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Objective Systemic lupus erythematosus (SLE) increases the risk of complications in pregnancy. Hydroxychloroquine (HCQ) decreases flares and neonatal lupus syndrome. Limited evidence suggests that HCQ also reduces preeclampsia and preterm birth in SLE pregnancies. We studied whether HCQ was associated with lower odds of preeclampsia and preterm delivery in SLE pregnancies. Study Design We conducted a retrospective cohort study of 129 deliveries of 110 patients with SLE delivered at a single institution (2000–2017). HCQ exposure and preeclampsia, along with other clinical data, were extracted from chart review. Crude and multivariable-adjusted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 41% were exposed to HCQ, of whom 13.5% were complicated by preeclampsia versus 26.3% unexposed to HCQ (adjusted OR = 0.5; 95% CI: 0.2–1.4). The difference was pronounced for first pregnancies (7 vs. 44%), but power was limited. The difference in preterm deliveries was less pronounced comparing HCQ-exposed pregnancies with HCQ-unexposed pregnancies (34 vs. 40.8%; OR = 0.3; 95% CI: 0.3–1.5). Conclusion Pregnant SLE patients trended toward less preeclampsia and preterm delivery when treated with HCQ. Future larger studies are needed to increase the statistical power, account for additional potential confounders, and more fully account for parity.

BACKGROUND Pregnant women are vulnerable to infection as their immune response is modulated. OBJECTIVE Serum biomarkers are used to diagnose and manage severe infections, but data on their utility during labor are limited. We compared lactate and procalcitonin levels in women with and without an intraamniotic infection to determine whether they are useful biomarkers for infection during labor. STUDY DESIGN We performed a prospective, observational cohort study of term, singleton pregnancies admitted with planned vaginal delivery in 2019 at a university medical center. The lactate and procalcitonin levels were determined during early labor, within 2 hours following delivery, and on postpartum day 1. Women with an intraamniotic infection in addition had their lactate and procalcitonin levels determined following an intraamniotic infection diagnosis. Samples were processed immediately in the hospital clinical laboratory. The primary outcome was the mean lactate level following delivery. The secondary outcomes were the lactate and procalcitonin levels at other time points. Comparisons based on infection status were performed using multivariate linear regressions. RESULTS A total of 22 women with intraamniotic infection and 29 uninfected women were included. The mean early labor lactate level (1.47 vs 1.49 mmol/L) and mean procalcitonin level (0.048 vs 0.039 ng/mL) did not differ and were normal in the uninfected and intraamniotic infection groups. The mean lactate level was highest following delivery for women in both the uninfected and intraamniotic infection groups (2.00 vs 2.33 mmol/L; adjusted P=.08; 95% confidence interval, 0.98–1.53). The lactate level returned to normal by postpartum day 1 and did not differ significantly based on the infection status at any time point in the adjusted models. The procalcitonin level following delivery was higher among women with vs without an intraamniotic infection (0.142 vs 0.091 ng/mL; adjusted P=.03). The procalcitonin level rose further in both the intraamniotic infection and uninfected groups on postpartum day 1 (0.737 vs 0.408 ng/mL; adjusted P=.05). CONCLUSION The lactate level is not significantly elevated in pregnant women with an intraamniotic infection above the physiological increase that is observed in women without infection at delivery. The procalcitonin level is elevated at delivery in women with an intraamniotic infection and warrants further investigation as a peripartum infection marker.

To assess the accuracy of different sonographic estimated fetal weight (EFW) cutoffs, and combinations of EFW and biometric measurements for predicting small for gestational age (SGA) in fetal gastroschisis.Gastroschisis cases from two centers were included. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated for different EFW cutoffs, as well as EFW and biometric measurement combinations.Seventy gastroschisis cases were analyzed. An EFW10% had 94% sensitivity, 43% specificity, 33% PPV and 96% NPV for SGA at delivery. Using an EFW cutoff of5% improved the specificity to 63% and PPV to 41%, but decreased the sensitivity to 88%. Combining an abdominal circumference (AC) or femur length (FL) z-score less than -2 with the total EFW improved the specificity and PPV but decreased the sensitivity.A combination of a small AC or FL along with EFW increases the specificity and PPV, but decreases the sensitivity of predicting SGA.

The aim of this study was to describe risks of systemic lupus erythematosus (SLE) in pregnancy and the importance of preconception counselling, medication optimization and close surveillance.Advances in care for pregnant patients with SLE have led to improved obstetric outcomes, but maternal and foetal risks continue to be elevated. Conception during periods of disease quiescence and continuation of most medications decrease adverse pregnancy outcomes. Hydroxychloroquine (HCQ) appears protective against flares in pregnancy, neonatal congenital heart block and preterm birth.SLE in pregnancy confers increased maternal and foetal risks, including disease flares, preeclampsia, preterm birth, foetal growth restriction, neonatal lupus erythematosus (NLE) and congenital heart block. Disease control on an effective medication regimen mitigates many of these risks, but pregnancy in women with SLE remains a high-risk condition requiring multidisciplinary care and an individualized approach to each patient.

Objectives Neonates with gastroschisis are often small for gestational age (SGA) based on population nomograms. Our objective was to evaluate the effect of SGA on perinatal and neonatal outcomes in cases of gastroschisis. Methods This is a retrospective study of neonates with prenatally diagnosed gastroschisis from two academic centers between 2008 and 13. Perinatal and neonatal outcomes of neonates with SGA at birth were compared with appropriate-for-gestational-age (AGA) neonates. The primary composite outcome was defined as any of the following: neonatal sepsis, short bowel syndrome at discharge, prolonged mechanical ventilation (upper quartile for the cohort), bowel atresia or death. Results We identified 112 cases of gastroschisis, 25 of whom (22%) were SGA at birth. There were no differences in adverse peripartum outcomes between SGA and AGA infants. No difference was found in the primary composite neonatal outcome (52% vs 36%, p = 0.21), but SGA infants were more likely to have prolonged mechanical ventilation (44% vs 22%, p = 0.04) and prolonged length of stay (LOS) (52% vs 22%, p = 0.007). After adjusting for GA at delivery, SGA remained associated with prolonged LOS (OR = 4.3, CI: 1.6–11.8). Conclusion Among infants with gastroschisis, SGA at birth is associated with a fourfold increase in odds for prolonged LOS, independent of GA. © 2015 John Wiley & Sons, Ltd.

To investigate the association between small-for-gestational age (SGA) and neurocognitive impairment at 2 years of corrected age among infants born at preterm gestational ages.A secondary analysis of a prospectively conducted NICHD/Maternal-Fetal Medicine Units BEAM trial. Non-anomalous pregnancies delivered before 37 weeks of gestation were included in the analysis. Neurocognitive outcomes at 2 years of corrected age were compared between infants who were SGA (10% for gestational age) and those appropriately grown (AGA). The primary outcome was a severe or moderate neurocognitive impairment at 2 years of corrected age among survivors, defined as either mental (MDI) or psychomotor (PDI) developmental index score70 for severe and85 for moderate impairment.Of 2299 preterm neonates 67 (3%) were SGA. SGA infants were more often twin pregnancies (31% vs 17%, P=0.003) and delivered more often by cesarean section (63% vs 40%, P0.001) at similar gestational ages (30.0±2.6 vs 29.5±2.8 weeks, P=0.11). At 2 years of corrected age, SGA and AGA survivors had similar rates of neurocognitive impairment (MDI70: 18% vs 18%, P=1.0; MDI85: 44% vs 46%, P=0.96; PDI70: 20% vs 15%, P=0.51; PDI85: 40% vs 34%, P=0.48).In this cohort, SGA at preterm gestational ages was associated with similar rates of neurocognitive impairment at two years of corrected age among surviving infants.

Non-technicalsummaryUsually nicotinic receptors in the central nervous system only influence the strength of a signal between neurons. At a few critical connections, for instance some of those involved in the flight response, nicotinic receptors not only modulate the signal, they actually determine whether a signal is conveyed or not. We show at one of the few such connections accessible for study, up to three different nicotinic receptor subtypes mediate the signal. The subtypesappeartobeclusteredinseparatelocations.Dependingonthenumberandcombination of the subtypes present the signal can range from short to long duration and from low to high amplitude.Thisprovidesacriticalconnectionwithabuilt-inplasticityandmayenableittoadapt to a changing environment. Abstract In this study, fast synaptic transmission at vertebrate CNS connections mediated by several different nicotinic ACh receptors (nAChRs) was investigated with paired recordings from pre- and postsynaptic neurons. Analysis of the response kinetics at the axo-axonic connections between the Mauthner (M-) axon and cranial relay neurons (CRN) indicates up to three main componentsarepresentandcanbecharacterizedbyfast, ∼1.5ms,intermediate, ∼6msandslow, ∼15ms, decay time constants. Further analysis indicates most responses have multiexponential decays and each response falls into one of six classes dependent on the weight and combination of kinetic components. Pharmacological results suggest that up to three nAChRs, α7 ∗ , α3β2 ∗ and α3β4 ∗ ,mediatethepostsynapticresponsesandcorrespondtothefast,intermediateandslowdecay components, respectively. The fast decay component is blocked by ∼35nM methyllycaconitine (MLA), 100 nM α-bungarotoxin (α-Btx) or 150 nM α-conotoxin (α-Ctx) ArIB. The intermediate decay component is blocked by 2 μM dihydro-beta-erythroidine (DHβE) or 200 nM α-Ctx GIC. The slow decay component is blocked by 10 μM α-Ctx AuIB, but not by 7.25 μM DHβE. Intriguingly, the mEPSPs (minis) at connections with evoked EPSPs best fitted by multiple exponentials, were not composite; rather, there were multiple populations of minis, each with single exponential decay times corresponding to those of the different evoked EPSP components. Thisindicatesthatthedifferentreceptorsaretopographicallysegregatedattheconnectionbetween the M-axon and CRN axon. These results suggest that, as with glutamate, fast nicotinic synaptic transmission in the CNS can be mediated by multiple receptors in the same postsynaptic neuron. The coexistence of EPSPs of different durations may have implications for network function and plasticity.

SUMMARYStartle behaviors in teleost fishes are well suited for investigations of mechanisms of sensorimotor integration because the behavior is quantifiable and much of the underlying circuitry has been identified. The teleost C-start is triggered by an action potential in one of the two Mauthner (M) cells. To correlate C-start behavior with electrophysiology, extracellular recordings were obtained from the surface of the medulla oblongata in the hindbrain,close to the M-axons, in freely swimming goldfish monitored using high-speed video. The recordings included action potentials generated by the two M-axons,as well as neighboring axons in the dorsal medial longitudinal fasciculus. Axonal backfills indicated that the latter originate from identifiable reticulospinal somata in rhombomeres 2-8 and local interneurons. Diverse auditory and visual stimuli evoked behaviors with kinematics characteristic of the C-start, and the amplitude of the first component of the hindbrain field potential correlated with the C-start direction. The onset of the field potential preceded that of the simultaneously recorded trunk EMG and movement initiation by 1.08±0.04 and 8.13±0.17 ms, respectively. A subsequent longer latency field potential was predictive of a counterturn. These results indicate that characteristic features of the C-start can be extracted from the neural activity of the M-cell and a population of other reticulospinal neurons in free-swimming goldfish.

In this study, fast synaptic transmission at vertebrate CNS connections mediated by several different nicotinic ACh receptors (nAChRs) was investigated with paired recordings from pre- and postsynaptic neurons. Analysis of the response kinetics at the axo-axonic connections between the Mauthner (M-) axon and cranial relay neurons (CRN) indicates up to three main components are present and can be characterized by fast, ∼1.5 ms, intermediate, ∼6 ms and slow, ∼15 ms, decay time constants. Further analysis indicates most responses have multiexponential decays and each response falls into one of six classes dependent on the weight and combination of kinetic components. Pharmacological results suggest that up to three nAChRs, α7*, α3β2* and α3β4*, mediate the postsynaptic responses and correspond to the fast, intermediate and slow decay components, respectively. The fast decay component is blocked by ∼35 nm methyllycaconitine (MLA), 100 nmα-bungarotoxin (α-Btx) or 150 nmα-conotoxin (α-Ctx) ArIB. The intermediate decay component is blocked by 2 μm dihydro-beta-erythroidine (DHβE) or 200 nmα-Ctx GIC. The slow decay component is blocked by 10 μmα-Ctx AuIB, but not by 7.25 μm DHβE. Intriguingly, the mEPSPs (minis) at connections with evoked EPSPs best fitted by multiple exponentials, were not composite; rather, there were multiple populations of minis, each with single exponential decay times corresponding to those of the different evoked EPSP components. This indicates that the different receptors are topographically segregated at the connection between the M-axon and CRN axon. These results suggest that, as with glutamate, fast nicotinic synaptic transmission in the CNS can be mediated by multiple receptors in the same postsynaptic neuron. The coexistence of EPSPs of different durations may have implications for network function and plasticity.