The aim with this thesis was to assess the impact of prenatal ultrasound exposure on psychotic illness, childhood brain tumors (CBT) and school achievement, and to evaluate prenatal X-ray exposure and the risk of CBT. In a cohort study, children born in Malmö 1973-1978, where prenatal ultrasound was used routinely, were considered exposed (n=13, 212) and children born at hospitals with no use of ultrasound, were considered unexposed (n=357,733). Exposed men had a tendency toward a higher risk of schizophrenia. For other psychoses there were no differences between groups. Other factors related to place of birth might have influenced the results. In a case control study, children born 1975-1984 with a diagnosis of CBT (n=512), and randomly selected control children (n=524) were included. Exposure data on X-ray and ultrasound from antenatal records was completed with information from the Medical Birth Register. We found no overall increased risk for CBT after prenatal X-ray exposure. When stratifying by histological subgroups, primitive neuroectodermal tumors had the highest risk estimates. For ultrasound exposure, no increased risk for CBT was seen and numbers of examinations or gestational age at exposure had no substantial impact on the results. In a follow-up of a randomized trial on prenatal ultrasound scanning 1985-87, we assessed the children’s school grades when graduating from primary school (15-16 years of age). We performed analyses according to randomization, ultrasound exposure in the second trimester and exposure at any time during pregnancy. There were no differences in school performance for boys or girls according to randomization or exposure in the second trimester. Boys exposed to ultrasound any time during fetal life had a reduced mean score in physical education and small, non-significant increased risk of poor school performance in general.

Für die Beurteilung der Hirnentwicklung erfolgte eine postmortale MRT- Untersuchung von totgeborenen Kindern im Rahmen einer virtuellen Autopsie. Besondere Berücksichtigung innerhalb dieses Datenmaterials fand die Oberflächenveränderung im Sinne der Entstehung von Gyri und Sulci. Weiterhin wurde geprüft, wie sich die morphologische Entwicklung und damit die Germination und Migration der Nervenzellen in diesem Schwangerschaftszeitraum in der MRT darstellen und beurteilen lässt. Im Ergebnis der Untersuchung zur Germination und Migration war vor allem zwischen der 18. und 25. SSW die zonale Gliederung des Hirnmantels mit “ventricular zone“, “intermediate zone“, “subplate zone“ und “cortical plate“ durch wechselnde Hypo –bzw. Hyperintensitäten in der MRT gut zu beurteilen. Der zeitlich geordnete Ablauf in der Entstehung einzelner Sulci konnte in dieser Arbeit unter anderem auch mittels eines atlasartigen Teils abgebildet werden. Dabei zeigte sich eine häufig etwas frühere Darstellbarkeit einzelner Sulci im postmortalen MRT im Vergleich zu den Studien an pränatalen MRT´s bei Schwangeren. Eine Streubreite des Auftretens der einzelnen Sulci von 2-3 Wochen bei gesunden Feten ist dabei zu berücksichtigen.

This study examined the effects of maintaining exercise training throughout pregnancy upon metabolic and physical properties of parametrial fat cells and fetal growth in Wistar rats. Eight weeks prior to mating the animals (n=10) were trained to run for 2 hrs/day, 5 days/wk at 31 m/min up an 8 0 incline. Control animals (n=6) remained sedentary. All animals were mated and trained animals resumed running on the second day of gestation. There was no variation in body weight (p > 0.05) between the trained (T) and sedentary control (S) rats at mating but S weight was significantly greater (p < 0.05) at Day 19. The T mothers had significantly smaller fat cells (p < 0.05) than S but cell number did not differ (p > 0.05). The rate of glucose oxidation (1C-1) by cells from T animals was significantly higher (p < 0.05) than the S in the presence of insulin, but much lower than oxidation rates of non-pregnant trained animals. In terms of the fetus, training reduced litter size (p < 0.05) and increased the incidence of fetal resorption. The results of this study indicate that the training adaptation of the adipocytes is largely lost during pregnancy but insulin responsiveness is maintained at a higher level than sedentary controls. This coupled with the apparent adverse effects of the training on the fetus suggests that exercise during pregnancy should be more closely investigated.Ball State UniversityMuncie, IN 47306

The modern world is facing a revolutionary development in the clinical medicine and biomedical sciences. Due to the different life supporting systems, it is easily possible to keep patients with severe diseases alive. With organ transplantation a lot of people, who would otherwise die can live long and happy lives. In vitro fertilization allows a woman to bear the child that is not genetically related to her. Due to the possibility of contraception, safe abortions and prenatal diagnosis, women and couples can make preferable choices concerning their future child. Such medical developments and improvements have a great impact on our life, and provoke a lot of ethical questions and moral dilemmas. The aim of this thesis is to answer the question whether prenatal diagnosis can be justified as it mainly leads to the selective abortion, whether and when the fetus counts as a person and whether the prospective parents can perform selective abortion on the basis of fetal disability; and to discuss ethical problems that are experienced by the doctor, who brings the news into the family and what is his/her role in the decision-making process.

Chicken fetuses exposed to chronic hypoxia suffer from growth retardation and induces an overall sympathetic activity, including elevation of the concentration of circulating catecholamines. Simultaneously, hypoxic fetuses display a lowered β-adrenoreceptor (βAR) density in myocardial tissue. In vertebrates, β1AR and β2AR are the most important signalling pathways for acute elevation of cardiac performance. The aim of this study was to see how chronic hypoxia affects the level of messenger RNA (mRNA) for the β1AR in the fetal chicken heart at different developmental ages. The broiler chicken is a suitable model organism for studying the progression of heart failure because the fast growth rate requires a large increase in blood perfusion at the end of fetal development. The β1AR sequence of the broiler chicken is 1587 bp and located on chromosome 6. When running a PCR for quantification of the sequence, primers for almost the whole sequence failed (1404 bp) and so did primers of 1193 bp; instead primers of 692 bp of the sequence were used and made quantification possible. Similar results were obtained from both the heart and liver of day 15 fetal chickens. The PCR product was cloned into a TOPO vector and sent for sequencing, to enable the making of a probe for a northern blot analysis of the mRNA in the fetal chicken hearts.

Placental vessels and the umbilical circulatory network function to carry oxygen and nutrients to the fetus. It is at this level that placental lesions such as villitis, obliterative vasculopathy, and thrombotic vasculopathy have been observed in association with fetal inflammatory response syndrome (FIRS) and cerebral palsy. We used human umbilical vein endothelial cells (HUVECs) as a model to study the regulation of inflammation and thrombosis in fetal vessels by microbial products. In this thesis we measured interleukin-8 (IL-8) and tissue factor (TF) expression by HUVECs treated with lipopolysaccharide (LPS), poly (I:C) (PIC), and peptidoglycan (PG). Our results show a profound induction of IL-8 by PIC, a TLR-3 ligand. We also show a moderate induction of tissue factor expression in PIC-treated HUVECs. These results show that HUVECs are exquisitely sensitive to PIC and suggests an important role for viral infection in umbilical vessel inflammation. We additionally treated HUVECs with dexamethasone (DEX), an anti-inflammatory steroid, and melatonin (MT), a pineal gland product with immunomodulatory and anti-oxidant properties. DEX reduced the level of both IL-8 and TF expression in PIC-treated cells. MT, however, further enhanced IL-8 expression in PIC-treated cells. Our results indicate a potential role for glucocorticoid therapy in reducing placental vessel inflammation and thrombosis. Thus, intervention with GC in pregnancies with FIRS may reduce the severity of placental lesions associated with cerebral palsy.

Physicians are familiar with organophosphates (OPs) as a classic, though obscure, cause of cholinergic poisoning. Many opportunities for human exposure existsixty million pounds of OPs are applied as insecticides to sixty million acres of U.S. land each year, and, until recently, over one-fifth of Americans used these chemicals in their homes. Most physicians, however, still know little about the dangers that these pesticides pose to the developing nervous system. By the late 1980s, toxicologists increasingly recognized that toxicants such as lead and mercury, even at doses well-below the level required to cause symptomatic poisoning, could induce subtle, yet permanent, neurological deficits if the exposure occurred during critical periods of brain development. In the early 1990s, scientists and regulators began to realize that developmental neurotoxicity (DNT), as this phenomenon was called, could also result from OPs. In 1996 Congress passed the Food Quality Protection Act (FQPA), marking a major turning point in the regulation of hazardous chemicals. Prior to the FQPA, the Environmental Protection Agency (EPA) based its calculations of pesticide risk on adults and largely neglected the increased susceptibility of infants and children. The new law took a precautionary stance, protecting the vulnerable neural and physical development of the fetus and child with the inclusion of a 10-X safety factor, and shifting the burden of proof from health advocates to the pesticide manufacturers. The ensuing ten-year battle between health groups, pesticide manufacturers, and the EPA over the laws enforcement now provides an instructive lesson into the complex scientific, political, and economic world of environmental health, and serves as a relatively successful example of effective policy improving public health.

This retrospective case-control study was designed to investigate the relationship between placental localization and intrauterine growth restriction (IUGR). Pregnant women with an anatomic survey from January 1, 2000, to December 31, 2005, and delivery of the pregnancy at Yale-New Haven Hospital (YNHH) were identified using clinical and billing records. Multiple gestation, fetal anomaly, and incomplete medical information were reasons for exclusion. Cases (N=69) were consecutive pregnancies with evidence of IUGR (estimated fetal weight <10th percentile for gestational age) at last follow-up ultrasound. Randomly selected controls (N=258) from the same time period had no evidence of IUGR. Maternal, ultrasound, delivery, and perinatal data were collected by retrospective medical record review, and IUGR cases and non-IUGR controls were compared using the Students t-test, Wilcoxon test, Chi-square analysis, Fishers exact test, and ANOVA. Placental location was determined from the anatomic survey record (obtained at 18.4 ± 1.2 weeks gestation in the IUGR group and 18.2 ± 1.0 weeks gestation in the control group; P=0.18). Multivariate logistic regression with adjustment for confounders was used to investigate the association between IUGR and placental localization. Consistent with known predictors of IUGR, the IUGR group had a higher proportion of black women (36.4% vs. 19.8%, P=0.03), chronic hypertension (26.0% vs. 3.5%, P<0.001), and hypertensive disorders of pregnancy (36.2% vs. 5.0%, P<0.001). Mean birth weights of IUGR and non-IUGR pregnancies differed by 2 kilograms (3244 ± 625 grams vs. 1277 ± 637 grams, P<0.001). IUGR infants were more likely to receive antenatal steroids, deliver preterm, deliver by cesarean section, and be admitted to neonatal intensive care. In both IUGR and non-IUGR pregnancies, the placenta was most commonly anterior or posterior. Unilateral placentas were three times more common in the IUGR group than in the non-IUGR group (17.4% vs. 5.0%, P=0.01). IUGR pregnancies were over four times as likely as control subjects to have unilaterally-located placentas compared to anterior placentas (OR 4.8, 95% confidence interval, 1.9-11.7). Adjusting for ethnicity, chronic hypertension, and hypertensive disorders of pregnancy did not affect this finding (OR 4.6, 95% confidence interval 1.6-13.5). In conclusion, we compared a group of 69 IUGR pregnancies to 258 non-IUGR controls and found intrauterine growth restriction to be associated with unilateral placentation.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The convergence of compelling evidence that transmission of HIV from a pregnant woman living with HIV to her foetus can be significantly interrupted due to advances in antiretroviral and obstetrical interventions, and worrisome epidemiologic data documenting a rise in HIV infection among Canadian women, spurred the development in Canada and world wide of policies and programmes aimed at increasing the number of pregnant women who are tested for HIV. Responding to innovative therapy reducing perinatal HIV transmission risk by increasing the number of pregnant women who agree to test for HIV is clearly an important prevention objective. However, the process must be accomplished in a way that is of most benefit to the pregnant woman herself and in a way that does not compromise a pregnant woman's rights to the established Canadian principles of HIV counselling and testing. / Working with pregnant women in Ontario, the province with the highest level of HIV infection among Canadian women, this thesis articulates and interprets their experiences of prenatal HIV counselling and testing and details their perspectives on best practices. The pregnant women's evidence-based recommendations for the re-design of prenatal HIV testing programmes are provided. These unique data have important utility for federal and provincial policy makers as HIV counselling and testing policies and programmes that encompass and are grounded in pregnant womens' experiences and perspectives are likely to be maximally acceptable and thereby increase the number of pregnant women who can be apprised of prophylactic treatment to take care of their own health needs as well as those of their unborn children. / In order for pregnant women to increase control over their own health and that of their unborn children, there is clear value in all pregnant women being afforded the opportunity to know their HIV status. However, the voices of the women in this study suggest that the autonomy rights of pregnant women may well be at risk in a programme in which the current emphasis is on potential HIV infection of the foetus rather than on potential or actual infection of the pregnant woman.