L’épreuve des liens : les relations entre intervenants et parents vivant en contexte de consommation maternelle au cours de la période périnatale

La période périnatale est particulièrement propice pour que les futures et nouvelles mères consommatrices de substances psychoactives et leur partenaire entrent en relation d’aide avec des intervenants médicaux et psychosociaux. Pour ces mères et ces pères, l’arrivée d’un poupon dans leur vie est une source de motivation pour entreprendre une démarche d’aide basée sur la confiance. Pourtant, plusieurs études soulignent différentes contraintes qui rendent difficile l’entrée en relation d’aide de ces parents avec des intervenants. Ce mémoire à donc pour objectif d’explorer, à partir du point de vue de mères consommatrices et de leur partenaire, la façon dont se vivent leurs expériences relationnelles avec des intervenants médicaux et psychosociaux au cours de la période périnatale, tout en identifiant des éléments qui ont influencé leurs rapports. Nous avons fait une analyse secondaire du discours de vingt mères consommatrices et de leur partenaire, recrutés au moment de la naissance dans le cadre d’une recherche de Morissette, Devault et Rondeau (2006-2010). Les résultats obtenus indiquent que les parents semblent généralement satisfaits de leurs relations avec les intervenants médicaux et psychosociaux qu’ils ont rencontrés à cette période, même s’ils rapportent vivre des peurs importantes qui nuisent à la relation d’aide. Nos résultats révèlent également plusieurs éléments qui influencent les relations relevant autant des contextes d’intervention que des intervenants eux-mêmes et de leurs rôles. Nous constatons d’après les résultats qu’en dépit de certains aspects qui nuisent aux relations avec des intervenants, le cumul des éléments qui les favorisent semble susciter une satisfaction des mères consommatrices et de leur partenaire. Dans les situations où plusieurs éléments nuisent à la relation d’aide, il se créer une dynamique de méfiance réciproque entre ces parents et les intervenants. Néanmoins, comme les relations ne sont pas immuables, il est possible de transformer les relations difficiles pour les rendre plus satisfaisantes pour les mères consommatrices, leur partenaire et les intervenants médicaux et psychosociaux.

Conséquences d’une restriction de croissance intra-utérine et du sexe biologique sur le métabolisme des acides gras dans les cardiomyocytes de rats foetaux

Il est désormais accepté qu'un environnement foetal défavorable prédispose à des maladies chroniques qui surviennent à l'âge adulte. Il a été démontré dans notre laboratoire qu'une diminution de perfusion placentaire induit une redistribution du débit sanguin vers le coeur chez le foetus ainsi qu’une restriction de croissance intrautérine. De plus, un remodelage et une diminution de la contractilité des cardiomyocytes ont été observés chez les femelles devenues adultes. En période périnatale, l’utilisation des acides gras comme substrat énergétique devient plus importante que celle du glucose au niveau des cardiomyocytes. Considérant qu'un mécanisme s'est mis en place in utero, nous émettons l’hypothèse que le transfert de la voie de l’utilisation du glucose vers l’utilisation des acides gras se fait plus tôt chez les foetus en restriction de croissance. L’objectif de cette étude est de mesurer, dans les coeurs foetaux, les constituants du métabolisme des acides gras, soit le transporteur principal des acides gras, la carnitine palmitoyltransférase‒1‒alpha, ainsi que ses protéines associées soit l’acyl‒CoenzymeA synthétase‒1 et le canal anionique voltage‒dépendant de type 1. Nous mesurerons l’activité du cytochrome c oxydase et le nombre de mitochondries. L’influence du sexe et la condition foetale (restriction de croissance intrautérine vs contrôle) seront comparés. Nous avons observé que l’expression protéique de la carnitine palmitoytransférase‒1α et de l’acyl‒CoenzymeA synthétase‒1 est significativement augmentée, mais pas celle du canal anionique voltage‒dépendant de type 1, dans les coeurs de foetus en restriction de croissance intrautérine femelles. Le nombre et l’activité des mitochondries est semblable dans tous les groupes. Ces résultats suggèrent que la condition foetale et le sexe altèrent la quantité du transporteur des acides gras, la carnitine palmitoytransférase‒1α, au niveau traductionnel sans toutefois affecter l’activité du cytochrome c oxydase et le nombre de mitochondries. À long terme, nos études permettront de mieux comprendre les conséquences et causes de la RCIU afin d’en permettre la prévention.

Liens entre l'histoire obstétrique, les facteurs de risque nutritionnels et génétiques, la santé mentale périnatale et la durée de la gestation

Problématique : La période périnatale est critique pour la santé et le développement de l’enfant. Les problèmes de santé mentale pendant la grossesse et après l’accouchement peuvent mener à des conséquences néfastes sur le développement de l’enfant et les issues plus tardives de sa santé. Cette thèse se concentre sur deux problèmes de santé mentale périnatale d’intérêt substantiel : le stress psychosocial pendant la grossesse et la dépression postnatale. Méthodes : Dans la première partie, nous donnons un aperçu de la dépression postnatale et effectuons une revue de la littérature portant sur deux facteurs de risque qui suscitent un nouvel intérêt, soit le génotype du transporteur de la sérotonine et l’état des acides gras oméga-3 polyinsaturés. Ensuite, dans le cadre de la deuxième partie, nous effectuons une revue de la littérature sur le stress psychosocial pendant la grossesse et la naissance prématurée, le tout en discutant les mécanismes physiologiques reliant ces deux derniers. Puis, nous examinons les liens existant entre le stress psychosocial et la durée de gestation au sein de la cohorte 3D, une étude longitudinale réalisée au Québec. Pour conclure, nous effectuons une investigation plus détaillée sur les facteurs de risque de l’anxiété liée à la grossesse dans la cohorte 3D, ceci en mettant l’accent sur l’historique des grossesses antérieures. Résultats : Dans la première partie, trois études menées rigoureusement révèlent des associations entre le génotype du transporteur de la sérotonine et la dépression postnatale. De même, les preuves s’accumulent à l’effet qu’une insuffisance en acides gras oméga-3 polyinsaturés soit associée à un risque plus élevé de dépression postnatale. Des données probantes préliminaires suggèrent qu’il pourrait y avoir une interaction entre les deux nouveaux facteurs de risque. Dans la deuxième partie, la littérature montre des liens entre le stress psychosocial pendant la grossesse et la naissance prématurée qui varient selon les dimensions du stress et le moment de mesure de celui-ci. Des associations plus fortes sont généralement trouvées plus tôt durant la gestation, alors que la perception subjective du stress et l’anxiété liée à la grossesse sont les plus étroitement associées à la naissance prématurée. Les voies comportementales, infectieuses, neuroinflammatoires, et neuroendocriniennes sont identifiées comme mécanismes physiologiques potentiels. Dans notre étude sur le stress psychosocial et la durée de la gestation au sein la cohorte 3D, nous avons observé une faible association entre l’anxiété liée à la grossesse au troisième trimestre et la naissance spontanée avant 39 semaines de gestation. Dans notre étude sur l’histoire obstétrique et l’anxiété liée à la grossesse, des liens indépendants ont été observés entre plusieurs issues de grossesses antérieures et l’anxiété liée à une grossesse subséquente. Conclusions : Les données probantes de la première partie soutiennent un programme de recherche ayant pour but de clarifier les liens entre les acides gras oméga-3 polyinsaturés, le génotype du transporteur de la sérotonine et la dépression postnatale. Dans la deuxième partie, nos résultats mettent en lumière l’importance relative du stress psychosocial comme prédicteur de la durée de gestation, tout en faisant une contribution importante pour des méta-analyses futures. Ils suggèrent d’ailleurs de nouvelles pistes de recherche pour les cadres conceptuels liant le stress et les issues de la naissance.

Uso del Sildenafil en hipertensión pulmonar del recién nacido. Revisión sistemática de la literatura

Antecedentes El desarrollo de la hipertensión pulmonar en el recién nacido es una condición grave que supone un peligro para su vida. Se ha propuesto el uso del sildenafil como tratamiento para esta enfermedad, sin embargo no ha sido evaluada su eficacia a través de una revisión sistemática. Objetivos Determinar el efecto del sildenafil en el manejo de recién nacidos con diagnóstico de hipertensión pulmonar a través de la realización de una revisión sistemática de la literatura. Metodología Se planteó la realización de una revisión sistemática de la literatura. La búsqueda fue realizada a través de las bases de datos: Pubmed, Embase, LiLaCS y Cochrane library. Se incluyeron ensayos clínicos controlados y estudios de cohortes publicados en los idiomas inglés y español. Las variables cualitativas fueron estimadas como riesgos relativos o odds ratios con sus IC95%, las variables cualitativas como diferencias de promedios con sus IC95%. Resultados Se incluyeron 4 estudios en la revisión sistemática. Dos estudios compararon el sildenafil contra el placebo. El uso del sildenafil se relacionó con una menor mortalidad y mejoría en los parámetros ventilatorios. Conclusión: Es aconsejable el uso del sildenafil en el manejo de la hipertensión pulmonar en niños.

Effects of Cadmium on the Rat Salivary Glands, During Lactation

Cadmium (Cd) in air, drinking water and food has the potential to affect the health of people, mainly those who live in highly industrialized regions. Cd affects placental function, can cross the placental barrier and directly modify fetal development. Once the organism is particularly susceptible to the exposition to the Cd during the perinatal period, and that this metal can be excreted in the milk, the aim of the present work was to study the effects of the constant exposition to drinkable water containing low levels of Cd during the lactation, on the salivary glands of the rat. Female rats received ad libitum drinking water containing 300mg/l of CdCl2 throughout the whole lactation. Control animals received a similar volume of water without Cd. Lactant rats (21 day old) were killed by lethal dose of anesthetic. The salivary glands were separated, fixed in ""alfac"" solution for 24 h, and serially sectioned. The 6 mu m thick sections were stained with hematoxylin and eosin. Nuclear glandular parameters were estimated, as well as cytoplasm and cell volume, nucleus/cytoplasm ratio, number and surface density, diameters and cell thickness. Mean body weight was 34.86 g for the control group and 18.56 g for the Cd-treated group. Histologically, the glandular acini were significantly smaller, the gland ducts were similar in both groups studied. The connective tissue was more abundant. In conclusion, the salivary glands (submandibular, parotid and sublingual) showed retarded growth after Cd intoxication.

Efeitos da mal nutrição protéica sobre o metabolismo da glicina em cerebelo de ratos durante o seu desenvolvimento

Malnutrition is a worldwide problem affecting millions of unborn and young children during the most vulnerable stages of brain development (1). All restriction of protein during the perinatal period of life can alter the development of mammalian fetus and have marked repercussions on development of the Central Nervous System (CNS). The brain is vulnerable to protein malnutrition with altered morphologic and biochemical maturation, leading to impaired functions. The focus of this study is to investigate [U-14C]glycine metabolism in malnourished rats submitted to pre- and postnatal protein deprivation (diet: 8% protein with addition and without addition of L-methionine) on glycine metabolism of rats (normonourished group: 25% protein). It was observed that protein malnutrition alters oxidation to CO2, conversion to lipids and protein synthesis from [U-14C]glycine in cerebellum of malnourished rats without addition of L-methionine on a diet at 7 and 21 days of postnatal life. Our results also indicate that protein malnutrition causes a retardation in the normally ordered progression of brain development, and the malnourished groups have smaller cells, reduction in cell numbers and smaller cerebellar weight comparing to the control group.

Humoral immune response of water buffalo monitored with three different antigens of Toxocara vitulorum

Humoral immune response of water buffalo naturally infected with Toxocara vitulorum was monitored using three different antigens of this parasite in serum and colostrum of buffalo cows and calves. Soluble extract (Ex) and excretory/secretory (ES) larval antigens and perienteric fluid antigen (Pe) of adult T vitulorum were used to measure the antibody levels by an indirect ELISA. Serum of 7-12 buffalo cows for the first 365 days and colostrum of the same number of buffalo cows for the first 60 days of parturition, and serum of 8-10 buffalo calves for the first 365 days afterbirth were assayed. The ELISA detected antibodies against all three T vitulorum antigens in the colostrum and serum of 100% of buffalo cows and calves examined. The highest antibody levels against Ex, ES and Pe antigens were detected in the buffalo cow sera during the perinatal period and were maintained at high levels through 300 days after parturition. on the other hand, colostrum antibody concentrations of all three antigens were highest on the first day post-parturition, but decreased sharply during the first 15 days. Concomitantly to the monitoring of immune response, the parasitic status of the calves was also evaluated. In calves, antibodies passively acquired were at the highest concentrations 24 h after birth and remained at high levels until 45 days coincidentally with the peak of T vitulorum infection. The rejection of the worms by the calves occurred simultaneously with the decline of antibody levels, which reached their lowest levels between 76 and 150 days. Thereafter, probably because of the presence of adults/larvae stimulation, the calves acquired active immunity and the antibodies started to increase slightly in the serum and plateaued between the days 211 and 365. All three antigens were detected by the serum antibodies of buffalo calves; however, the concentration of anti-Pe antibody was higher than anti-EX and anti-ES, particularly after 90 days of age. By conclusion, the buffalo cows develop immunity and keep high levels of antibodies against T vitulorum-Ex, ES and Pe antigens and these antibodies are transferred to their calves through the colostrum. This passively acquired immunity does not protect the calves against the acquisition of the infection, but these antibodies, passively or actively acquired, may have an important role during worm rejection by the calves and prevention of intestinal reinfection. (C) 2004 Elsevier B.V. All rights reserved.

Detection of Streptococcus agalactiae colonization in pregnant women by using combined swab cultures: cross-sectional prevalence study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Reproductive and sexual behavior changes in male rats exposed perinatally to picrotoxin

Previous studies in rats suggested that picrotoxin, a GABA(A) receptor antagonist, may cause long-term changes in male reproductive physiology and behavior in rats exposed during prenatal and postnatal periods. The present study has further examined this phenomenon. Wistar rat dams were dosed subcutaneously with 0.75 mg/kg picrotoxin in saline, or vehicle alone, during the perinatal period (day 19 of gestation, immediately after parturition, and once a day during the first 5 days of lactation). Birth weight and sexual maturation of pups were unchanged; however, plasma testosterone levels and sexual behavior was altered in male offspring. Although fertile, these males showed altered mating behavior in terms of a decrease in the mean number of mounts during a 30-min observation period with normal females. Some showed homosexual behavior when castrated and pretreated with exogenous estrogen. These findings suggest that perinatal exposure to picrotoxin alters sexual dimorphism in the developing rat brain, manifesting as altered reproductive performance and sexual behavior of males. (c) 2004 Elsevier B.V. All rights reserved.

An enzyme-linked immunosorbent assay (ELISA) for detection of antibodies against Toxocara vitulorum in water buffaloes

Toxocara vitulorum, a parasite of the small intestine of cattle and water buffaloes, is mainly acquired by calves via the colostrum/milk from infected cows. To understand the development of immune responses in calves, antibody levels to a soluble extract antigen (Ex) from T. vitulorum infective larvae were measured by an indirect ELISA with sera of 15 buffalo calves, which were sampled every 15 days for the first 180 days after birth and 9 buffalo cows during the perinatal period. From all serum samples examined during the first 180 days, antibody level was lowest and highest in calves at 1 day of age before and after suckling colostrum, respectively, suggesting that the origin of antibodies was the colostrum. Immediately after birth, antibody levels in suckled calves remained at high levels until day 15, began to decrease to lower levels between 15 and 30 days and remained relatively stable until 120 days. By comparing the immune responses of these animals with their parasitological status it was considered possible to determine if passively acquired or actively produced antibodies provided protection against the infection. High numbers of T. vitulorum eggs in the feces between 30 and 60 days indicated that passively acquired antibodies did not provide protection against the infection, at least during these first days, and the maximum fecal egg counts during 30-45 days were coincident with decreased antibody levels. Between 60 and 120 days, when serum antibodies were detected at reduced, but stable levels, adult nematodes were expelled from the intestines and no more T. vitulorum eggs were found, suggesting development of acquired resistance. However, the potential and functional protective role of the antibodies against T. vitulorum infection and the process of self-cure requires further investigation. (C) 2001 Elsevier B.V. B.V. All rights reserved.

Developmental and behavioral effects of postnatal amitraz exposure in rats

The effects of postnatal amitraz exposure on physical and behavioral parameters were studied in Wistar rats, whose lactating dams received the pesticide (10 mg/Kg) orally on days 1, 4, 7, 10, 13, 16 and 19 of lactation; control dams received distilled water (1 ml/kg) on the same days. A total of 18 different litters (9 of them control and 9 experimental) born after a 21- day gestation were used. The results showed that the median effective time (ET50) for fur development, eye opening, testis descent and onset of the startle response were increased in rats postnatally exposed to amitraz (2.7, 15.1, 21.6 and 15.3 days, respectively) compared to those of the control pups (1.8, 14.0, 19.9 and 12.9 days, respectively). The ages of incisor eruption, total unfolding of the external ears, vaginal and ear opening and the time taken to perform the grasping hindlimb reflex were not affected by amitraz exposure. Pups from dams treated with amitraz during lactation took more time (in seconds) to perform the surface righting reflex on postnatal days (PND) 3 (25.0 ±2.0), 4 (12.3 ± 1.2) and 5 (8.7 ± 0.9) in relation to controls (10.6 ± 1.2; 4.5 ± 0.6 and 3.4 ± 0.4, respectively); the climbing response was not changed by amitraz. Postnatal amitraz exposure increased spontaneous motor activity of male and female pups in the open-field on PND 16 (140± 11)and 17(124± 12), and 16 (104±9), 17 (137 ± 9) and 18 (106 ± 8), respectively. Data on spontaneous motor activity of the control male and female pups were 59 ± 11 and 69 ± 10 for days 16 and 17 and 49 ± 9, 48 ± 7 and 56 ± 7 for days 16, 17 and 18, respectively. Some qualitative differences were also observed in spontaneous motor behavior; thus, raising the head, shoulder and pelvis matured one or two days later in the amitraz- treated offspring. Postnatal amitraz exposure did not change locomotion and rearing frequencies or immobility time in the open-field on PND 30, 60 and 90. The present findings indicate that postnatal exposure to amitraz caused transient developmental and behavioral changes in the exposed offspring and suggest that further investigation of the potential health risk of amitraz exposure to developing human and animal offsprings may be warranted.

Reproductive changes in male rats treated perinatally with an aromatase inhibitor.

The effects of maternal exposure to aromatase inhibitor during the perinatal period of sexual brain differentiation were studied. The fertility was assessed in adult, male rat offspring of aromatase inhibitor-treated dams. The following results were obtained: (1) Sexual maturation, body weight, and wet weights of testis, pituitary, seminal vesicle, ventral prostate, and levatori ani muscle were unchanged at adult life. (2) Fifty percent of the animals were able to mate with normal females, which became pregnant but exhibited an increased number of preimplantation loss. (3) There was a decrease in the number of spermatozoa found in the testes and in the daily sperm production. (4) Of those, 25% of the male rats treated with aromatase inhibitor did not present male sexual behavior, showing female behavior when pretreated with estrogen. These results indicate that perinatal exposure to aromatase inhibitor during the critical period of male brain sexual differentiation has a long-term effect on the reproductive physiology and behavior of male rats.

Endocrine Disruptors and Hypothalamic Sexual Differentiation

The so-called endocrine disruptors have been described as compounds which interfere with the estrogen action in their receptors and may exert a crucial role in the development of the reproductive tract and in the brain sexual differentiation. Thus, conducts and/or exposure to these drugs in the perinatal period that apparently do not endanger the neonate may cause side effects. During embrionary development, the gonads, through discharge of a small quantity of reproductive hormones, will guarantee the phenotype of male or female at birth, as well as actuate in specific areas sexual differentiation of the central nervous system. Several experimental models have shown an interference of drugs acting as endocrine disruptors in hypothalamic sexual differentiation. Thus, reproductive function is impaired by exposure to estrogen in the perinatal life of rats and the mechanisms involved in this effect are distinct for males and females. Perinatal exposure to drugs which may be considered endocrine disrupters may induce an incomplete masculinization and defeminization of the central nervous system. Alterations in these processes, if present, generally are perceived only at puberty or adult reproductive life. These later alterations may include anomalies in the process of fertility or in sexual behavior.

Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 266/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. © 2012 Nature America, Inc.

Influence of the physiological state on infestation by Rhipicephalus microplus in dairy cows

The purpose of this study was to identify the influence of physiological state, season, breed, number of lactations, dairy productivity, and stocking rate on infestation by Rhipicephalus microplus in dairy cows. Two hundred cows were selected through proportional representative sampling at the Seropédica Experimental Station (Pesagro-Rio), Brazil. Fully or partially engorged R. microplus females measuring between 4.5 and 8.0. mm were counted on the right side of each animal. The tick infestation prevalence data were analyzed in relation to the risk factors, using multiple logistic regression. Associations between prevalence and its possible influencing determinants were measured using odds ratios. The average tick count of cows during the peripartum and lactation periods was significantly higher (p<0.05; OR=4.82) than the count in dry cows. Taurine animals showed significantly higher infestation (p<0.05; OR=3.28) than pure zebuine animals. Among cross-bred animals, the infestation was higher (p<0.05) in F1 animals (1/2 taurine × 1/2 zebuine) than in Girolando animals (5/8 zebuine × 3/8 taurine). Primiparous cows (p<0.05) had significantly heavier infestations than multiparous cows. Dairy production showed a positive correlation with tick infestation (p<0.03; OR=2.94), such that the most productive animals were the most parasitized ones. Animals kept at high densities were significantly more heavily infested (p<0.05, OR=6.32) than animals kept at low density. First-lactation and high-productivity taurine animals were more vulnerable to R. microplus, thus comprising a high-risk group in dairy herds. © 2012 Elsevier GmbH.