Current Women's Health Reviews - Volume 5, Issue 2, 2009

Preeclampsia-eclampsia is one of the leading causes of maternal death in low and middle income countries (LMICs) accounting for more than seventy-five thousands maternal deaths every year. In high income countries, where treatment is more readily available, few women die of this disease, but complications- including rupture of liver, kidney failure, hemorrhage, and stroke - can cause lasting health problems. In addition, preeclampsia is among the most common causes of preterm births in high income countries. Preeclampsia-eclampsia is one of the pregnancy complications which has gained great attention in the research field and there are a number of international and national scientific societies as well as journals dealing exclusively with it. There are two major foci of research, those looking for the etiology of the disease and those looking for the prevention and treatment. Regardless that the disease has been observed for more than two thousand years still the etiology is unknown. Preeclampsia is known as the disease of theories and the history of research is prolific about big amounts of theories. Many years ago a researcher discovered a parasite in the placentas of women with preeclampsia, and the findings were published in a relevant journal, but a great disappointment came afterwards since the results showed that pieces of cotton swabs had become mixed in with the placentas; and under the microscope they looked like parasites. In contrast with this failure many relevant studies have provided clues that are approaching to solve this subject. In this issue a comprehensive and detailed review about the role that implantation and trophoblast invasion have in the genesis of preeclampsia was given by Ribeiro and coworkers. A promising area requiring more support is the role of angiogenic agents in the development of preeclampsia. Many ongoing studies are looking for modifications in maternal homeostasis previous to the development of preeclampsia that could contribute to better identify changes that can be associated with this disease. The possibility to perform genes studies could give information to assess the role of the genetic constitution of mother, the father and even the fetus on the genesis of preeclampsia. Studies about the etiology of preeclampsia will give a clue about approaches that could prevent this disease, but we are still far from obtaining such approaches and meanwhile many women in LMICs are dying as a consequence of this disease. Studies focused on the prevention and treatment of preeclampsia has given some relevant interventions and the challenge to make available such interventions to women living in LMICs. Antiplatelet agents, largely low-dose aspirin, have moderate benefits when used for prevention of pre-eclampsia and its consequences. There is a 17% reduction in the risk of pre-eclampsia associated with the use of antiplatelet agents (relative risk (RR) 0.83, 95% confidence interval (CI) 0.77 to 0.89), and 72 (CI 52 to 119) women need to receive such therapy to avoid one women with preeclampsia [1]. Disappointing results have been obtained with antioxidants since trials with supplements of vitamin C and E did not show any effects on preeclampsia prevention [2].

Menopause is characterized by a decrease of estrogen and progesterone levels. It is also associated with deleterious changes in body composition and blood lipids that increase the risks of type 2 diabetes and cardiovascular diseases (CVD). Physical activity and hormone-replacement therapy (HRT) have been suggested to act in synergy on important risk factors. However, HRT has recently been associated with a greater risk of CVD in older women, which has lead to an acute interest in alternative therapies. Soy isoflavones, a class of phytoestrogens, have shown beneficial effects on body composition of peri- and postmenopausal Japanese women. Recently, some studies combining isoflavones and exercise have suggested potential actions on risk factors of CVD.

Trophoblast invasion during implantation and placentation is critical for successful gestation and it is thought that invasion insufficiencies during placentation contribute to a number of obstetrical complications. However, relatively little is known regarding the regulation of this process and its link with the formation of new vascular beds during early pregnancy. Here, we review literature concerning the potential significance of inadequate uterine invasion as a contributor to the obstetrical complications of spontaneous abortion and preeclampsia. Studies have shown that both extrinsic and intrinsic factors involved in trophoblast invasion modulation seemed to be involved in some common obstetrical complications as early pregnancy loss and preeclampsia. Lipid molecules (i.e. prostaglandins, lysophosphatidic acid, anandamide), nitric oxide, metalloproteases and uterine natural killer cells, which are involved in implantation deficiencies, are also reported to be part of vascular abnormalities observed during preeclampsia. Trophoblast invasion together with placental vascularization reflects a complex interaction of regulatory factors. Understanding the regulation of trophoblast growth in the uterine matrix will provide much needed insight into implantation failure and placenta-related vascular insufficiencies.

This dual purpose of this review was to organize and synthesize what is known about women's psychological and behavioral responses to perinatal loss and examine perinatal loss as a predictor of compromised parenting. The conditions surrounding distinct losses (miscarriage, relinquishment of a child for adoption, and abortion) are highly variable necessitating examination of the differential impact of the various forms of loss on women's mental health and parenting. Preliminary assessment of relevant literature suggests the psychological experience and the cultural context of abortion may render this form of perinatal loss particularly damaging to the parenting process.

Risk-benefit analysis of medication used for psychiatric disorders is in general a challenge for medical doctors and a detailed analysis is required, which takes into account the age of the patient. Furthermore, it is even more difficult to find a suitable treatment for women who are planning to or become pregnant, because in this case it is also necessary to evaluate the potential risks of the drugs on the offspring, since some of them can pass the placental membranes reaching the fetal circulation. Atypical antipsychotic drugs including risperidone, quetiapine, clozapine and olanzapine are commonly used in patients with schizophrenia and other psychiatric disorders, but there are few studies of their effects during pregnancy. This is a subject which merits further investigation, especially taking into account that this group of drugs reaches in higher concentration values in fetal blood than in the maternal circulation. In this article we review the literature related to the effects of atypical antipsychotics during pregnancy and the neonatal period, focusing both on the mother and the fetus.

Preconception counseling has been a public health dilemma for many years as industrialized nations try to reconcile their fortitude in medicine with their poor pregnancy outcomes. Prior to the Center for Disease Control's (CDC) national recommendations in 2006, survey data showed that many providers were not addressing this stage in a women's life. Only 1 of 6 Primary Care Providers in the United States provided preconception care for women prior to their prenatal care. This problem is further complicated by chronic diseases that are now appearing in women of reproductive age. Globally, diabetes will increase by more than 50% in the next 10 years. This has translated into a 76% increase in prevalence among women in the last 25 years. However, this proportional increase has not translated into better care. This paper will summarize the need for preconception care for the Type 2 diabetic woman, look at challenges in the first trimester, and offer a literature review of the clinical guidelines for the primary care provider, obstetrician, and the endocrinologist.

Studies on the origin of aneuploid conceptions have indicated that many chromosomal abnormalities arise during maternal meiosis. Therefore, the direct cytogenetic analysis of female gametes is of interest to evaluate underlying mechanisms. Human oocytes failing to fertilize after the application of assisted reproductive technologies have predominantly been used for this purpose. In addition, indirect data can be obtained from the examination of the first polar body that reflects the chromosomal constitution of the oocyte. Both approaches have been conducted with different methods and provided substantial information on the incidence of aneuploidy originating from errors during first meiotic division. However, the results reported so far display great variability, most probably due to technical problems and heterogeneity of the study population. Notwithstanding these limitations, it was unequivocally shown that two aneuploidy-causing mechanisms exist: non-disjunction, resulting in the loss or gain of whole chromosomes, and predivision, resulting in the loss or gain of single chromatids in mature oocytes. All chromosome groups are affected by aneuploidy but abnormalities in groups D, E, and G exceed the expected values. Considering only abnormal complements with one extra or missing chromosome/chromatid reveals a slight increase in predivision compared with non-disjunction. Chromosome and chromatid abnormalities are positively correlated to maternal age. The simultaneous analysis of oocytes and first polar bodies suggests that some cases of aneuploidy are caused by gonadal mosaicism instead of meiotic errors.