A Flöck

Antiplatelet effects of antidepressant treatment: a randomized comparison between escitalopram and nortriptyline.

INTRODUCTION Depressive disorders have been identified as independent risk factors for coronary heart disease. The present study (i) compared platelet function of depressed patients with that of healthy controls, (ii) analysed possible aggregability changes during 3 months of treatment with antidepressants, and (iii) sought to assess different effects of escitalopram and nortriptyline on platelet aggregation. METHODS Blood samples of 91 major depressed patients and 91 healthy controls were analysed with whole blood aggregometry in a case-control setting. Depressed patients were randomized to two groups treated either with escitalopram (n=47) or nortriptyline (n=44). Platelet aggregation was studied on days 0, 1, 3, 7, 14, 21, 84 of continuing medication and was determined in response to adenosine diphosphate (ADP) and collagen. RESULTS Platelet aggregation induced by ADP was increased among depressive patients compared with that of healthy controls (26%, p=0.006). With antidepressant treatment, changes in platelet aggregation remained comparable in both groups at early time points (d1 to 21). In contrast, at day 84, patients with antidepressive response revealed significant differences in both medication groups: Patients receiving escitalopram showed a 23% decrease of ADP induced aggregation (p=0.03) and a 15% decrease of collagen induced aggregation (p=0.03). With nortriptyline the increase in impedance was reduced by 29% after ADP induction (p=0.046). CONCLUSION Depressed patients have higher ex vivo platelet aggregation that may contribute to increased cardiovascular morbidity. After three months of antidepressant treatment with either escitalopram or nortriptyline, platelet aggregation was significantly reduced in antidepressant responders, irrespective of the antidepressant medication type.

Determinants of brain-derived neurotrophic factor (BDNF) in umbilical cord and maternal serum.

OBJECTIVE Brain-derived neurotrophic factor (BDNF) plays a fundamental role in brain development; additionally, it is involved in various aspects of cerebral function, including neurodegenerative and psychiatric diseases. Involvement of BDNF in parturition has not been investigated. The aim of our study was to analyze determinants of umbilical cord BDNF (UC-BDNF) concentrations of healthy, term newborns and their respective mothers. METHODS This cross-sectional prospective study was performed at a tertiary referral center. Maternal venous blood samples were taken on admission to labor ward; newborn venous blood samples were drawn from the umbilical cord (UC), before delivery of the placenta. Analysis was performed with a commercially available immunoassay. Univariate analyses and stepwise multivariate regression models were applied. RESULTS 120 patients were recruited. UC-BDNF levels were lower than maternal serum concentrations (median 641 ng/mL, IQR 506 vs. median 780 ng/mL, IQR 602). Correlation between UC- and maternal BDNF was low (R=0.251, p=0.01). In univariate analysis, mode of delivery (MoD), gestational age (GA), body mass index at delivery, and gestational diabetes were determinants of UC-BDNF (MoD and smoking for maternal BDNF, respectively). Stepwise multivariate regression analysis revealed a model with MoD and GA as determinants for UC-BDNF (MoD for maternal BDNF). CONCLUSIONS MoD and GA at delivery are determinants of circulating BDNF in the mother and newborn. We hypothesize that BDNF, like other neuroendocrine factors, is involved in the neuroendocrine cascade of delivery. Timing and mode of delivery may exert BDNF-induced effects on the cerebral function of newborns and their mothers.

Monochorionic diamniotic in vitro fertilization twins have a decreased incidence of twin-to-twin transfusion syndrome

OBJECTIVE To compare the incidence of twin-to-twin transfusion syndrome (TTTS) in spontaneous versus IVF-conceived twin pregnancies. DESIGN Retrospective multicenter study. SETTING University-affiliated tertiary medical centers. PATIENT(S) Women admitted for 11-14 weeks scan between January 1997 and July 2013 who were diagnosed with monochorionic (MC) diamniotic twin pregnancies. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Mode of conception, TTTS. RESULT(S) The study cohort included 327 pregnant women with live MC diamniotic twins. Of them, 284 (86.9%) and 43 (13.1%) were spontaneous and IVF conceived, respectively. The mean maternal age was significantly higher in IVF compared with in spontaneously conceived pregnancies (33.8 ± 5.5 vs. 31.6 ± 5.4, respectively). Thirty-seven twins (11.3%) had TTTS, of whom 36/284 (12.7%) versus 1/43 (2.3%) were spontaneously and IVF conceived, respectively. The mean week of delivery was significantly lower in MC twins diagnosed with TTTS compared with those without TTTS (32.7 ± 3.3 vs. 35.5 ± 2.5, respectively). Furthermore, there was a significantly higher birthweight discordancy in twins diagnosed with TTTS compared with those without (20.6% vs. 11%, respectively). CONCLUSION(S) The significantly lower proportion of TTTS found in IVF-conceived twins may suggest a different embryological process that lies at the core of IVF conception of monozygotic twinning.

Non-invasive prenatal testing (NIPT): Europe’s first multicenter post-market clinical follow-up study validating the quality in clinical routine

PurposeNon-invasive prenatal tests (NIPT) for the determination of fetal aneuploidies from maternal blood are firmly established in clinical routine. For the first time, the accuracy of an NIPT for the determination of trisomies 21, 18 and 13 in singleton pregnancies was assessed by means of a prospective German-wide multicenter post-market clinical follow-up study, to reliably evaluate the quality in clinical routine.MethodsThe study covered the indications for testing, the test results, the rate of invasive diagnostics and the pregnancy outcome. 2232 cases were tested for trisomy 21. Of these, 1946 cases were additionally examined for trisomy 18 and 13.ResultsSensitivity and specificity for trisomy 21 (43/43) and for trisomy 13 (2/2) were 100%, for trisomy 18 the sensitivity was 80% (4/5) with a specificity of 99.8%. Three false-positive results for trisomy 18 were observed (FPR 0.15%). The no-call rate was 0.5%. In this subgroup, 27.3% (3/11) aneuploidies were diagnosed. The rate of invasive procedures was 2.6%.ConclusionNIPT provides a very high quality for the fetal trisomies 21, 13 and 18 in clinical routine. The results support the recommendation that NIPT should be offered after genetic counseling and only in conjunction with a qualified ultrasound examination.

Impact of chorionicity on first-trimester nuchal translucency screening in ART twin pregnancies

Nuchal translucency (NT) measurement in assisted reproduction treatment (ART) twins is less extensively investigated. Therefore, the present study compared NT measurements of spontaneously conceived twins with ART twins in dichorionic (DC) and monochorionic (MC) pregnancies.

Clinical spectrum of fetal long QT syndrome: a single-center experience

Abstract Objective: A considerable proportion of unexplained intrauterine fetal deaths are attributed to long QT syndrome (LQTS) susceptibility. Additionally, the estimated prevalence of LQTS in newborns is 1 in 2000. Still, prenatal diagnosis of LQTS is very rare. The aim of this study was to assess the frequency of prenatal diagnosis of LQTS at our institution, present the cases, compare our findings with the existing literature and propose a possible screening approach. Methods: We searched our fetal database between 2006 and 2013 for cases with suspected diagnosis of LQTS. Results: During the investigation period around 26 000 fetuses were evaluated and three cases of suspected fetal LQTS identified. Two cases of familial LQTS had no or mild intrauterine manifestation of the condition, the third fetus had a de-novo mutation with severe, early-onset disease. Conclusions: LQTS continues to be a challenging prenatal diagnosis. In fetuses who present with complex arrhythmias, a high degree of suspicion is required, and close surveillance and timely delivery in the presence of a multidisciplinary team are necessary. For asymptomatic cases or screening purposes, routine fetal heart rate registration and detailed assessment of cases with a low for gestational age baseline may be an option.

Progressive cardiac dysfunction in Bethlem myopathy during pregnancy.

BACKGROUND: Bethlem myopathy is a congenital myopathy presenting with muscle weakness and joint abnormalities. Although cardiac involvement is frequent in other inherited myopathies, it has not yet been described in Bethlem myopathy. CASE: We report a case of progressive deterioration of left ventricular function during pregnancy in a patient with Bethlem myopathy. Worsening of clinical symptoms, particularly dyspnea, necessitated delivery at 36 2/7 weeks of gestation. Myocardial function recovered postpartum with improvement of clinical symptoms. CONCLUSION: Bethlem myopathy may be associated with progressive left ventricular dysfunction during pregnancy and may require early delivery.

Corrigendum to “Determinants of brain-derived neurotrophic factor (BDNF) in umbilical cord and maternal serum” [Psychoneuroendocrinology 63 (2016) 191–197]

Please cite this article in press as: Flöck, A., et al., Corrigendum to “Determinants of brain-derived neurotrophic factor (BDNF) in umbilical cord and maternal serum” [Psychoneuroendocrinology 63 (2016) 191–197]. Psychoneuroendocrinology (2016), http://dx.doi.org/10.1016/j.psyneuen.2016.11.001 erum) mentioned in the publication should read fourfold higher. This applies to the abstract, results section, Table 2 and Figs. 1 and 2. nalyses and conclusions remain valid in their entirety. (b) The correct unit for BDNF is pg/mL. This relates to the abstract and results ection. The authors would like to apologise for any inconvenience caused.

Einflussfaktoren auf Adipozytokin-Spiegel in mütterlichem Blut und Nabelschnurblut bei Geburt

Ziel: Verschiedene Einflussfaktoren der Adipozytokinspiegel, wie Leptin, Resistin, Adiponectin, Tumornekrose faktor alpha (TNF alpha) und Interleukin-6 (IL-6), in mutterlichen Blut und Nabelschnurblut wurden bei Geburt analysiert. Methodik: Die mutterlichen Blutproben wurden bei Aufnahme zur Geburt im Kreissaal abgenommen, die Nabelschnurblutproben wurden direkt nach Geburt des Kindes bereits vor Geburt der Plazenta aus der Nabelschnurvene abgenommen. Die Analyse erfolgte mittels Immunoassay. Alle Werte wurden mit nichtparametrischen Tests untersucht. Ergebnisse: Es wurden 120 Patientinnen rekrutiert. Fur die Resistinspiegel des Kindes und der Mutter zeigte sich das Gestationsalter als Einflussfaktor. Fur den kindlichen Leptinspiegel sind das Gestationsalter, Geschlecht des Kindes und die Perzentile des Geburtsgewichts, fur den der Mutter der BMI bei Geburt, Kindsgeschlecht, Kopfumfangsperzentile und Praeklampsie signifikante Faktoren. Wir fanden keine Einflussfaktoren auf den Adiponectin- und TNF alpha-Spiegel von Kind und Mutter und den IL-6-Spiegel der Mutter. Fur den IL-6-Spiegel des Kindes sind das Gestationsalter, der Geburtsmodus und die Narkoseform unter der Geburt Einflussfaktoren. Schlussfolgerung: Bei der Beurteilung der Adipozytokinspiegeln in mutterlichem Blut und Nabelschnurblut bei Schwangerschaftsveranderungen und -komplikationen mussen diverse Einflussfaktoren bedacht werden.

Adipokine-myokine-hepatokine compartment-system in mothers and children: An explorative study

Objective Maternal lifestyle during pregnancy has an effect of gestational development and neonatal outcome. Overweight gravidas and gravidas with excessive weight gain have an increased risk of gestational complications and neonatal metabolic disorder. The underlying mechanisms are still under discussion, but the hormonally active fat mass and its biomarkers, adipocytokines, may play a key role by potentially having a direct impact on the metabolic homeostasis of the system in concert with other biomarkers like hepatokines and myokines. Up to now little is known in terms of lifestyle habits and their effect on this complex model on maternal and fetal outcome. Therefore, we aim to investigate the influence of maternal lifestyle clusters during pregnancy on the maternal and fetal biomarkers of compartments, specifically those implying maternal fat and muscle mass, maternal liver and the placenta and who are associated with maternal body composition and birth weight. Methods In this exploratory pilot study at least 100 singleton pregnancies and their newborns will be included. The women will undergo assessments of anthropometric measurements, venous blood samples will be drawn and physical activity and nutritional status will be collected through questionnaires. Newborns will undergo assessments of anthropometric measurements, umbilical cord samples will be drawn and birth outcomes will be evaluated. We will measure adipokines, myokines and hepatokines and relate them to maternal lifestyle clusters and fetal outcome. Conclusion Our study will be the first to examine the relationship between maternal body composition, birth weight and potential biomarkers based on an innovative compartment model.