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Preterm birth is the leading cause of neonatal and child mortality worldwide. Globally, 1.4 million pregnant women are estimated to be living with HIV/AIDS, the majority of whom live in sub-Saharan Africa. Maternal HIV infection and antiretroviral treatment (ART) have been associated with increased rates of preterm birth, but the underlying mechanisms remain unknown. Acute HIV infection is associated with a rapid depletion of all three subsets of innate lymphoid cells (ILCs), ILC1s, ILC2s and ILC3s, which is not reversed by ART. ILCs have been found at the maternal–fetal interface and we therefore investigated the potential association between maternal HIV infection, peripheral ILC frequencies and preterm birth. In our study of pregnant South African women with accurately dated pregnancies, we show that maternal HIV infection is associated with reduced levels of all three ILC subsets. Preterm birth was also associated with lower levels of all three ILC subsets in early pregnancy. ILC frequencies were lowest in HIV positive women who experienced preterm birth. Moreover, ILC levels were reduced in pregnancies resulting in spontaneous onset of preterm labour and in extreme preterm birth (< 28 weeks gestation). Our findings suggest that reduced ILC frequencies may be a link between maternal HIV infection and preterm birth. In addition, ILC frequencies in early pregnancy may serve as predictive biomarkers for women who are at risk of delivering preterm. [ABSTRACT FROM AUTHOR]

Objectives: Influenza infection is a significant cause of respiratory morbidity among pregnant women. Seasonal influenza vaccination engages innate immune receptors to promote protective immunity. A coding polymorphism (R620W) in PTPN22 imparts elevated risk for human infection and autoimmune disease, predisposes to diminished innate immune responses, and associates with reduced immunization responses. We sought to quantify the effects of PTPN22-R620W on humoral and cell-mediated immune responses to the inactivated influenza vaccine among healthy pregnant women. Study Design: Immune responses were measured in healthy pregnant R620W carrier (n = 17) and non-carrier (n = 33) women receiving the 2013 quadrivalent inactivated influenza vaccine (Fluzone). Hemagglutination inhibition assays were performed to quantify neutralizing antibodies; functional influenza-reactive CD4 T cells were quantified by flow cytometry, and influenza-specific CD8 T cells were enumerated with MHC Class I tetramers. Antibody seroconversion data were evaluated by Chi-square analysis, and the Mann-Whitney or Wilcoxon signed-rank tests were applied to T cell response data. Results: PTPN22 R620W carrier (n = 17) and non-carrier (n = 33) groups did not differ in age, parity, BMI, gestational age at time of vaccine, or history of prior influenza vaccination. After Fluzone exposure, 51.5% of non-carriers met criteria for antibody seroconversion to H1N1 influenza, compared with 23.5% of R620W carriers (p = 0.06). Influenza-reactive CD4 T cells showed modest increase at days 9–15 after vaccination in both R620W carriers and non-carriers (p = 0.02 and p = 0.04, respectively). However, there was no difference in overall response between the two groups (p = 0.6). The vaccine did not result in significant induction of influenza-specific CD8 T cells in either group. Conclusions: There was no significant difference among healthy pregnant R620W carriers and non-carriers in H1N1 antibody seroconversion rates after influenza vaccination. Studies of larger cohorts will be needed to define the effect of PTPN22 risk allele carriage on antibody and T cell responses to influenza vaccination during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Asthma and pregnancy are both sources of anxiety for women. Although there has been a focus on physiological management of asthma and pregnancy, there has been little research on the impact that personalised support can have on asthma care during pregnancy. This systematic review and narrative synthesis of the literature set out to answer the question 'What are women's experiences of asthma care, its management and education, during pregnancy?'Methods: This systematic review was carried out using accepted methodology from the York Centre for Reviews and Dissemination. Electronic database searches were conducted using PsycInfo, CINAHL, MedLine, Google Scholar and the Cochrane Library, using the combination search terms: 'Asthma' AND 'Pregnancy' AND 'Care' AND ('Education OR Information OR Experience'). Hand searching of journals and searches for grey literature were also undertaken. Independent quality appraisal by the three authors took place using the criteria detailed by Kmet et al. (Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields, 2004).Results: All papers scoring in excess of 60% were deemed to be of adequate quality for inclusion, of which there were five: two qualitative designs and three quantitative designs. The designs were too methodologically heterogeneous to permit statistical meta-analysis so narrative review and synthesis was undertaken. Despite an embryonic evidence bases, it is reasonable to conclude that personalised care has beneficial outcomes for pregnant asthmatic women.Conclusions: Larger randomised controlled trials investigating personalised care are required to build an evidence base which can establish the efficacy of such interventions. [ABSTRACT FROM AUTHOR]

Background Maternal asthma has been associated with adverse pregnancy outcomes. Little is known about the influence of other atopic diseases on pregnancy outcomes. We assessed how various maternal atopic diseases might affect preterm birth, stillbirth, and neonatal death. Methods By linking Norwegian national registries, we acquired information on maternal health, socio-demographic factors, pregnancy, birth, and neonatal outcome on all births in Norway from 1967 to 2003. Results A total of 1 974 226 births were included. Of these, 1.8% had a record of maternal asthma, 3.4% of maternal atopic dermatitis, and 0.4% of maternal allergic rhinoconjunctivitis. Overall rates of preterm birth, stillbirth, and neonatal death were 6.0%, 0.6%, and 0.5%, respectively. After adjustments for possible confounders, maternal asthma was associated with increased risk of preterm birth (relative risk ( RR), 1.15, [95% confidence interval ( CI) 1.10, 1.21]). In contrast, maternal atopic dermatitis was associated with decreased risk of preterm birth ( RR 0.90, [95% CI 0.86, 0.93]), stillbirth ( RR 0.70, [95% CI 0.62, 0.79]), and neonatal death ( RR 0.76, [95% CI 0.65, 0.90]). Similarly, maternal allergic rhinoconjunctivitis was associated with decreased risk of preterm birth ( RR 0.84, [95% CI 0.76, 0.94]) and stillbirth ( RR 0.40, [95% CI 0.25, 0.66]). Conclusions We confirmed the previously reported association of maternal asthma with increased risk for preterm birth. Unexpectedly, maternal atopic dermatitis and allergic rhinoconjunctivitis were associated with decreased risk of preterm birth and stillbirth. Mechanisms for these protective associations are unclear, and our findings require confirmation in further studies. [ABSTRACT FROM AUTHOR]

Background: The approach not to screen thyroid function of all pregnant women is mainly based on conflicting evidence of whether treatment of women with mild hypothyroidism is beneficial. However, there is consensus that all women with overt hypothyroidism (OH) and those with a thyrotropin (TSH) >10 mIU/L should be treated immediately, but data on these conditions are scarce. We assessed the prevalence of OH and a TSH >10 mIU/L during the first trimester of pregnancy. Methods: Thyroid function was assessed at 10-12 weeks gestation in 4199 Dutch Caucasian healthy pregnant women from three studies conducted in 2002, 2005, and 2013 from the same iodine sufficient area in the southeast of The Netherlands. We defined the first trimester specific cutoffs (2.5th-97.5th percentile) for TSH and free thyroxine (fT4) in thyroid peroxidase antibody (TPO-Ab) negative women in each study to determine the prevalence of women with OH and those with a TSH >10 mIU/L. We extrapolated these figures to the pregnant population of 2012 in The Netherlands, the United Kingdom, and the United States. Results: The prevalence of OH or a TSH >10 mIU/L in these 4199 women was 26 (0.62%) of whom 96% had (highly) elevated TPO-Ab titers. Based on the birth figures of 2012, if all pregnant women from The Netherlands, the United Kingdom or the United States were screened, the conservative annual number of cases would be 1000, 4500, and 25,000 respectively. However, the United Kingdom and parts of the United States have recently been demonstrated to be iodine deficient, which will result in even higher numbers. Conclusion: Our findings show that the discussion concerning thyroid screening during pregnancy should be based on data of overt hypothyroidism in healthy pregnant women. Screening of thyroid function is not expensive because all pregnant women have a standardized blood sample test at 8-12 weeks' gestation. Positive patients largely benefit from a cheap, safe, and effective treatment. [ABSTRACT FROM AUTHOR]

Background While reviews have been published on asthma management in pregnant women, none has examined the effectiveness of non-pharmacological healthcare interventions for optimizing asthma management in pregnant women. This systematic review aims to identify nonpharmacological healthcare interventions for optimizing asthma management during pregnancy and to examine their effects on maternal asthma control and neonatal outcomes. Methods The Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL Plus and International Pharmaceutical Abstracts (IPA) were searched. Two reviewers independently assessed the identified studies against the eligibility criteria and extracted relevant information. The effects of the intervention were assessed qualitatively. Results Nine studies were identified, of which six were rejected according to the exclusion criteria. The three studies included in the final review described an education program, progressive muscle relaxation (PMR) and Fraction of exhaled Nitric Oxide (FeNO) guided management of asthma in pregnant women. The PMR and FeNO-guided interventions showed significant improvements in maternal asthma control (lung function and quality of life) and neonatal outcomes (birth weight). Conclusions Further evidence from well-designed studies evaluating non-pharmacological healthcare interventions for optimizing asthma management in pregnant women is required. [ABSTRACT FROM AUTHOR]

Abstract: Background: Primary CMV infections in pregnancy are usually asymptomatic and only detected by serology. Estimating the onset of infection is a major diagnostic goal, since primary infections around conception and in early gestation hold a higher risk for congenital disease than those in later pregnancy. Objectives: To assess the ability of serological supplementary CMV assays to date the onset of primary infection. Study design: From our routine diagnosis we identified 61 pregnant women (n =188 serum samples) with precisely determined onset of CMV primary infection either by IgG seroconversion (n =24) or by significant IgG antibody rise (n =37). One hundred and forty-seven sera were investigated using the VIDAS® CMV IgG avidity EIA (BioMèrieux) and 83 sera using the recomBlot CMV IgG with avidity (Mikrogen). Results: Both assays proofed to be reliable in terms of timing the onset of CMV primary infection. An avidity index (AI) in the VIDAS avidity EIA of <40% indicated primary infection within the last 20 weeks (positive predictive value 93.4%; 99/106), whereas an intermediate AI excluded primary infection within the last 12 weeks (negative predictive value 88.2%; 15/17). The recomBlot showed high reliability (PPV 96.9%; 31/33) for timing the onset of infection within the last 14 weeks. Avidity testing by blot however could not be interpreted in 11 of 47 sera (23.4%). Conclusion: For timing the onset of infection (before or in early pregnancy) CMV avidity testing is most helpful if carried out within the first trimester up to the beginning of second trimester. [Copyright &y& Elsevier]

A literature survey on primary antiphospholipid syndrome was conducted in order to provide an updated information as reference tool to guide diagnostic and therapeutic actions, aimed at treating pregnant women with this autoimmune disease and at decreasing not only the incidence of the thromboembolic disease in pregnancy, but also the pregnancy loss, preeclampsia, uterine growth retardation, which will contribute to the reduction of maternal and perinatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Study Objective To describe changes in inhaled corticosteroid use during pregnancy and markers of uncontrolled asthma, and to evaluate the association between them. Design Population-based, cross-sectional study. Data Source Three administrative claims databases in Québec, Canada. Patients A cohort of 4434 asthmatic women (4920 pregnancies) who delivered their infants between 1990 and 2002 and who used inhaled corticosteroids before their pregnancy. Measurements and Main Results The average daily doses of inhaled corticosteroids during pregnancy and during the 9 months before conception were compared; the change in use was categorized as discontinuation (reduction of ≥75%), reduction (26-75% reduction), no change (±25% change), or increase (increase of ≥25%). The markers of uncontrolled asthma included at least one asthma exacerbation and the use of three or more doses/week of a short-acting β2-agonist during pregnancy. Generalized estimating equation models were used for statistical analyses. In nearly 50% of the pregnancies (2388 [48.5%] of 4920), the women either stopped or reduced their doses of corticosteroid during pregnancy, and these doses were already quite low before pregnancy. The proportion of women who had an asthma exacerbation during pregnancy was 8.2% among women who discontinued corticosteroids and greater than 20% in all of the other groups. All of the groups used frequent doses of short-acting β2-agonists. Discontinuing inhaled corticosteroid use during pregnancy was associated with a lower risk of exacerbations (odds ratio [ OR] 0.42, 95% confidence interval [ CI] 0.33-0.54), whereas increasing inhaled corticosteroid use was associated with a higher risk ( OR 1.42, 95% CI 1.17-1.72), compared with no change in use. Conclusion Because of residual confounding by asthma severity, our study was not able to show that women who stopped inhaled corticosteroids during pregnancy were at increased risk of having an asthma exacerbation. However, women who stopped corticosteroids tended to have a milder form of asthma, which is reassuring and suggests that women can recognize, to a certain extent, the need to continue taking their controller agents if necessary. [ABSTRACT FROM AUTHOR]

Background: Health systems that deliver prevention of mother to child transmission (PMTCT) services in low and middle income countries continue to underperform, resulting in thousands of unnecessary HIV infections of newborns each year. We used a combination of approaches to health systems strengthening to reduce transmission of HIV from mother to infant in a multi-facility public health system in South Africa. Methodology/Principal Findings: All primary care sites and specialized birthing centers in a resource constrained sub-district of Cape Metro District, South Africa, were enrolled in a quality improvement (QI) programme. All pregnant women receiving antenatal, intrapartum and postnatal infant care in the sub-district between January 2006 and March 2009 were included in the intervention that had a prototype-innovation phase and a rapid spread phase. System changes were introduced to help frontline healthcare workers to identify and improve performance gaps at each step of the PMTCT pathway. Improvement was facilitated and spread through the use of a Breakthrough Series Collaborative that accelerated learning and the spread of successful changes. Protocol changes and additional resources were introduced by provincial and municipal government. The proportion of HIV-exposed infants testing positive declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and postnatal HIV testing from 79% to 95%) compared to baseline. Conclusions/Significance: System improvement methods, protocol changes and addition/reallocation of resources contributed to improved PMTCT processes and outcomes in a resource constrained setting. The intervention requires a clear design, leadership buy-in, building local capacity to use systems improvement methods, and a reliable data system. A systems improvement approach offers a much needed approach to rapidly improve under-performing PMTCT implementation programmes at scale in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

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The authors comments on a research on no activation of microglial cells in the embryo due to maternal immune activation (MIA) by polyinosinic-polycytidylic acid (poly I:C) by S. Smolders and colleagues, published in a 2015 issue of the periodical. Topics discussed include effect of lipopolysaccharide (LPS) and poly I:C on activation of microglia, induction of developmental abnormalities due to direct action of poly I:C on neural development, and effect of poly I:C on astrocytes.

The article discusses the management of rhesus alloimmunization in pregnancy. Diagnostic methods for rhesus alloimmunization include middle cerebral artery Doppler, maternal titer and fetal blood sampling. As a general rule, the patient's first RhD-sensitized pregnancy involves minimal fetal/neonatal disease and subsequent gestations are associated with a worsening degree of anemia. Intrauterine transfusion is a recommended therapeutic option.

Background: Invasive techniques such as amniocentesis and cordocentesis are used for diagnosis and treatment in fetuses at risk for anemia due to maternal red-cell alloimmunization. The purpose of our study was to determine the value of noninvasive measurements of the velocity of blood flow in the fetal middle cerebral artery for the diagnosis of fetal anemia.Methods: We measured the hemoglobin concentration in blood obtained by cordocentesis and also the peak velocity of systolic blood flow in the middle cerebral artery in 111 fetuses at risk for anemia due to maternal red-cell alloimmunization. Peak systolic velocity was measured by Doppler velocimetry. To identify the fetuses with anemia, the hemoglobin values of those at risk were compared with the values in 265 normal fetuses.Results: Fetal hemoglobin concentrations increased with increasing gestational age in the 265 normal fetuses. Among the 111 fetuses at risk for anemia, 41 fetuses did not have anemia; 35 had mild anemia; 4 had moderate anemia; and 31, including 12 with hydrops, had severe anemia. The sensitivity of an increased peak velocity of systolic blood flow in the middle cerebral artery for the prediction of moderate or severe anemia was 100 percent either in the presence or in the absence of hydrops (95 percent confidence interval, 86 to 100 percent for the 23 fetuses without hydrops), with a false positive rate of 12 percent.Conclusions: In fetuses without hydrops that are at risk because of maternal red-cell alloimmunization, moderate and severe anemia can be detected noninvasively by Doppler ultrasonography on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery. [ABSTRACT FROM AUTHOR]

Gestational pemphigoid, a rare autoimmune skin disease typically occurring during pregnancy, is caused by autoantibodies against collagen XVII. Clinically it is characterised by severe itching followed by erythematous and bullous lesions of the skin. Topical or oral glucocorticoids usually relieve symptoms, but in more severe cases systemic immunosuppressive treatments are needed. Data on immunosuppressive medication controlling gestational pemphigoid are sparse. We report 3 intractable cases of gestational pemphigoid treated with cyclosporine. [ABSTRACT FROM AUTHOR]

Provides information on a study which reported a survey of physicians in Thailand regarding treatment and care of pregnant women with HIV infection. Emphasis on the use of zidovudine treatment; Factors associated with advocation of pregnancy termination for HIV-infected pregnant women; Limitations of the study.

The course of asthma during pregnancy may be affected by maternal physiological changes and triggers of asthma such as viral infections, exposure to allergens, and nonadherence with therapy. If asthma is uncontrolled, there are recognized harmful effects not only to the mother but also to the fetus. However, with effective asthma control, most women have outcomes, at or near that of the general population. Many medications are considered appropriate for use in pregnancy including inhaled corticosteroids (ICSs) such as budesonide, beclomethasone dipropionate, and fluticasone and the leukotriene receptor antagonists montelukast and zafirlukast. When ICSs or ICS/long-acting beta2-adrenergic agonist combinations are not effective during exacerbations of asthma, short courses of oral corticosteroids should be administered earlier rather than later. Spirometry and flow volume loop tracings are useful measures of pulmonary function for gravidas. Results may be compared with nonpregnant reference values. Vocal cord dysfunction may be suspected when the inspiratory loop is truncated. The gravida does not reject the fetus because of lack of vascular continuity, a trophoblast layer causing separation, and suppressive mechanisms at the placental interface. The secretion of IL-10 increases in pregnancy and is lower in women with recurrent spontaneous abortions. Only immunoglobulin G (IgG) subclasses are transported across the placenta, especially IgG1, IgG3, and IgG4. Fetal B cells can produce endogenous IgE by 20 weeks of gestation. [ABSTRACT FROM AUTHOR]

Allergy has a very strong hereditary component but even in identical twins, concordance for the development of allergic disease can be as low as 50%. This suggests that there is a very strong environmental influence on manifestations of sensitization. To what extent environment might have an influence on the ontogeny of sensitization antenatally has hitherto not been a focus of much research. However, circumstantial evidence suggests that this may be important. [ABSTRACT FROM AUTHOR]

The authors explore on the early-life origins of allergic disease during the postnatal period of pregnancy. They highlight the importance of allergy management in childhood to prevent major allergic syndromes. The authors mention the increase rate of allergic conditions worldwide related to the early-life environment of the new generation of adult immigrants from countries with low rates of allergic diseases than to those with the higher prevalence but low risk of the diseases.

The article reports on research on asthma during pregnancy which was conducted by physician Peter Gibson of the University of Newcastle in New South Wales, Australia. Gibson's research found that asthma exacerbations during pregnancy declined 50% in patients who were managed by a clinical algorithm that was guided by exhaled nitric oxide and that the time to first exacerbation was significantly prolonged in patients who were managed by the fraction of exhaled nitric oxide (FENO) algorithm, associated with a hazard ratio of 0.565.

The article discusses various reports published within the issue including one on the management of group A streptococcal puerperal sepsis, one on HIV during pregnancy, and another on sexually transmitted infections (STI) in pregnancy.

Focuses on the treatment for women with HIV. Response of women with drug-resistant viruses to the antiretroviral nevirapine; Effect of drug in combination with nevirapine on women and her unborn child; Details of information on the arguments of health personnel on the effects of nevirapine to both mothers and her unborn child.