Jay Bolnick

Substance use disorders in women: special considerations during pregnancy

Care of substance-using pregnant women is complex, difficult, and often demanding. Womens care providers must be aware of these womens unique psychologic and social needs and the related legal and ethical ramifications surrounding pregnancy. In addition, relating specific substances to perinatal outcome is difficult, because concurrent use of multiple substances is frequent and many pregnant abusers are members of economically disadvantaged segments of society in which unfavorable perinatal outcomes are more common. It is also difficult to follow up outcomes in such pregnancies prospectively and to analyze research data. This article discusses various issues related to pregnancies complicated by substance use, including perinatal pharmacology and teratogenic risks, identification of substance abuse, treatment approaches, and comprehensive perinatal management.

Cross-over trial of fetal heart rate response to halogen light and vibroacoustic stimulation

Objective. The purpose of this study was to compare the effect of halogen light and vibroacoustic stimulation on fetal heart rate (FHR) responsiveness and on nonstress test (NST) results. Methods. Sixty consecutively-chosen patients between 33 and 39 weeks of gestation underwent an NST on at least three weekly occasions. Each received halogen light (Vector Compact Sport Spot, Ft Lauderdale, FL, USA), vibroacoustic (SolaTone Artificial Larynx, Temecula, CA, USA), and no stimulation in a randomized order. The transabdominal light or vibroacoustic stimulation lasted for 10 seconds. If no initial FHR acceleration occurred, then the stimulus was repeated 10 minutes later up to a maximum of three times. The investigators who interpreted the FHR patterns were blinded as to the type of stimulus used. Results. Reactive results were present in 171 tests (vibroacoustic: 98.3%; light: 96.6%; none: 93.3%). Compared with no stimulation, the mean difference in time from the onset of recorded ‘stimulation’ to the first FHR acceleration was shorter (p < 0.01) with either light (2.7 minutes, 95% confidence interval (CI) 0.9–4.5 minutes) or vibroacoustic stimulation (2.6 minutes, 95% CI 0.8–4.4 minutes). The mean time difference until a reactive result was also shorter (p < 0.05) with either light (2.7 minutes, 95% CI 0.1–4.9 minutes) or vibroacoustic stimulation (2.4 minutes, 95% CI 0.1–4.7 minutes) than with no stimulation. The need for repeated stimulation during each test was infrequent (light: 5.0%; vibroacoustic: 3.3%). No adverse effect from external stimulation was noted on the FHR tracing. Conclusion. Halogen light stimulation is an acceptable alternative to vibroacoustic stimulation in provoking a more rapid fetal heart rate response and in shortening the time before a reactive nonstress test result.

Blocking Epidermal Growth Factor Receptor Signaling in HTR-8/SVneo First Trimester Trophoblast Cells Results in Dephosphorylation of PKBα/AKT and Induces Apoptosis.

We identified a major peptide signaling target of EGF/EGFR pathway and explored the consequences of blocking or activating this pathway in the first trimester extravillous trophoblast cells, HTR-8/SVneo. A global analysis of protein phosphorylation was undertaken using novel technology (Kinexus Kinetworks) that utilizes SDS-polyacrylamide minigel electrophoresis and multi-lane immunoblotting to permit specific and semiquantitative detection of multiple phosphoproteins. Forty-seven protein phosphorylation sites were queried, and the results reported based on relative phosphorylation at each site. EGF- and Iressa-(gefitinib, ZD1839, an inhibitor of EGFR) treated HTR-8/SVneo cells were subjected to immunoblotting and flow cytometry to confirm the phosphoprotein screen and to assess the effects of EGF versus Iressa on cell cycle and apoptosis. EGFR mediates the phosphorylation of important signaling proteins, including PKBα/AKT. This pathway is likely to be central to EGFR-mediated trophoblast survival. Furthermore, EGF treatment induces proliferation and inhibits apoptosis, while Iressa induces apoptosis.