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Biomedical subjects

P Grella

Publications and source records attributed to P Grella.

At least 19 recordsLinked to original sources
PubMed2001

Viral load in HCV RNA-positive pregnant women.

OBJECTIVES: The risk of hepatitis C virus (HCV) infection in the newborn is estimated to be around 5%, but becomes very high in the case of coinfection with HIV. One of the main factors associated with the vertical transmission of HCV is the viral load. Our objective was to investigate the behavior of HCV viral load during pregnancy in relation to HIV coinfection, liver enzymes, and vertical transmission. METHODS: Three thousand seven hundred forty-eight women seen consecutively in their first trimester of pregnancy were screened for HCV infection. Sixty-five were found to be anti-HCV+/HCV RNA+ and were followed up with clinical and serological assessment (i.e., transaminases and quantitative polymerase chain reaction [PCR] for viral load) in their second and third trimesters and 6 months after delivery. All were anti-HIV and hepatitis B surface antigen negative. HCV RNA was 12.0+/-19.9 x 10(6) copies/ml in the first trimester and 10.9+/-13.3 x 10(6) in the second, but increased to 19.5+/-25.1 x 10(6) in the third trimester. Six months after delivery the viral load returned to the baseline levels; the changes in viral load did not reach any statistical significance, however. Transaminases tended toward a reduction from the baseline during the second and third trimesters, and then an increase in both AST and ALT was recorded 6 months after delivery. However, when the group whose AST/ALT were found abnormal at the first test was considered, no significant changes were recorded during the follow-up. The overall rate of vertical transmission was 4.6 CONCLUSIONS: With HCV+ mothers monitoring transaminases during pregnancy is unnecessary, and testing liver enzymes at the beginning of pregnancy is sufficient. Qualitative PCR should be done once during the pregnancy, but any staging of the liver disease should be taken after delivery. Quantitative PCR testing is expensive and pointless. Any decision for elective cesarean section in HCV RNA+ mothers should be confirmed by other studies.

Alanine Transaminase↗
PubMed2000

Hepatitis C virus, hepatitis B virus and human immunodeficiency virus infection in pregnant women in North-East Italy: a seroepidemiological study.

BACKGROUND: Pregnant women can be considered a sentinel population, because they are a relatively unselected population whose prevalence data may be extended to the general population. METHODS: A seroepidemiological study was carried out in Padua (North-East Italy) to assess the epidemiological aspects of HCV. HBV and HIV infection in 2059 pregnant women consecutively seen at the Department of Obstetrics and Gynaecology during 1996. Out of them, 1804 (87.2%) were indigenous and 255 (12.8%) immigrants. Sociodemographical and sanitary data were collected for each woman. RESULTS: The overall prevalence of anti-HCV was 1.9% (42.5% with detectable HCV-RNA); HBsAg was found in 1.0%: the prevalence of anti-HIV was 0.3%. Findings are substantially consistent with the epidemiological picture of such infections in the general population of our geographic area. A parenteral risk factor for HCV infection was found in 19 subjects (47.5%): 18 were intravenous drug users and 1 a blood transfusion recipient. HBsAg seroprevalence was higher in immigrants than in autochthonous (3.1% vs. 0.7% respectively, p < 0.01). One of the 6 anti-HIV positive women was intravenous drug user. Logistic regression analysis was carried out for each viral agent to determine which characteristics were independently associated with infection: anti-HCV prevalence resulted independently associated to Italian origin (OR: 3.7), unmarried status (OR: 2.7), unemployed condition (OR: 6.1) and history of previous abortion (OR: 2.8). HBsAg prevalence was independently associated to unemployed condition (OR: 10.8), whereas HIV positivity was significantly related to the unmarried status (OR: 18.5). CONCLUSION: Our study pinpoints the need of screening all pregnant women for HCV and HIV infection, in addition to the HBsAg screening which is compulsory in Italy.

Adult↗
PubMed2000

Seroprevalence of HIV infection among pregnant women in the Veneto region (north-east Italy).

A heterogeneous population of 4396 consecutive pregnant women (86.6% indigenous, 13.4% immigrants) attending the Department of Obstetrics and Gynecology of the University of Padua (north-east Italy) were counselled and tested for HIV infection between September 1995 and December 1997. Sociodemographic and sanitary data were collected on each case. Anti-HIV prevalence was 0.57%. Intravenous drug use and foreign birth accounted for 28% and 24%, respectively, of the anti-HIV positive cases; 44% of the HIV-positive subjects reported no risk factors. In the logistic regression HIV positivity proved independently associated with intravenous drug use (adjusted OR 76. 6), sexually transmitted diseases (adjusted OR 13.2), unmarried status (adjusted OR 4.8), birth outside the European Union (EU) (adjusted OR 3.1) and age (adjusted OR 1.1). Heterosexual HIV spread appears to be a major concern. The monitoring of trends in HIV infection among subgroups should be continued in order to control the AIDS epidemic appropriately both by promoting HIV counselling and individual care, and by watching for changes in the social background.

Adolescent↗
PubMed1998

Obstetric complications in Marfan's syndrome pregnancy.

Marfan syndrome is usually inherited as an autosomal dominant trait with high degree of penetrance. It is caused by an abnormal fibrillin gene located on chromosome 15q. Cardiovascular involvement in Marfan syndrome has been overstressed, although very little attention has been given to obstetric complications. Marfan syndrome may be responsible of cervical incompetence, abnormal placental site and post partum haemorrhagic complications. A 22-year-old woman with Marfan syndrome had mitral regurgitation since childhood. In addition aortic root dilatation was documented over six years by means of echocardiography and had been followed up regularly in a district hospital. Echocardiography six months before pregnancy had shown minimal mitral and aortic regurgitation and aortic root dilatation of 4.1 cm; left ventricular function was normal. Repeat echocardiography evaluations during pregnancy confirmed an aortic root dilatation. Routine booking and screening investigations were all within normal limits. At the 25th week, admission was necessary following a vaginal bleeding, without pain contraction. Echography showed a placenta praevia and cervical dilatation 2.8 cm of diameter. Bed rest and intravenous thocolitic therapy were immediately enhanced. A cervical cerclage, as described by McDonald, was placed. At the 37th week the patient was admitted and cerclage removed before the caesarean section. A healthy female of 2900 g was born. The postoperative period was favourable and patient was discharge after 7 days. In the present case, it is suggested that cervical incompetence and placenta praevia may be caused by an alteration of microfibrillar fibers.

Adult↗
PubMed1996

Trends in immunoglobulin G anticardiolipin antibodies in ten successful heparin-treated pregnancies.

The pregnancies of ten women, all with histories of at least two spontaneous abortions of unknown cause, were followed. All patients were positive for immunoglobulin (Ig) G anticardiolipin antibodies (aCL) and one also for IgM aCL, while none had lupus anticoagulant activity. During pregnancy, the patients were treated with calcium heparin in doses varying between 15,000 and 30,000 IU daily. IgG aCL were assayed on average at the 9th, 17th, 24th and 29th weeks of pregnancy and at the moment of delivery. Mean values of IgG aCL levels during the 10 pregnancies steadily fell as the pregnancies progressed, and this decrease was significant (r = 0.985, P = 0.002). All pregnancies terminated favourably, although delivery was brought forward in eight patients and six of the nine placentas examined showed signs of thrombotic events. We assume that a steady fall in IgG aCL levels during pregnancy may be considered as indicative of a favourable outcome.

Adult↗
PubMed1996

Hepatitis C virus infection in pregnancy.

OBJECTIVES: To evaluate the clinical aspects of hepatitis C virus (HCV) liver disease in anti-HCV+ve mothers, both during pregnancy and six months after delivery, and to assess the outcome of pregnancy. SETTING: Obstetric department for high risk pregnancies of the University of Padova, Italy. PARTICIPANTS: Seventeen hundred consecutive pregnant women were studied. METHODS: Each woman underwent the following: 1. serological screening for hepatitis surface antigen (HBsAg), antibodies to HCV (anti-HCV), antibodies to human immunodeficiency virus type 1 (HIV1) within the first trimester of pregnancy; and 2. clinico-biochemical assessment in order to ascertain previous or active liver disease and risk factors for viral infections. RESULTS: Twenty-nine (1.7%) of the 1700 women were found anti-HCV positive. Eight of them had an associated positivity for HIV infection. HCV-RNA was positive in 64.2% of anti-HCV positive women. Liver function tests (included transaminases) were within the normal range in 27 mothers (both during and six months after delivery). Only 2/29 women had a slight increase in AST/ALT; liver biopsy in these cases was compatible with mild chronic active chronic active hepatitis. In all women the outcome of pregnancy was favourable (12/29 anti-HCV positive mothers underwent caesarean delivery for causes independent from HCV infection). CONCLUSIONS: A substantial proportion of anti-HCV positive pregnant mothers, even if asymptomatic, have circulating HCV-RNA. The pregnancy does not induce a deterioration of liver disease, and vice versa, HCV infection does not increase the risk of obstetric complications.

Adult↗
PubMed1995

Relation between erythropoietin and vitamin B12 in normal and anemic pregnant women.

In this cross-sectional study of 178 pregnant women between the 7th and 42nd week of pregnancy, we analyzed correlations between erythropoietin (EPO) and vitamin B12 (B12) in different stages of pregnancy and in relation to hemoglobin (Hb) levels. Patients with hypertension, fetal growth retardation and severe systemic diseases were excluded. EPO (by ELISA), B12 (by RIA) and Hb were assayed in the same blood sample taken on admission. On the basis of weeks of pregnancy, EPO levels and B12 levels, the 178 subjects were found to fall into two clusters, before and after the 27th week of gestation. The correlation coefficient between EPO and B12 was highly significant in the first group but not in the second (R = -0.33; p < 0.01). When the patients were divided on the basis of Hb levels (< or = or > 11 g/dl), a significant correlation was found only in the 88 patients with Hb > 11 g/dl (R = -0.44; p < 0.001) and not in the 72 anemic subjects. Moreover, in the former group the correlation between EPO and B12 was high before and after the 27th week, unlike in the latter group for which no significant correlation was found. These results suggest that EPO and B12 act together to establish normal erythropoiesis in pregnancy.

Adult↗
PubMed1994

The effect of fetal infection with human immunodeficiency virus type 1 on birthweight and length of gestation. SIGO Study Group of HIV Infection in Pregnancy.

We sought to evaluate the effect of vertical transmission of human immunodeficiency virus type 1 (HIV-1) on birthweight and length of gestation. For this purpose we used maternal and pregnancy data of 559 HIV-1-seropositive pregnant women delivered at 13 Italian centers from 1985 to 1991. The mother-to-child transmission rate of HIV infection was 18.2% (84/461). After adjustment for potential confounders with multiple linear regression analysis, there were no differences in birthweight, gestational age, and proportion of expected birthweight (observed birthweight/expected birthweight) between infected and uninfected children. Intravenous drug abuse during current pregnancy was the factor which correlated best with a reduction in birthweight (mean reduction, 214.4 g; 95% confidence interval (CI), 61.7-367.1), length of gestation (mean reduction, 9.3 days; 95% CI, 3.9-14.7) and proportion of expected birthweight (mean reduction, 12.1%; 95% CI, 4.7-19.5%). In our population, HIV-1 infection of the fetus has little effect on length of gestation and birthweight.

Adult↗
PubMed1994

Pattern of vitamin B12 and folic acid during pregnancy.

The aim of this study was to evaluate folate and vitamin B12 serum concentrations and their reciprocal relationships during pregnancy in relation to gestational age and levels of hemoglobin. Serum levels of vitamin B12 (B12) and folic acid (FA) were assessed by RIA in 213 women between the 6th and 43rd week of pregnancy. For 195 of these subjects, hemoglobin and hematocrit values were available. The logarithm (log) of B12 levels was found to be inversely correlated with weeks of pregnancy (R = -0.261; p < 0.001). A decrease in B12 levels occurred before the 27th week and was significant only in the subgroup of patients having hemoglobin levels above 11 g/dl. The log FA concentrations did not show any significant correlation with weeks of pregnancy irrespective of Hb levels. There was also a highly significant correlation between log B12 and log FA after 27 weeks and in the subgroups divided according to Hb levels (< or = and > 11 g/dl). It is therefore concluded that: (1) the demand for vitamin B12 is high in the first 27 weeks of pregnancy due to increasing maternal and embryo-fetal erythropoiesis and in order to sustain normal maternal Hb levels in the last weeks of pregnancy; (2) vitamin B12 might favor the absorption and utilization of FA after 27 weeks of pregnancy.

Adolescent↗
PubMed1993

Erythropoietin and transferrin concentrations during pregnancy in relation to hemoglobin levels.

Serum levels of erythropoietin (EPO) were assayed by ELISA at the same time as red blood cells (RBC), hemoglobin (Hb), hematocrit (Hct), serum iron and transferrin in 136 pregnant women, divided on the basis of hemoglobin values (> or < or = 10.5 g/dl) and weeks of pregnancy (< or > or = 27th week). In the overall population, a parallel increase with weeks of pregnancy was shown by serum concentrations of EPO expressed as a logarithm (multiple R = 0.367, P < 0.0001), and transferrin levels (multiple R = 0.529, P < 0.0001). It was found that EPO levels did not differ significantly between anemic and non-anemic patients before the 27th week, but the difference became highly significant (P < 0.01) after the 27th week in favour of anemic patients. Before the 27th week, the correlations between log EPO and RBC, Hct, Hb and iron were not significant, whereas the correlation between log EPO and transferrin was significant (P < 0.01); after the 27th week, the correlations and significance of the regression found were: log EPO vs Hb (Pearson coefficient = -0.384; P < 0.001), vs Hct (Pearson coefficient = -0.370; P < 0.01), vs transferrin (Pearson coefficient = 0.392; P < 0.0001), vs iron (Pearson coefficient = -0.274, P < 0.05). In the population divided according to Hb levels, the correlation was positive and significant in both groups between log EPO and transferrin (Hb > 10.5 g/dl: Pearson coefficient = 0.524, P < 0.0001; Hb < or = 10.5: Pearson coefficient = 0.614, P < 0.0001), but was inverse and significant only in the group with Hb < or = 10.5 g/dl between log EPO and serum iron (Pearson coefficient = -0.481, P < 0.01). The variations in EPO were related to Hb levels after the 27th week of pregnancy and were closely correlated with transferrin over the whole period. The physiological mechanism of these changes is discussed.

Enzyme-Linked Immunosorbent Assay↗
PubMed1993

The significance of the relationship between serum levels of cobalamin and MCHC during pregnancy.

Cobalamin concentration and mean corpuscular haemoglobin concentration (MCHC) were found to have highly significant inverse correlation with the weeks of pregnancy (respectively -.278 P < .0001 and .342 P < .00001) in 205 pregnant women. Among all haematometric parameters cobalamin concentrations during pregnancy only correlates with MCHC (P < .01). This datum seems to indicate an influence of B12 on erythropoiesis which adequate the concentration of haemoglobin to circulatory modifications of pregnant women.

Adult↗
PubMed1992

Iron balance in pregnancy in relation to anemia.

Blood levels of iron, transferrin and ferritin varied in the course of pregnancy (6th to 42nd week) in 136 women. Analysis of variance showed that the factor "weeks of pregnancy" (< or = 27 or > 27 weeks) was correlated differently with the variables "ferritin" and "iron" according to the presence or absence of anemia (Hb < or = or > or = 11 g/dl). In anemic women the correlation was significant (F-ratio = 5.90; P = 0.018) for iron (which decreased from initial low level until term) but not ferritin, whereas in non-anemic women the correlation was significant (F-ratio = 13.306; P = 0.0006) for ferritin (which decreased to less than 20 micrograms/ml around the 34th week) but not iron. In both anemic and non anemic subjects, transferrin levels increased with weeks of pregnancy. It is concluded that towards the end of pregnancy, some decrease in ferritin (> or = 15 micrograms/ml) is physiological, and in the absence of anemia (Hb > 11 g/dl) iron supplements are not necessary.

Analysis of Variance↗
PubMed1990

Antenatal aminophylline and steroid exposure: effects on glomerular filtration rate and renal sodium excretion in preterm newborns.

Creatinine clearance and renal sodium excretion were measured consecutively in three groups of 12 premature infants (gestational age less than or equal to 35 weeks) whose mothers had received either steroids or aminophylline, or steroids and aminophylline before delivery. We found no significant differences for plasma and urine creatinine and its clearance in the groups considered. The steroid group presented urine osmolality and urine/plasma osmolality ratio significantly higher than among the other groups. Furthermore, urine potassium excretion increased, and urine sodium and sodium fractional excretion were reduced. Aminophylline exposure did not interfere with the hydrosaline equilibrium nor with renal function of the preterms at birth. Our results reconfirm that corticosteroid hormones play an important part in the fetal renal maturation process, inducing a precocious maturation of the tubular Na(+)-K+ ATPase enzymatic system, that is substantially unmodified by aminophylline exposure. However, due to the prolonged half-life of aminophylline in prematures, it seems reasonable to verify the coupling of tubular and glomerular functions also in the following days of life.

Aminophylline↗
PubMed1985

Levels of total and free tryptophan in maternal and in umbilical blood of infants born by vaginal delivery and by elective cesarean section.

The variations of total and free tryptophan levels in samples of maternal and umbilical blood obtained on the occasion of elective cesarean section have been compared with similar samples taken from vaginal deliveries. In the neonates studied the umbilical blood levels of total and free tryptophan have been found to be higher than in the blood of the respective mothers, while the percentage of free tryptophan is comparable. In addition, the umbilical blood levels of both fractions of tryptophan appeared to be higher in newborn infants after spontaneous delivery than in those after elective cesarean section. These data show an active transport of tryptophan through the placental barrier that seems to be favored by spontaneous delivery.

Cesarean Section↗
PubMed1984

[Antineoplastic agents and pregnancy].

The current impossibility of establishing a definite causal relationship between the administration of antineoplastic drugs before and/or during pregnancy and possible modifications of the gestational attitude in the treated women is discussed after a review of the Literature. The data till now reported are often deficient as far as concerns the evaluation of either the fetal, perinatal and post-natal parameters and the past and current reproductive performance of the patients on study. The need for strict methodology in the study and report of feto-maternal parameters to provide a comprehensive answer to the questions raised by the use of antineoplastic drugs before and/or during pregnancy is discussed in detail.

Abnormalities, Drug-Induced↗