Effect of Bauhinia forficata extract in diabetic pregnant rats: maternal repercussions

Bauhinia forficata, commonly known as paw-of-cow, is widely used in Brazil folk medicine for the treatment of Diabetes mellitus. The purposes of present study were to determine the repercussions of diabetes on the defense system against oxidative stress in pregnant female rats and to characterize the influence of the treatment with Bauhinia forficata extract on the antioxidant system, glycemic control, hepatic glycogen, cholesterol, triglycerides, total proteins and lipids. Virgin female Wistar rats were injected with 40 mg/kg streptozotocin (STZ) before mating. Oral administration of an aqueous extract of Bauhinia forficata leaves was given to non-diabetic and diabetic pregnant rats in 3 doses: 500 mg/kg from 0 to 4(th) day of pregnancy, 600 mg/kg from 5(th) to 14(th) day and 1000 mg/kg from 15(th) to 20(th) day. All the females were killed on the day 21 of pregnancy. A maternal blood sample was collected by venous puncture and the maternal liver was removed for biochemical measurement. The diabetic pregnant rats presented hyperglycemia, hyperlipemia, bypertriglyceridemia, hypercholesterolemia, hyperuricemia, decreased determinations of reduced glutathione (GSH) and superoxide dismutase (SOD). Treatment with B. forficata extract did not interfere in the albumin, total protein and lipid, triglyceride, cholesterol and SOD determinations. Increased hepatic glycogen, decreased uric acid concentration and increased GSH activity was observed. This last fact suggests that the plant may have some action on antioxidant defense system. However, the demonstration of the active component present in B. forficata responsible for its antioxidant effect and the increase in hepatic glycogen deserve further investigation.

Accuracy of fetal gender determination in maternal plasma at 5 and 6 weeks of pregnancy

Objective To assess the viability of the early diagnosis of fetal gender in material plasma before 7 weeks of pregnancy by real-time polymerase chain reaction (real-time PCR), starting at 5 weeks of pregnancy.Method peripheral blood was collected from pregnant women, starting at 5 weeks of gestation. After centrifugation, plasma was separated for fetal DNA extraction. DNA was analyzed by quantitative real-time PCR for two genomic regions, one on the Y chromosome (DYS-14) and the other shared by both sexes (beta-globin), by the TaqMan Minor Groove Binder (MGB) probe assay. The results of the examinations were compared to fetal gender determined after delivery.Results A total of 79 examinations of fetal DNA in maternal plasma were performed for 52 pregnant women. Accuracy according to gestational age was 92.6% (25 of 27 cases) at 5 weeks, and 95.6% (22 of 23 cases) at 6 weeks. These results also demonstrate that fetal DNA is present at low concentrations in maternal plasma at 5 weeks (8.5 genome equivalents (GE)/mL) and 6 weeks (34.1 GE/mL) of pregnancy.Conclusion Quantitative real-time PCR and TaqMan MGB probes specific for the detection of fetal gender in maternal plasma starting at 5 weeks of gestation have good sensitivity and excellent specificity. Copyright (c) 2006 John Wiley & Sons, Ltd.

Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement

There is an urgent need to find consensus on screening, diagnosing and treating all degrees of DYSGLYCEMIA that may occur during pregnancies in Brazil, considering that many cases of DYSGLYCEMIA in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of Dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of Dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.

Levels of toxic and essential metals in maternal and umbilical cord blood from selected areas of South Africa-results of a pilot study

This pilot study uses concentrations of metals in maternal and cord blood at delivery, in seven selected geographical areas of South Africa, to determine prenatal environmental exposure to toxic metals. Samples of maternal and cord whole blood were analysed for levels of cadmium, mercury, lead, manganese, cobalt, copper, zinc, arsenic and selenium. Levels of some measured metals differed by site, indicating different environmental pollution levels in the regions selected for the study. Mercury levels were elevated in two coastal populations studied (Atlantic and Indian Ocean sites) with mothers from the Atlantic site having the highest median concentration of 1.78 mu g/L ranging from 0.44 to 8.82 mu g/L, which was found to be highly significant (p < 0.001) when compared to other sites, except the Indian Ocean site. The highest concentration of cadmium was measured in maternal blood from the Atlantic site with a median value of 0.25 mu g/L (range 0.05-0.89 mu g/L), and statistical significance of p < 0.032, when compared to all other sites studied, and p < 0.001 and p < 0.004 when compared to rural and industrial sites respectively, confounding factor for elevated cadmium levels was found to be cigarette smoking. Levels of lead were highest in the urban site, with a median value of 32.9 mu g/L (range 16-81.5 mu g/L), and statistically significant when compared with other sites (p < 0.003). Levels of selenium were highest in the Atlantic site reaching statistical significance (p < 0.001). All analysed metals were detected in umbilical cord blood samples and differed between sites, with mercury being highest in the Atlantic site (p < 0.001), lead being highest in the urban site (p < 0.004) and selenium in the Atlantic site (p < 0.001). To the best of our knowledge this pilot investigation is the first study performed in South Africa that measured multiple metals in delivering mothers and umbilical cord blood samples. These results will inform the selection of the geographical sites requiring further investigation in the main study.

Study of the evolution of the placenta and fetal pancreas in the pathophysiology of growth retardation intrauterine due to restricted maternal diet

CONTEXTO: O retardo do crescimento intra-uterino (RCIU) continua sendo importante problema em perinatologia neste final de século. A natureza do agente etiológico, o período da gestação em que ocorreu o insulto e a sua duração influenciam o tipo de RCIU. OBJETIVO: Estudar a fisiopatologia do retardo de crescimento intrauterino (RCIU) em ratas, decorrente da restrição protéico-calórica materna, em relação à evolução do pâncreas fetal e placenta entre o 18o e 21o dias de prenhez. TIPO DE ESTUDO: Ensaio clínico randomizado em animal de laboratório. PARTICIPANTES: 41 ratas prenhes, normoglicêmicas, da raça Wistar. INTERVENÇÃO: Constituíram-se seis grupos experimentais: controle, com dieta ad libitum e cesárea, respectivamente, no 18º e 21º dias; grupos dieta restritiva a 25% introduzida no 1o dia da prenhez e cesárea no 18o e 21o dias; grupos com a mesma restrição, porém iniciada no 3o dia, com cesárea no 18o e 21o dias. VARIÁVEIS ESTUDADAS: Os recém-nascidos foram classificados, em relação à média mais ou menos um desvio padrão do grupo controle, em peso pequeno (PIP), adequado (AIP) e grande (GIP) para a idade de prenhez; as placentas foram pesadas e processadas para estudo histopatológico, incluindo morfologia e histoquímica, e os pâncreas fetais, para estudo morfológico. RESULTADOS: A desnutrição protéico-calórica materna causou RCIU após o 18o dia da prenhez. Antes desse período não ocorreu RCIU, porque a desnutrição materna diminuiu o número da prole e a placenta tornou-se vicariante. A restrição alimentar não interferiu com a morfologia do pâncreas fetal, e o estudo imunohistoquímico da placenta mostrou que, quando a restrição é introduzida no 1o dia de prenhez, os estoques de glicogênio também não sofrem alterações, diminuindo entre o 18o e 21o dias, como na prenhez normal. A restrição no 3o dia cursou com baixas concentrações de glicogênio placentário no 18o dia e desaparecimento no 21o dia. CONCLUSÃO: A fisiopatologia do RCIU, decorrente da restrição protéico-calórica materna em ratas, está relacionada com menor peso placentário e baixos estoques de glicogênio placentário.

Prova de Trabalho de Parto Após uma Cesárea Anterior

Objetivo: estudar a validade da prova de trabalho de parto (PTP) em gestantes com uma cesárea anterior. Métodos: estudo retrospectivo, tipo coorte, incluindo 438 gestantes com uma cesárea anterior ao parto em estudo e seus 450 recém-nascidos (RN), divididas em dois grupos - com e sem PTP. O tamanho amostral mínimo foi de 121 gestantes/grupo. Considerou-se variável independente a PTP e as dependentes relacionaram-se à ocorrência de parto vaginal e à freqüência de complicações maternas e perinatais. Foram efetuadas análises uni e multivariada, respectivamente. A comparação entre as freqüências (%) foi analisada pelo teste do qui-quadrado (chi²) com significância de 5% e regressão logística com cálculo do odds ratio (OR) e do intervalo de confiança a 95% (IC95%). Resultados: a PTP associou-se a 59,2% de partos vaginais. Foi menos indicada nas gestantes com mais de 40 anos (2,7% vs 6,5%) e nas portadoras de doenças associadas e complicações da gravidez: síndromes hipertensivas (7,0%) e hemorragias de 3º trimestre (0,3%). A PTP não se relacionou às complicações maternas e perinatais. As gestantes que tiveram o parto por cesárea, independente da PTP, apresentaram maior risco de complicações puerperais (OR = 3,53; IC95% = 1,57-7,93). A taxa de mortalidade perinatal foi dependente do peso do RN e das malformações fetais e não se relacionou à PTP. Ao contrário, as complicações respiratórias foram mais freqüentes nos RN de mães não testadas quanto à PTP (OR = 1,92; IC95% = 1,20-3,07). Conclusões: os resultados comprovaram que a PTP em gestantes com uma cesárea anterior é estratégia segura - favoreceu o parto vaginal em 59,2% dos casos e não interferiu com a morbimortalidade materna e perinatal. Portanto, é recurso que deve ser estimulado.

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO do ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em hospital universitário, sendo incluídas todas as gestantes com diabetes pregestacional e gestacional ou com hiperglicemia leve que não desenvolveram intercorrências clínicas na gestação e que tiveram parto no Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (HC-FMB-Unesp). MÉTODOS: Trinta gestantes tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta e insulina foram abordadas com hospitalizações curtas e frequentes. Foram obtidos custos diretos (pessoal, material e exames) e indiretos (despesas gerais) a partir de dados contidos no prontuário e no sistema de custo por absorção do hospital e posteriormente calculado o custo-benefício. RESULTADOS: O sucesso do tratamento das gestantes diabéticas evitou o gasto de US$ 1.517,97 e US$ 1.127,43 para pacientes hospitalizadas e ambulatoriais, respectivamente. O custo-benefício da atenção hospitalizada foi US$ 143.719,16 e ambulatorial, US$ 253.267,22, com rentabilidade social 1,87 e 5,35 respectivamente. CONCLUSÃO: A análise árvore de decisão confirma que o sucesso dos tratamentos elimina custos no hospital. A relação custo-benefício indicou que o tratamento ambulatorial é economicamente mais vantajoso do que a hospitalização. A rentabilidade social de ambos os tratamentos foi maior que 1, indicando que ambos os tipos de atendimento à gestante diabética têm benefício positivo.

Effect of Bauhinia forficata aqueous extract on the maternal-fetal outcome and oxidative stress biomarkers of streptozotocin-induced diabetic rats

Ethnopharmacological relevance: Bauhinia forficata Link, commonly known as paw-of-cow, is widely used in Brazilian folk medicine for the treatment of diabetes.Aim of this study: To evaluate the effect of Bauhinia forficata treatment on maternal-fetal outcome and antioxidant systems of streptozotocin-induced diabetic rats.Materials and methods: Virgin female Wistar rats were injected with 40 mg/kg streptozotocin before mating. Oral administration of an aqueous extract of Bauhinia forficata leaves was given to non-diabetic and diabetic pregnant rats at increasing doses: 500 mg/kg from 0 to 4th day of pregnancy, 600 mg/kg from 5th to 14th day and 1000 mg/kg from 15th to 20th day. At day 21 of pregnancy the rats were anaesthetized with ether and a maternal blood sample was collected for the determination superoxide dismutase (SOD) and reduced glutathione (GSH). The gravid uterus was weighed with its contents and fetuses were analyzed.Results and conclusion: The data showed that the diabetic dams presented an increased glycemic level, resorption, placental weight, placental index, and fetal anomalies, and reduced GSH and SOD determinations, live fetuses, maternal weight gain, gravid uterine weight, and fetal weight. It was also verified that Bauhinia forficata treatment had no hypoglycemic effect, did not improve maternal outcomes in diabetic rats, but it contributed to maintain GSH concentration similarly to non-diabetic groups, suggesting relation with the decreased incidence of visceral anomalies. (C) 2007 Elsevier B.V. All rights reserved.

Influence of Maternal Hyperglycemia on IL-10 and TNF-alpha Production: The Relationship with Perinatal Outcomes

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