Speciality
Spotlight

 




   


Perinatology


    

 




 Fetal
Therapy

   

  • JP
    Newnham, SF Evans, M Godfrey, et al (Univ. of
    Western Australia, Perth; 
    Children’s Hosp. Med. Ctr. Cincinnati, Ohio)

    Maternal, but not fetal,
    administration of corticosteroids restricts fetal
    growth:

    J
    Matern Fetal Med. 8:81-87,

    1999

      

    Repeated maternal doses of betamethasone resulted in
    decreases in birth weight as well as in lower
    weights of the placenta and major organs. 
    However, injection directly into the fetus
    did not affect birth weight, placental weight,
    placental to birth weight ratio, or the weights of
    the major organs, except for the liver.

     

    Maternal
    administration of corticosteroids certainly results
    in improved new born lung function in immature
    fetuses born of human and a variety of other
    mammals.  
    In the human, evidence of fetal growth
    retardation on exposure to multiple maternal
    corticosteroid dosages, although not entirely
    conclusive, does appear to exist in some cases.

     

    No
    effects on fetal growth was seen among fetuses
    injected transdermally with either single or
    multiple doses.

         

  • NP
    French et al
    (
    King Edward Mem Hosp. Perth, Western Australia)

    Repeated antenatal
    corticosteroids: Size at birth
    and subsequent
    development

    Am J Obstet Gynecol, 180:114-121, 1999.

     

    In terms of perinatal mortality and morbidity,
    recipients of steroids showed the favourable effects
    expected on pulmonary maturation, but no impact
    could be noted based on the number of steroid doses.




        

  • SZ
    Wiktor,  et
    al (Ctrs of Disease Control and Prevention, Atlanta,
    Ga; Cote d’Ivoire Ministry of Public Health,
    Abidjan)

    Short-course Oral Zidovudine
    for Prevention of Mother-to-Child Transmission of
    HIV-1 in Abidjan, Cote d’Ivoire: A Randomized Trial.
     

    Lancet 353: 781-785, 1999.

      

    The risk of mother-to-child HIV-1 transmission is
    high in Africa. 
    A short course of perinatal oral zidovudine
    may reduce the rate of this transmission. 
    The safety and efficacy of a short course of
    oral zidovudine among HIV-1- seropositive breast
    feeding women in Abidjan were reported.

      

    Method:
    280 patients received placebo or zidovudine
    in 300mg tablets. 1
    tablet twice a day until labour onset, 1 tablet at
    labour onset and 1 tablet over 3 hours until the
    delivery. All
    infants were breast-fed.

      

    Findings: 
    The estimated risk of HIV-1 transmission was
    21.7% in placebo group and 12.2% in the zidovudine
    group at 4 weeks and 24.9% and 15.7% respectively at
    3 months.  Efficacy
    at 4 weeks and 3 months was 44% and 37%
    respectively.

     

    Conclusion: 
    A short course of oral zidovudine appears to
    be safe and effective in reducing mother-to-child
    transmission of HIV infections at 3 months of age. 
    The women tolerated this agent well. 
    Successful, widespread implementation of this
    treatment will require substantial efforts.

         


  •  F 
    Dabis, for the DITRAME Study Group (Universite
    Victor Segalen Bordeaux 2, France; 
    ORSTOM Petit Bassam, Abidjan; 
    Centr Muraz, OCCGE, Bobo-Dioulasso, Burkina
    Faso; et al)

    6-Month Efficacy, Tolerance and Acceptability of a Short Regimen of Oral
    Zidovudine to Reduce Vertical Transmission of HIV in
    Breastfed children in Cote d’Ivoire and Burkina
    Faso: A double-blind placebo controlled multicentre
    trial. 

    Lancet 353: 786-792, 1999.

      

    Findings: 
    The probability of HIV infection at 6 months
    of age was 18% among babies in the zidovudine group
    and 27.5% among those in the placebo group.

     

    Conclusion: 
    A short course of oral zidovudine in the
    peripartum period provides a 38% decrease in early
    vertical HIV-1 transmission, despite breast-feeding.

      

    Editorial
    comments: For emerging nations, early detection of
    HIV positivity, the logistic of assuring regular
    prenatal care visits and drug administration, the
    use of IV administration during labour and neonatal
    treatment in multiple drug doses usually exceed
    available financial and health group personnel
    resources. The cultural norms that value nursing
    despite the estimated 7% to 14% increase in
    maternal-to-fetal transmission thought to occur by 3
    months of age in infants nursed by HIV positive
    women.

      

    Infant
    infection rate increased with age as the effects of
    breast milk transmission of the virus played its
    part.  The
    lesser reduction in incidence rate exhibited by
    these West African studies makes clear the
    importance of avoiding nursing to preclude
    horizontal transmission from mother to infants in
    the postpartum period. 
    On the other hand, these studies show that
    even when abbreviated, zidovudine therapy is quite
    effective in reducing vertical transmission.

        

  • NA
    Wade, et al (AIDS Inst, 
    Albany, NY: New York State Department of
    Health, Albany; Univ of Albany, NY

    Abbreviated regimens of
    zidovudine prophylaxis and perinatal transmission of
    theHuman Immunodeficiency virus.
    )

    N
    Engl J Med 339: 1409-1414, 1998
    .

      

    Editorial
    comments:  The
    important message is that women and their infants
    who have not benefited from intrapartum AZT may
    still be afforded some reduction in the incidence of
    newborn infection if therapy is begun during labour
    and before the third day of newborn life.




        

  • D
    Dunn,  et
    al   (Univ College London; Hopital de la Croix-Rousse, Lyon,
    France; Statens Serum Institut, 
    Copenhagen)

    Mother-to-child transmission of
    toxoplasmosis : Risk estimates for clinical
    counselling.

    Lancet
    353: 1829-1833, 1999.

      

    Reliable estimate of the risk of congenital
    toxoplasmosis infection and its clinical sequelae in
    women who acquire this infection during pregnancy
    are currently not available. 
    Risk estimates for mother-to-child
    transmission of toxoplasmosis were determined for
    use in clinical counselling.

      

    Findings: 
    The overall maternal fetal transmission rate
    was 29%.  Risk
    of transmission increased markedly with duration of
    gestation from 6% at 13 weeks to 72 % at 36 weeks. 
    Fetuses infected early in pregnancy were much
    more likely to have clinical signs of infection. 
    Women sero-converting between 24 and 30
    weeks’ gestation had the greatest risk (10%) of
    having a congenitally infected child with early
    clinical signs and possible long term complications.

      

    Editorial
    comments:  Maternal diagnosis was based on the new appearance of
    immunoglobulin (Ig)M in serum, and gravidas with IgG
    were excluded as having been previously infected. 
    Only 5% of the newly infected gravidas had
    symptoms.  Fetal
    diagnosis  was
    based on mouse inoculation of umblical
    vein
    blood (22-32 weeks gestational age) or of amniotic
    fluid (16-30 weeks gestational age), supplemented by
    PCR for toxoplasmosis DNA in amniotic fluid after
    1994.  All gravidas with IgM conversion were treated with spiramycin
    and fetuses were treated with pyrimethamine and
    sulfadiazine if converison occurred past the 32nd
    week of pregnancy.

      

    The
    role of spiramycin in preventing fetal infection
    cannot be evaluated because of lack of controls. A
    recent analytical review finds no convincing
    evidence of benefit from maternal intrapartum
    prophylaxis for this disease. 
    Prenatal screening for maternal toxoplasmosis
    is not recommended. Whether newborn IgM screening
    for toxoplasmosis infection is cost effective is
    also uncertain.

       

 



 

 

Speciality Spotlight

 

   
Perinatology
    

 

 Fetal Therapy
   

  • JP Newnham, SF Evans, M Godfrey, et al (Univ. of Western Australia, Perth;  Children’s Hosp. Med. Ctr. Cincinnati, Ohio)
    Maternal, but not fetal, administration of corticosteroids restricts fetal growth: J Matern Fetal Med. 8:81-87, 1999
      
    Repeated maternal doses of betamethasone resulted in decreases in birth weight as well as in lower weights of the placenta and major organs.  However, injection directly into the fetus did not affect birth weight, placental weight, placental to birth weight ratio, or the weights of the major organs, except for the liver.
     
    Maternal administration of corticosteroids certainly results in improved new born lung function in immature fetuses born of human and a variety of other mammals.   In the human, evidence of fetal growth retardation on exposure to multiple maternal corticosteroid dosages, although not entirely conclusive, does appear to exist in some cases.
     
    No effects on fetal growth was seen among fetuses injected transdermally with either single or multiple doses.
         

  • NP French et al ( King Edward Mem Hosp. Perth, Western Australia)
    Repeated antenatal corticosteroids: Size at birth and subsequent development Am J Obstet Gynecol, 180:114-121, 1999.
     
    In terms of perinatal mortality and morbidity, recipients of steroids showed the favourable effects expected on pulmonary maturation, but no impact could be noted based on the number of steroid doses.


        

  • SZ Wiktor,  et al (Ctrs of Disease Control and Prevention, Atlanta, Ga; Cote d’Ivoire Ministry of Public Health, Abidjan)
    Short-course Oral Zidovudine for Prevention of Mother-to-Child Transmission of HIV-1 in Abidjan, Cote d’Ivoire: A Randomized Trial. 
    Lancet 353: 781-785, 1999.
      
    The risk of mother-to-child HIV-1 transmission is high in Africa.  A short course of perinatal oral zidovudine may reduce the rate of this transmission.  The safety and efficacy of a short course of oral zidovudine among HIV-1- seropositive breast feeding women in Abidjan were reported.
      
    Method: 280 patients received placebo or zidovudine in 300mg tablets. 1 tablet twice a day until labour onset, 1 tablet at labour onset and 1 tablet over 3 hours until the delivery. All infants were breast-fed.
      
    Findings:  The estimated risk of HIV-1 transmission was 21.7% in placebo group and 12.2% in the zidovudine group at 4 weeks and 24.9% and 15.7% respectively at 3 months.  Efficacy at 4 weeks and 3 months was 44% and 37% respectively.
     
    Conclusion:  A short course of oral zidovudine appears to be safe and effective in reducing mother-to-child transmission of HIV infections at 3 months of age.  The women tolerated this agent well.  Successful, widespread implementation of this treatment will require substantial efforts.
         

  •  F  Dabis, for the DITRAME Study Group (Universite Victor Segalen Bordeaux 2, France;  ORSTOM Petit Bassam, Abidjan;  Centr Muraz, OCCGE, Bobo-Dioulasso, Burkina Faso; et al)
    6-Month Efficacy, Tolerance and Acceptability of a Short Regimen of Oral Zidovudine to Reduce Vertical Transmission of HIV in Breastfed children in Cote d’Ivoire and Burkina Faso: A double-blind placebo controlled multicentre trial. 
    Lancet 353: 786-792, 1999.
      
    Findings:  The probability of HIV infection at 6 months of age was 18% among babies in the zidovudine group and 27.5% among those in the placebo group.
     
    Conclusion:  A short course of oral zidovudine in the peripartum period provides a 38% decrease in early vertical HIV-1 transmission, despite breast-feeding.
      
    Editorial comments: For emerging nations, early detection of HIV positivity, the logistic of assuring regular prenatal care visits and drug administration, the use of IV administration during labour and neonatal treatment in multiple drug doses usually exceed available financial and health group personnel resources. The cultural norms that value nursing despite the estimated 7% to 14% increase in maternal-to-fetal transmission thought to occur by 3 months of age in infants nursed by HIV positive women.
      
    Infant infection rate increased with age as the effects of breast milk transmission of the virus played its part.  The lesser reduction in incidence rate exhibited by these West African studies makes clear the importance of avoiding nursing to preclude horizontal transmission from mother to infants in the postpartum period.  On the other hand, these studies show that even when abbreviated, zidovudine therapy is quite effective in reducing vertical transmission.
        

  • NA Wade, et al (AIDS Inst,  Albany, NY: New York State Department of Health, Albany; Univ of Albany, NY
    Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of theHuman Immunodeficiency virus.)
    N Engl J Med 339: 1409-1414, 1998.
      
    Editorial comments:  The important message is that women and their infants who have not benefited from intrapartum AZT may still be afforded some reduction in the incidence of newborn infection if therapy is begun during labour and before the third day of newborn life.


        

  • D Dunn,  et al   (Univ College London; Hopital de la Croix-Rousse, Lyon, France; Statens Serum Institut,  Copenhagen)
    Mother-to-child transmission of toxoplasmosis : Risk estimates for clinical counselling.
    Lancet 353: 1829-1833, 1999.
      
    Reliable estimate of the risk of congenital toxoplasmosis infection and its clinical sequelae in women who acquire this infection during pregnancy are currently not available.  Risk estimates for mother-to-child transmission of toxoplasmosis were determined for use in clinical counselling.
      
    Findings:  The overall maternal fetal transmission rate was 29%.  Risk of transmission increased markedly with duration of gestation from 6% at 13 weeks to 72 % at 36 weeks.  Fetuses infected early in pregnancy were much more likely to have clinical signs of infection.  Women sero-converting between 24 and 30 weeks’ gestation had the greatest risk (10%) of having a congenitally infected child with early clinical signs and possible long term complications.
      
    Editorial comments:  Maternal diagnosis was based on the new appearance of immunoglobulin (Ig)M in serum, and gravidas with IgG were excluded as having been previously infected.  Only 5% of the newly infected gravidas had symptoms.  Fetal diagnosis  was based on mouse inoculation of umblical vein blood (22-32 weeks gestational age) or of amniotic fluid (16-30 weeks gestational age), supplemented by PCR for toxoplasmosis DNA in amniotic fluid after 1994.  All gravidas with IgM conversion were treated with spiramycin and fetuses were treated with pyrimethamine and sulfadiazine if converison occurred past the 32nd week of pregnancy.
      
    The role of spiramycin in preventing fetal infection cannot be evaluated because of lack of controls. A recent analytical review finds no convincing evidence of benefit from maternal intrapartum prophylaxis for this disease.  Prenatal screening for maternal toxoplasmosis is not recommended. Whether newborn IgM screening for toxoplasmosis infection is cost effective is also uncertain.
       

 

 

By |2022-07-20T16:43:41+00:00July 20, 2022|Uncategorized|Comments Off on  Fetal Therapy

About the Author: