G. Caserta

Technological advancement and human reproduction: where can we go or where do we want to go?

The desire to have a child is innate in human nature, and failure to do so is one of the most painful experiences through which a couple can go. Since Louise Brown’s birth, the use of biotechnologies in assisted reproduction has gone through significant advancement. Almost every day, new options are featured in both the scientific literature and the lay press. In attempting to have a child, sometimes doctors and infertile couples have made use of procedures that are not fully validated, and of screening methods whose long-term effects are unknown. The efficacy of different applied biotechnologies has been exclusively evaluated in terms of numbers of children born, with no longitudinal evaluations of the psychophysical health of the children themselves. From time to time, social and ethical issues have merged. However, biotechnologies are still allowed in accordance with the ethical principle of respect for autonomy1. Many aspects of assisted reproduction are called into question by ethical problems. Here, we shall deal with some of the most debated problems, offering our own very personal view: preimplantation genetic diagnosis, nonselective multiple pregnancy reduction, genital organ transplant, and human cloning.

Potential effects of nutrients on placental function and fetal growth.

Intrauterine nutritional deficits can trigger adaptation mechanisms with modifications that can predispose an individual’s later life to various pathologies (cardiovascular, metabolic, endocrine). It is difficult to individualize both the nutrient or nutrients responsible for the damage and the relation between cause and effect quantitatively (nutritional effect entity) and timing (time lag for the start of the pathology). It is therefore not easy to prove that placental function and fetal growth can be deeply influenced by specific nutrients rather than by variation in the intake of calories, that is to say by nutrition as a whole. Furthermore, every country, except the developing ones, has particular nutritional habits. As a consequence of that, recommendations worked out in some geographical areas with specific nutritional deficit may not be so efficacious as in other areas where this deficit is not as evident (for instance the administration of folic acid in the Mediterranean area). The results of recently reported studies focus attention on: (1) soluble gas such as nitric oxide (NO) which, as has been demonstrated, can affect both placental function and fetal growth, also taking into consideration that its effects can be mediated both by drugs and nutrients, (2) adequate antioxidant status during pregnancy could prevent and control those mechanisms induced by maternal oxidative stress that could lead to both impaired placental function and fetal growth. Hornstra G, Uauy R, Yang X (eds): The Impact of Maternal Nutrition on the Offspring. Nestlé Nutrition Workshop Series Pediatric Program, vol 55, pp 73–82, Nestec Ltd., Vevey/S. Karger AG, Basel,

Maternal haemodynamic and haemorrheologic considerations in fetal I.U.G.R.

IUGR is a symptom which has many causes; genetic abnormalities, feto-maternal infections, maternal drug intake, smoking, socio-demographic factors, all are related to fetal IUGR, but the most common underlying cause is the inadequate or inappropriate placental function. This is obvious because placenta plays a central role in fetal nutrition and there is no survival of the fetus in utero without the support of the placenta. The diminished fetal growth rate can be considered äs an intrauterine mechanism of defence against hypoxic damage, because in this way there is a saving of oxygen for the cerebral tissue.