ACTA ENDOCRINOLOGICA (BUC)

Context. Foetal asphyxia, a frequent birth complication, detrimentally impacts the immature brain, resulting in neuronal damage, uncontrolled seizure activity and long-term neurological deficits. Oxytocin, a neurohormone mediating important materno-foetal interactions and parturition, has been previously suggested to modulate the immature brain’s excitability, playing a neuroprotective role. Our aim was to investigate the effects of exogenous oxytocin administration on seizure burden and acute brain injury in a perinatal model of asphyxia in rats. Animals and methods. Asphyxia was modelled by exposing immature rats to a 90-minute episode of low oxygen (9% O2) and high CO2 (20% CO2). Control rats were kept in ambient room-air for the same time interval. In a third group of experiments, oxytocin (0.02 UI/g body weight) was nasally administered 30 minutes before the asphyxia episode. Seizure burden was assessed by the cumulative number of loss of righting reflex (LRR) over a two-hour postexposure period. Acute brain injury was assessed through hippocampal S-100 beta, a biomarker of cellular injury, 24-hours after exposure. Results. Asphyxia increased both LRR and hippocampal S-100 beta protein compared to controls, and these effects were significantly reduced by oxytocin administration. Conclusion. Oxytocin treatment decreased both seizure burden and hippocampal injury, supporting a potential neuroprotective role for oxytocin in perinatal asphyxia.

Context. Underweight, overweight and obesity are important global public health issues and risk factors for adverse perinatal outcomes. Objective. To assess the distribution of the body mass index (BMI) in the Romanian obstetric population in the first trimester of pregnancy and its correlation with pregnancy outcomes. We also report the distribution of blood pressure (BP) parameters and their correlation with BMI. Design. This retrospective study includes 9,064 women attending routine first trimester visit and ultrasound scan at 12.8(±0.6) gestational weeks. Characteristics, parity, method of conception, blood pressure (from 3,650 women), maternal weight and height, BMI and foetal ultrasound were recorded. Pregnancy outcomes were available for 1,607 deliveries. The Pearson correlation coefficient was assessed for each BMI group vs. blood pressure parameters, gestational age and birth weight. ANOVA analysis and post hoc tests were used to determine group differences. Linear regression was applied to estimate the contribution of BMI and gestational age to birth weight variance. Results. In our population, 66.37% pregnant women had a normal BMI, 19.29% were overweight, and 7.56% were obese. There was a weak-to-medium positive correlation between BMI and blood pressure parameters, for all weight categories. The correlation between maternal BMI and birth weight was positive for normal and overweight. Conclusions. Our findings highlight the need for more effective health strategies targeting reduction of weight-related problems in women of childbearing age.

This review discusses current international recommendations for GDM diagnosis and management and argues whether it would be worth considering first, universal screening for GDM in our country, second, updating of management guidelines and third, organized follow-up of women diagnosed with GDM and adoption of lifestyle interventions after delivery that could reduce the onset and prevalence of type 2 DM.

Introduction. Glucocorticoids (GC) are largely used for their anti-inflammatory and immunosuppressive effects. Until recently “local” administration (inhalation, topical, intra-articular, ocular and nasal) was considered devoid of important systemic side effects, but there is no administration form, dosing or treatment duration for which the risk of iatrogenic Cushing’s syndrome (CS) and consequent adrenal insufficiency (AI) can be excluded with certainty. Patients and methods. We present the case of a pregnant woman who developed overt CS with secondary AI in the second trimester of pregnancy. She had low morning plasma cortisol 6.95 nmol/L (normal non-pregnant range 166 – 507) and low ACTH level 1.54 pg/mL (normal range 7.2 – 63.3), suggestive for iatrogenic CS. A thorough anamnesis revealed chronic sinusitis long-term treated with high doses of intranasal betamethasone spray (6 - 10 applications/day, approximately 10 mg betamethasone/week, for 5 months). After decreasing the dose and switching to an alpha-1 adrenergic agonist spray, the adrenal function recovered in a few weeks without manifestations of AI. The patient underwent an uneventful delivery of a normal baby. A review of the literature showed that only a few cases with exogenous CS and consequent AI caused by intranasal GC administration were described, mostly in children, but none during pregnancy. Conclusion. Long-term high doses of intranasal GC may induce iatrogenic CS and should be avoided. Low levels of ACTH and cortisol should prompt a detailed anamnesis looking for various types of glucocorticoid administration.