Nausea And Speeding Heart Can Be Signs Of Flu In Pregnant Women

Nausea And Speeding Heart Can Be Signs Of Flu In Pregnant Women



Nausea in pregnant women tends to fade after the first three months, but during the second and third trimesters it can be a sign of flu, researchers at UT Southwestern Medical Center have found in a study of expectant women who sought medical care.

"People don't necessarily think of influenza when you include the symptoms of nausea or vomiting, but our study showed that they are common with influenza in pregnancy," said Dr. Vanessa Rogers, assistant professor of obstetrics and gynecology and lead author of the study, which appears in the May edition of Obstetrics and Gynecology.

"Both physicians and patients should be aware of these findings so treatment is not delayed," she said. "I think our findings should encourage people to be vigilant and to take symptoms seriously."

Adults with flu tend not to have nausea or vomiting, according to the Centers for Disease Control and Prevention. These symptoms are more typical in children.

The researchers studied the cases of pregnant women during the 2003-2004 flu season, when the most common strain of influenza caused more severe symptoms than usual. There also were more cases of flu than expected, because the vaccine given that year didn't match the strain that was predominant.

During that period, 107 pregnant women were diagnosed with flu at Parkland Memorial Hospital in Dallas. Ninety-three percent of the women had a cough, and 89 percent had fever common signs of flu the researchers found. Eighty-five percent had a "profound" elevated heart rate, and 60 percent had nausea and/or vomiting. Although "morning sickness" and nausea are common during pregnancies, the researchers said that reporting any unusual additional symptoms (fever, coughing, elevated heart rate) could help diagnose the disease earlier in these patients.

Nearly two-thirds of the expectant women treated at Parkland were sick enough to require hospitalization. The most common complication was pneumonia, which occurred in 12 percent of the cases.

Despite the illness, there was no significant difference in complications between women with flu and women without flu who gave birth at the hospital during flu season. After birth, the babies also showed no significant difference in complications.

"Early diagnosis and treatment might be the reason our patients did so well," Dr. Rogers said.

Other UT Southwestern researchers involved in the study were Dr. Jeanne Sheffield, associate professor of obstetrics and gynecology; Dr. Scott Roberts, professor of obstetrics and gynecology; Dr. Donald McIntire, professor of obstetrics and gynecology; Dr. James Luby, professor of internal medicine; Sylvia Trevino, infection preventionist in internal medicine; and Dr. George Wendel, professor of obstetrics and gynecology.

Treating Depression In Mothers Of Older Children

Treating Depression In Mothers Of Older Children



Depression among economically disadvantaged mothers could last well beyond the postpartum period and become a chronic condition, suggests a new study by researchers at Yale School of Medicine. The study also finds that symptoms could improve with brief treatment.

The results were presented by lead author Carol C. Weitzman, M.D., associate professor of pediatrics and in the Child Study Center at Yale School at Yale School of Medicine, at the Pediatric Academic Societies (PAS) Annual Meeting in Vancouver, British Columbia Medicine.

Depression in underserved women of childbearing age is extremely common, and nearly one in five mothers of children age one and older reports moderate to severe depressive symptoms, according to Weitzman.

"This finding reinforces that depression in mothers is not restricted to the postpartum period, and in fact after the postpartum period as children get older, the prevalence of maternal depression may be higher," said Weitzman.

Maternal depression has been linked to health and developmental problems in children. Therefore, to optimize children's health, mothers who are depressed should be identified and treated, said Weitzman. As parents routinely bring their children for check-ups, this may present an opportunity to identify depressed mothers, as so many women do not seek treatment for their symptoms, she notes.

In the study, Weitzman and her colleagues asked 931 mothers to complete a 16-item measure of depression severity before a well-child visit in a clinic that care for disadvantaged children. Women who screened positive were interviewed to confirm that they had depressive symptoms.

Seventy-one mothers with depression were randomly assigned to receive either six sessions of on-site cognitive behavior therapy or case management, which consisted of speaking with a social worker and getting assistance with referrals. Their children's social-emotional functioning was measured before and after treatment.

Results showed that 45 percent of mothers screened positive for depressive symptoms (26 percent had mild symptoms, 13 had moderate symptoms and 6 percent had severe symptoms). All of the women who received treatment showed improvements in their depression symptoms. The scores improved greatly in women who received cognitive behavioral therapy, while those who received case management did not show a dramatic change.

Children under age four whose mothers received cognitive behavioral therapy also had fewer behavioral challenges. No significant changes were reported among the women who received case management or those with children older than age four.

"A depressed parent can have a significant effect on a child," said Weitzman. "Brief on-site treatment can help reduce symptoms of depression in a mother and may also improve her perspective about her child's behavior."

The study was funded by the Robert Wood Johnson, Finding Answers, Disparities Research for Change and the Children's Fund of Connecticut.

How Active Immune Tolerance Makes Pregnancy Possible

How Active Immune Tolerance Makes Pregnancy Possible


Understanding of mouse immune-system response to specific fetal antigens also may provide insight into issues that arise during human pregnancies.

The concept of pregnancy makes no sense - at least not from an immunological point of view. After all, a fetus, carrying half of its father's genome, is biologically distinct from its mother. The fetus is thus made of cells and tissues that are very much not "self" - and not-self is precisely what the immune system is meant to search out and destroy.

Women's bodies manage to ignore this contradiction in the vast majority of cases, making pregnancy possible. Similarly, scientists have generally paid little attention to this phenomenon - called "pregnancy tolerance" - and its biological details.

Now, a pair of scientists from the California Institute of Technology (Caltech) have shown that females actively produce a particular type of immune cell in response to specific fetal antigens - immune-stimulating proteins - and that this response allows pregnancy to continue without the fetus being rejected by the mother's body.

Their findings were detailed in a recent issue of the Proceedings of the National Academy of Sciences (PNAS).

"Our finding that specific T regulatory cells protect the mother is a step to learning how the mother avoids rejection of her fetus. This central biological mechanism is important for the health of both the fetus and the mother," says David Baltimore, Caltech's Robert Andrews Millikan Professor of Biology, recipient of the 1975 Nobel Prize in Physiology or Medicine, and the principal investigator on the research.

Scientists had long been "hinting around at the idea that the mother's immune system makes tolerance possible," notes paper coauthor Daniel Kahn, a visiting associate in biology at Caltech, and an assistant professor of maternal-fetal medicine at the University of California, Los Angeles (UCLA). What they didn't have were the details of this tolerance - or proof that it was immune-related.

Now they do. To pin down those details, the two scientists began looking at the immune system's T regulatory cells (Tregs) in a strain of inbred mice that are all genetically identical - except for one seemingly tiny detail. Male mice - including male fetuses - carry on their cells' surfaces a protein known as a "minor transplantation antigen." Female mice lack this antigen.

Under normal circumstances, this antigen's existence isn't a problem for the male fetuses because the pregnancy tolerance phenomenon kicks in and protects them from any maternal immune repercussions.

To demonstrate the role of Tregs, Baltimore and Kahn used a drug to selectively target and destroy the cells. If the Tregs were indeed the source of pregnancy tolerance, they reasoned, their destruction would give the immune system free rein to go after the antigen-laden fetuses.

"In this case," says Kahn, "we knew the only possible immune response would be against the males - that the males would be at risk."
Indeed they were. When Baltimore and Kahn looked at the offspring of mice who'd been treated with the toxin, they found that fewer of the male fetuses survived to birth; those males that did survive were of significantly lower birthweight, presumably because of the inflammation caused by the mother's immune response to that single antigen.

"These T cells are functioning in an antigen-specific manner," Kahn notes. "In other words, their function requires the presence of the specific fetal antigens."

In their studies of these animals, the scientists also found that pregnancy tolerance "develops actively as a consequence of pregnancy," says Kahn. "The mice are not born with it." Indeed, virgin mice showed no signs of these pregnancy-specific Treg cells. Conversely, the cells were found in larger numbers in those individual mice that had given birth to more male babies, with the level of Treg cells increasing with the number of male births.

The next step, Kahn adds, is to look at Tregs and their role in pregnancy tolerance in humans - a line of research that may lead to new insights into such pregnancy-related conditions as preeclampsia, in which high blood pressure and other symptoms develop in the second half of pregnancy. Preeclampsia is a major cause of maternal mortality around the world.

"There's a lot to be learned," he says. "Pregnancy is often ignored in research because it's usually successful, and because - from an immunologic standpoint - it has such complexity. Until now, it's been difficult to grab a handle on how the immunology of pregnancy really works."

The work described in the PNAS article, "Pregnancy induces a fetal antigen-specific maternal T regulatory cell response that contributes to tolerance," was supported in part by a research grant from the Skirball Foundation. Kahn is supported by the National Institutes of Health's Building Interdisciplinary Research Careers in Women's Health Center at UCLA.

Increased Risk Of Birth Defects From Psychotropic Medications

Increased Risk Of Birth Defects From Psychotropic Medications



A new study shows that use of psychotropic medications during pregnancy increase the probability of birth defects. Researchers at the University of Copenhagen have published an article that documents the serious side effects that can be associated with these types of medications.

Between 1998 and 2007, psychotropic medications were associated with 429 adverse drug reactions in Danish children under the age of 17. Researchers from the University of Copenhagen's Faculty of Pharmaceutical Studies have published an article in the open access journal BMC Research Notes concluding that more than half of the 429 cases were serious and several involved birth defects, such as birth deformities and severe withdrawal syndromes.

Professors Lise Aagaard and Ebbe Holme Hansen from the University of Copenhagen studied all 4,500 paediatric adverse drug reaction reports submitted during the study period to find those which were linked to psychotropic medications. The two researchers found that 42 percent of adverse reactions were reported for psychostimulants, such as Ritalin, which treats attention deficit disorder (ADD), followed by 31 percent for antidepressants, such as Prozac, and 24 percent for antipsychotics, such as Haldol.

"A range of serious side effects such as birth deformities, low birth weight, premature birth, and development of neonatal withdrawal syndrome were reported in children under two years of age, most likely because of the mother's intake of psychotropic medication during pregnancy," says Associate Professor Lisa Aagaard.

Use of antidepressants is increasing

The researchers believe that these tendencies should serve as a warning to doctors and health care personnel.

"Psychotropic medication should not be prescribed in ordinary circumstances, because this type of medication has a long half-life. If people take their medicine as prescribed it will be a constantly high dosage, and it could take weeks for one single tablet to exit the body's system. Three out of four pregnancies are planned, and therefore society must take responsibility for informing women about the serious risks of transferring side effects to their unborn child," says Aagaard.

There is a clear indication that use of antidepressants is increasing in Denmark, as well as in many other countries, and the tendency is the same when it comes to pregnant women.

"We are constantly reminded about the dangers of alcohol use and smoking during pregnancy, but there is no information offered to women with regards to use of psychotropic medication. There is simply not enough knowledge available in this area," concludes Aagaard, suggesting that greater control should be required when prescribing psychotropic medications to pregnant women.

How Botulism-Causing Toxin Can Enter Circulation

How Botulism-Causing Toxin Can Enter Circulation



New research in the Journal of Cell Biology helps explain how the toxic protein responsible for botulism can enter circulation from the digestive system. The study appears online May 10.

Botulism, a rare but serious paralytic illness, is caused by botulinum neurotoxin (BoNT), an extremely toxic protein that is produced by the bacterium Clostridium botulinum. In food-borne botulism, the nontoxic components of BoNT - including hemagglutinin (HA) - protect the toxin from the low pH and enzymes encountered in the digestive tract. BoNT then passes through the intestinal epithelial barrier to enter circulation from the gut.

Although studies have examined how BoNT crosses the intestinal epithelial barrier, the mechanism by which it accomplishes this feat has remained a mystery. In this study, a team of Japanese researchers led by Yukako Fujinaga shows that HA plays a role. HA binds epithelial cadherin (E-cadherin), disrupting E-cadherin-mediated cell-to-cell adhesion and thereby disrupting the epithelial barrier.

Interestingly, the research demonstrates a species-specific interaction between HA and E-cadherin. Although HA binds human, bovine, and mouse E-cadherin, for instance, it does not bind rat or chicken.