of benign breast disorders in long term.

To be or not to be: endothelial cell plasticity in development, repair, and disease.

Endothelial cells display an extraordinary plasticity both during development and throughout adult life. During early development, endothelial cells assume arterial, venous, or lymphatic identity, while selected endothelial cells undergo additional fate changes to become hematopoietic progenitor, cardiac valve, and other cell types. Adult endothelial cells are some of the longest-lived cells in the body and their participation as stable components of the vascular wall is critical for the proper function of both the circulatory and lymphatic systems, yet these cells also display a remarkable capacity to undergo changes in their differentiated identity during injury, disease, and even normal physiological changes in the vasculature. Here, we discuss how endothelial cells become specified during development as arterial, venous, or lymphatic endothelial cells or convert into hematopoietic stem and progenitor cells or cardiac valve cells. We compare findings from in vitro and in vivo studies with a focus on the zebrafish as a valuable model for exploring the signaling pathways and environmental cues that drive these transitions. We also discuss how endothelial plasticity can aid in revascularization and repair of tissue after damage- but may have detrimental consequences under disease conditions. By better understanding endothelial plasticity and the mechanisms underlying endothelial fate transitions, we can begin to explore new therapeutic avenues.

Структурно-функциональные изменения почек и их влияние на сердечно-сосудистый риск у пожилых пациентов

Like other organ systems, the kidneys also go through process of normal senescence, including both anatomical and physiological changes. Normal physiological aging is characterized by the expected age-related changes in the kidneys. With age, the kidneys are subject to structural changes, for example, there is a decrease in the number of functional glomeruli due to an increase in the prevalence of nephrosclerosis (atherosclerosis, glomerulosclerosis, atrophy of the tubules with interstitial fibrosis) and to some extent compensatory hypertrophy of the remaining nephrons. Older age is also associated with reduced cortical volume, increased medullary, and larger and more numerous renal cysts. Changes in normal aging are important in clinical practice. Against the background of suppression of reparative capabilities, the elderly are more prone to acute damage and chronic kidney disease, aggravation of the course of chronic kidney disease. The elderly have less renal functional reserve when they do actually develop chronic kidney disease and they are also at higher risk for acute kidney injury. Cardiovascular disease is a leading cause of death and a common comorbidity among patients with kidney disease. In this review, we have identified the most characteristic structural and functional changes in the kidneys in elderly patients and their impact on cardiovascular risk.

Physical physiological and biochemical changes during pregnancy

Pregnancy is associated various physiological changes in order to ensure care, support and protection of the developing embryo and also prepare mother for labour and delivery. These changes influence all physical, physiological, biochemical and immunological status of the mother. Normal physiological changes that are observed include missed period, nausea, fatigue, motion sickness, mood swings, bloating, and tenderness in breast while biochemical and immunological changes include change in levels of blood levels of certain parameters like urea, creatinine, human chorionic gonadotropin, localisation of immune-modulators in uterus etc. This review highlights the important changes taking place during normal pregnancy so that it may aid in educating the expectant mothers regarding such changes facilitate them to cope up with proper health care. Keywords: Pregnancy, Trimester, Foetus, Biochemical, Physiological, Physical, Immunity.

Evaluation of physiological changes and therapeutic approaches of hypertension in pregnancy

There are various physiological and pharmacokinetic changes occur in pregnancy to nurture the developing foetus, avoid toxicities, resistance to infections and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease and alter the kinetic parameters of the drugs. It is important to differentiate between normal physiological changes and disease pathology. This article highlights the important changes that take place during normal pregnancy, development of common conditions and pharmacokinetic variations. This review also will describe basic concepts in pharmacokinetics and their clinical relevance and highlight the variations in pregnancy that may impact the pharmacokinetic properties of medications, different treatment approaches, contraindications and drugs used in pregnancy&#x0D; Key words: Physiological changes in pregnancy, Hypertension, pregnancy disorders.

INFLUENCE OF MATERNAL MUSCLE ACTIVITY ON LABOR AND PREGNANCY OUTCOME

Physical activity in all stages of life maintains and improves cardio respiratory fitness, reduces the risk of obesity and associated comorbidities and results in greater longevity. Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modifications to exercise routines may be necessary because of normal anatomic, physiologic changes and fetal requirements. So, this is a hospital longitudinal study extended from January 2015 to August 2015 on 100 female subjects all are volunteers seen in first stage of labor of full-term pregnancy, 63 subjects are performing relatively maternal muscle activity and 37 female subjects are performing strenuous muscle activity are included in the study. Then all participants had their labor and new born outcomes evaluated through consultation of medical records. There were statistically significant differences between the two groups regarding duration of 2nd stage of labour, type of labour, Apgar score and placental separation whether early or late, but no significant difference between the two groups regarding complete or partial separation of placenta. Conclusion: Relatively maternal muscle activity of women is healthy and beneficial and is associated with less disturbance of pregnancy and labor outcomes, while on the other hand strenuous muscle activity is harmful being associated with many pregnancy complications such as prolonged second and third stage of labor, lower odds ratio of eutocic birth, statistically significant decrease in first and fifth minute APGAR score after labor, increased rate of Cesarean section and difficult vaginal delivery. Recommendation: All obstetricians, family medicine doctors and health care providers trained for advice and intervention to modify pregnant physical activity to adapt her life circumstances and her pregnancy issues. Further studies to examine association between maternal muscle activity and pregnancy and labor outcomes.

Comparison of Liver Function Tests in Normal Pregnancy with Non-pregnant Matched Controls

Background: Change of liver biochemical profiles is normal during pregnancy. It is almost impossible to understand disease processes that can threaten women during pregnancy without understanding normal physiological change. Aim of this study is to evaluate changes in serum liver function tests in normal pregnant women in first, second and third trimester.&#x0D; Material and Methods: The cross-sectional comparative study was carried out in the Department of Obstetrics &amp; Gynaecology of Rajshahi Medical College Hospital, Bangladesh in 2019. This study consists of 90 pregnant women and 90 matched control. Among the 90 pregnant women, 30 were in first trimester, 30 were in second trimester and 30 were in third trimester. Blood samples were taken for routine liver function and protein profiles&#x0D; Results: Serum total and direct bilirubin concentrations were significantly lower in second and third trimester. The mean ALP level was slightly increased in 2nd trimester and drastically increased in 3rd trimesters during pregnancy. Serum ALT and AST activity was significantly increased in third trimester. No significant change in serum total proteins concentration, but serum albumin concentration was significantly lower and serum globulin concentration was significantly higher in all three trimester. Serum albumin/globulin ratio was significantly reduced in second and third trimester.&#x0D; Conclusion: Relative values of various liver function tests during gestational trimesters appear to be the best guide to confirm the diagnosis and treatment strategies. Thus, gynecologists should routinely monitor liver function tests in all gestational trimesters to avoid the future complications to mother and offspring.&#x0D; TAJ 2020; 33(1): 17-24