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Nature Reviews. Microbiology Feb 2022Infections are a major threat to human reproductive health, and infections in pregnancy can cause prematurity or stillbirth, or can be vertically transmitted to the... (Review)
Review
Infections are a major threat to human reproductive health, and infections in pregnancy can cause prematurity or stillbirth, or can be vertically transmitted to the fetus leading to congenital infection and severe disease. The acronym 'TORCH' (Toxoplasma gondii, other, rubella virus, cytomegalovirus, herpes simplex virus) refers to pathogens directly associated with the development of congenital disease and includes diverse bacteria, viruses and parasites. The placenta restricts vertical transmission during pregnancy and has evolved robust mechanisms of microbial defence. However, microorganisms that cause congenital disease have likely evolved diverse mechanisms to bypass these defences. In this Review, we discuss how TORCH pathogens access the intra-amniotic space and overcome the placental defences that protect against microbial vertical transmission.
Topics: Cytomegalovirus Infections; Female; Fetal Diseases; Herpes Simplex; Humans; Infectious Disease Transmission, Vertical; Placenta; Pregnancy; Rubella; Toxoplasma; Toxoplasmosis, Congenital
PubMed: 34433930
DOI: 10.1038/s41579-021-00610-y -
Journal of Clinical Pharmacology Sep 2022One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. This management usually takes place during the second... (Review)
Review
One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. This management usually takes place during the second or third trimester. While most arrhythmias in the fetus are benign, both tachy- and bradyarrhythmias can lead to fetal hydrops or cardiac dysfunction and require treatment under certain conditions. This review will highlight precise diagnosis by fetal echocardiography and magnetocardiography, the 2 primary means of diagnosing fetuses with arrhythmia. Additionally, transient or hidden arrhythmias such as bundle branch block, QT prolongation, and torsades de pointes, which can lead to cardiomyopathy and sudden unexplained death in the fetus, may also need pharmacologic treatment. The review will address the types of drug therapies; current knowledge of drug usage, efficacy, and precautions; and the transition to neonatal treatments when indicated. Finally, we will highlight new assessments, including the role of the nurse in the care of fetal arrhythmias. The prognosis for the human fetus with arrhythmias continues to improve as we expand our ability to provide intensive care unit-like monitoring, to better understand drug treatments, to optimize subsequent pregnancy monitoring, to effectively predict timing for delivery, and to follow up these conditions into the neonatal period and into childhood. Coordinated initiatives that facilitate clinical fetal research are needed to address gaps in knowledge and to facilitate fetal drug and device development.
Topics: Arrhythmias, Cardiac; Child; Electrocardiography; Female; Fetal Diseases; Fetus; Humans; Infant, Newborn; Pregnancy; Prognosis
PubMed: 36106782
DOI: 10.1002/jcph.2129 -
Gynakologisch-geburtshilfliche Rundschau 2008The intrauterine environment not only influences fetal well-being and behaviour during pregnancy, but also predisposes the fetus in many health aspects of later life....
The intrauterine environment not only influences fetal well-being and behaviour during pregnancy, but also predisposes the fetus in many health aspects of later life. The terms 'fetal programming' and 'developmental origins of health and disease' reflect the enormous impact of pregnancy-related factors on the individual and the health.
Topics: Fetal Development; Fetal Diseases; Genetic Predisposition to Disease; Humans
PubMed: 19096216
DOI: 10.1159/000154803 -
Hormone Research in Paediatrics 2017Fetal and neonatal autoimmune hyperthyroidism is a rare, serious but transient disorder. Early diagnosis and treatment are key objectives for an optimal prognosis and... (Review)
Review
Fetal and neonatal autoimmune hyperthyroidism is a rare, serious but transient disorder. Early diagnosis and treatment are key objectives for an optimal prognosis and the well-being of the child. This review focuses on the management of these patients during the fetal and neonatal periods. We propose a diagnostic algorithm for high-risk pregnancies in mothers with current or past hyperthyroidism related to Graves' disease, involving repeated fetal thyroid gland assessments from 20 weeks of gestation onwards and maternal serum thyroid-stimulating hormone receptor antibody (TRAb) determination, with close monitoring if TRAb levels exceed 2 to 3 times the upper limit of the normal range. In fetuses with goiter, the main clinical issue is determining whether the cause is (1) maternal antithyroid drug (ATD) treatment that is appropriate for achieving normal maternal thyroid function but inappropriate and excessive for the fetus, resulting in hypothyroidism and necessitating a decrease in the ATD dose during pregnancy, or (2) the presence of TRAbs resulting in fetal thyroid stimulation and hyperthyroidism, requiring an increase in the maternal ATD dose. Methimazole/carbimazole treatment should be initiated as soon as possible during the neonatal period, carefully managed and maintained over a period of 1-3 months and then stopped when TRAb is no longer detectable in serum.
Topics: Antithyroid Agents; Autoantibodies; Female; Fetal Diseases; Graves Disease; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Maternal Exposure; Pregnancy; Receptors, Thyrotropin
PubMed: 27978517
DOI: 10.1159/000453065 -
Frontiers in Bioscience (Scholar... Jun 2010Clinical fetal heart failure occurs in conditions associated with increasing left and right atrial filling and/or central venous pressures and manifests as right heart... (Review)
Review
Clinical fetal heart failure occurs in conditions associated with increasing left and right atrial filling and/or central venous pressures and manifests as right heart failure with the development of pericardial and pleural effusions, ascites and peripheral and placental edema. Fetal heart failure may occur in primary myocardial disease, in presence of the extracardiac pathology impacting the loading conditions of the fetal heart and in conditions associated with secondary myocardial dysfunction including structural heart defects, bradycardia or tachycardia. This review summarizes recent literature of the understanding of the normal fetal circulation and the pathogenic mechanisms responsible for the evolution of fetal heart failure, strategies for fetal and perinatal management of fetal heart failure, and future directions that may lead to novel strategies to treat affected pregnancies and.
Topics: Echocardiography; Female; Fetal Diseases; Fetal Heart; Heart Defects, Congenital; Heart Failure; Humans; Hydrops Fetalis; Myocardial Contraction; Pregnancy; Ultrasonography, Prenatal
PubMed: 20515832
DOI: 10.2741/s109 -
Pediatrics and Neonatology Apr 2015The present article aims to highlight fetal cardiac interventions (FCIs) in terms of indications, strategies, and fetal prognoses. FCIs of the early years were... (Review)
Review
The present article aims to highlight fetal cardiac interventions (FCIs) in terms of indications, strategies, and fetal prognoses. FCIs of the early years were predominantly pharmacological therapies for fetal arrhythmia or heart block. A transplacental transmission of therapeutic agents has now become the main route of pharmacological FCIs. There have been various FCI strategies, which can be categorized into three types: pharmacological, open FCIs, and closed FCIs. Rather than as a routine management for materno-fetal cardiac disorders, however, FCIs are only applied in those fetal cardiac disorders that are at an increased risk of mortality and morbidity and warrant an interventional therapy. Pharmacological FCIs have been well applied in fetal arrhythmias but require further investigations for novel therapeutic agents. The development of open FCI in humans is an issue for the long run. Closed FCIs may largely rely on advanced imaging techniques. Hybrid FCIs might be the future goal in the treatment of fetal heart diseases.
Topics: Fetal Diseases; Fetal Therapies; Heart Diseases; Humans; Prognosis
PubMed: 25088192
DOI: 10.1016/j.pedneo.2014.04.007 -
Molecular Diagnosis & Therapy Apr 2020Significant advances in the safety and efficacy of gene therapy have sparked a new frontier in therapeutics for genetic diseases as evidenced by the greater than 700... (Review)
Review
Significant advances in the safety and efficacy of gene therapy have sparked a new frontier in therapeutics for genetic diseases as evidenced by the greater than 700 active gene therapy investigational new drug applications reported by the NIH and the US Food and Drug Association. Although postnatal gene therapy trials are encouraging, limitations to effective therapy including an immune barrier and initiation of treatment after disease onset can exist. Advances in prenatal diagnostics provide hope that many genetic abnormalities will be able to be diagnosed before birth. Prenatal gene therapy has the potential to take advantage of normal developmental properties of the fetus and overcome some of the current limitations to efficient postnatal gene therapy. The rationale for prenatal gene therapy includes the small fetal size, the tolerogenic fetal immune system, the presence of highly proliferative and accessible stem/progenitor cells of multiple organs, and, ultimately, the ability to treat diseases in which irreversible pathology begins prior to birth. This rationale is based on and supported by a number of published animal studies. Unique ethical considerations exist in the context of prenatal gene therapy, including the importance of rigorous evaluation of the effect of the therapy on fetal germ cells and developing organs as well as the mother. To date, animal studies have not demonstrated any significant germline or maternal effect of prenatal gene therapy. Finally, practical considerations of future clinical prenatal gene therapy will include, but not be limited to, determining the initial target disease characteristics and the importance of non-directive prenatal counseling of families carrying a fetus with a genetic diagnosis.
Topics: Animals; Biomedical Research; Clinical Trials as Topic; Female; Fetal Diseases; Genetic Counseling; Genetic Predisposition to Disease; Genetic Therapy; Humans; Pregnancy; Prenatal Diagnosis
PubMed: 32020561
DOI: 10.1007/s40291-020-00445-y -
Child's Nervous System : ChNS :... Jul 2017The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological... (Review)
Review
The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.
Topics: Cerebrospinal Fluid Shunts; Disease Management; Fetal Diseases; Humans; Neurosurgical Procedures; Prenatal Diagnosis
PubMed: 28555310
DOI: 10.1007/s00381-017-3442-x -
Upsala Journal of Medical Sciences May 2016Diabetic embryopathy is a theoretical enigma and a clinical challenge. Both type 1 and type 2 diabetic pregnancy carry a significant risk for fetal maldevelopment, and... (Review)
Review
Diabetic embryopathy is a theoretical enigma and a clinical challenge. Both type 1 and type 2 diabetic pregnancy carry a significant risk for fetal maldevelopment, and the precise reasons for the diabetes-induced teratogenicity are not clearly identified. The experimental work in this field has revealed a partial, however complex, answer to the teratological question, and we will review some of the latest suggestions.
Topics: Animals; Apoptosis; Arachidonic Acid; Diabetes Mellitus; Diabetes Mellitus, Experimental; Endoplasmic Reticulum Stress; Epigenesis, Genetic; Female; Fetal Diseases; Genetic Predisposition to Disease; Glucose; Glycation End Products, Advanced; Hypoxia; Isoprostanes; Ketones; Mice; Nitrogen; Oxidative Stress; Pregnancy; Pregnancy in Diabetics; Rats; Reactive Oxygen Species; Receptor for Advanced Glycation End Products; Teratogens; Teratology
PubMed: 27117607
DOI: 10.3109/03009734.2016.1165317 -
British Medical Journal (Clinical... Oct 1981
Topics: Ascites; Female; Fetal Diseases; Heart Defects, Congenital; Humans; Pregnancy; Prenatal Diagnosis; Ultrasonography
PubMed: 6793179
DOI: 10.1136/bmj.283.6297.934