pregnancy Archivi

Metabolic syndrome and birth risks

Nicoletta Di Simone¹– , Gloria Lalli²– , Greta Barbaro³–

1 – MD, PhD at Humanitas University, Milan

2 – MD at Humanitas University, Milan

3 – MD at Università Cattolica del Sacro Cuore, Rome

Corresponding Author: Nicoletta Di Simone

nicoletta.disimone@hunimed.eu

DOI: 10.53146/lriog1202156

Abstract

Metabolic syndrome is a condition characterized by the simultaneous presence of a cluster of risk factors leading to an increased cardiovascular risk. During pregnancy this syndrome has important repercussions on the maternal and fetal well-being and can cause important risks at the time of delivery. Pregestational hypertension increases the risk of preeclampsia, intrauterine fetal growth restriction and abruptio placentae. Also type II diabetes is a risk factor for preeclampsia and hypodevelopment but may also involve the appearance of fetal macrosomia and polyamnios. Fetal macrosomia is responsible for an increased risk of shoulder dystonia and polyamnios can determine the umbilical cord prolapse at the time of rupture of the membranes. Obesity is another element of metabolic syndrome. The obese pregnant patient has an increased risk of premature childbirth, she has a lower probability of response to the medical induction of labor and requires higher doses of oxytocin. In addition, the management of these patients is also complicated from an anesthesiological point of view: the placement of the peridural catheter is more difficult and they have a higher risk that it will displace, therefore getting a good epidural analgesia in these patients is not always easy. In obese patients, the risk of performing an urgent cesarian section is higher and leads to increased anaesthetic complications (tough intubation and difficult mechanical ventilation), intraoperative complications (increased bleeding and difficult fetal extraction) and post-operative (increased risk of surgical site infection). Still unclear are the effects of a dyslipidic state on pregnancy, although the change in lipidic profile is, within certain limits, physiological. Metabolic syndrome is therefore a condition that must be intercepted before pregnancy arises, as all the factors that compose it are modifiable.

Keywords: metabolic syndrome; pregnancy; obesity; hypertension; diabetes; delivery.

Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283

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Love cells: the affective role of the fetal cells migration into the maternal limbic system

Mario Valerio Tartagni¹– , Alessandra Graziottin^2,3–

1 – “Fontana” Department of Gynecology and Obstetrics, Kantonsspital Graubünden, Chur, Switzerland.

2 – Graziottin Foundation for the treatment of pain in women, Onlus

3 – Center of Gynecology and Medical Sexology, H. San Raffaele Resnati Milan

Corresponding Author: Mario Valerio Tartagni

DOI: 10.53146/lriog1202142

Abstract

Why do foetal cells migrate in mother’s limbic system? During pregnancy the mother’s brain undergoes both microscopic and macroscopic changes. The foetus, throughout the whole pregnancy, sends its own cells (Pregnancy Associated Progenitor Cells, PAPCs) to colonize many maternal organs, inclu- ding the brain and the limbic system. This phenomenon is known as “micro- chimerism”. The migration of PAPCs has both an evolutionary and affective meaning because the limbic system is the department of the brain dedicated to the regulation of emotions and memory. Here, the PAPCs will differen- tiate into neurons and glial cells, forming new synapses and therefore new connections with and among maternal neurons. This process is accompanied by structural alterations (documented by magnetic resonance imaging and orchestrated by the hormonal changes characteristic of gestation) invol- ving the limbic system and the other brain structures closely connected to it, which are the very same areas colonized by the migration of the foetal cells. Instrumental diagnostics and specific tests showed that greater volumetric losses of grey matter during pregnancy were strongly related to the quality of mother-child attachment and absence of hostility towards the newborn in the postpartum period. Greater brain alterations during gestation were asso- ciated to a higher degree of maternal attachment to her child after birth. For the first time in literature. In this review we have integrated the studies on the migration of PAPCs in the maternal brain with those, very recent, on the morphological and functional alterations that the maternal brain undergoes during pregnancy, indicating a possible synergistic effect of these two com- ponents. Part of the biologic base of the maternal-child attachment takes place during this migration suggesting that the foetus could play a surprising active role in modulating the mother’s ability to love him, right from its life in uterus.

Keywords: limbic system; pregnancy associated progenitor cells (PAPCs); pregnancy; microchimerism; stem-cell migration.

Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283

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