Gestational Disease

This chapter introduces the major gestational diseases in respect to the development of prenatal screening describing the developments from the preproteomics era to current research and to the future role of proteomics in the discovery of novel placental peptide markers. Here, the additional proteomic challenges that are needed to accommodate the study of peptides, being that, by their nature they are smaller and consequently have different... 

Many of the currently used tests for gestational disease provide only an estimation of risk as many mothers and foetuses never actually have or will ever develop the disease. Hence, it is vital to develop new prenatal screening tests that are more reliable and specific. We believe peptide markers may be able to fill this niche, however, ideally they should be unique to the... 

The incidence and severity of ROP both rise with decreasing birthweight and gestational age. Fielder et al. (1992) have shown that the incidence of ROP in infents of < 1700 g birthweight is about 50%, although only 5% had severe disease. Severe ROP results in vitreous haemorrhage from new vessel formation on the immature retina, retinal traction and eventually retinal detachment (Fig. 9.6). In the most severe cases, retinal detachment is complete, resulting in total blindness. Treatment with cryotherapy or laser has halved the incidence of retinal detachment. 

Infant respiratory distress syndrome (IRDS), also known as hyaline membrane disease, is one of the most common causes of respiratory disease in premature infants. In fact, it occurs in 30,000 to 50,000 newborns per year in the U.S. — most commonly in neonates bom before week 25 of gestation. IRDS is characterized by areas of atelectasis, hemorrhagic edema, and the formation of hyaline membranes within the alveoli. IRDS is caused by a deficiency of pulmonary surfactant. Alveolar type II cells, which produce surfactant, do not begin to mature until weeks 25 to 28 of... 

Infants are protected during gestation because the placenta clears most potential toxins. The classical form of the disease therefore does not become clinically manifest until a few days after birth. An initial phase of alternating irritability and lethargy progresses over a period of days to frank coma and respiratory embarrassment. Irreversible brain damage is common in babies who survive, particularly those whose treatment is delayed until after the first week of life. 

Uncommon causes of diabetes (1% to 2% of cases) include endocrine disorders (e.g., acromegaly, Cushing s syndrome), gestational diabetes mellitus (GDM), diseases of the exocrine pancreas (e.g., pancreatitis), and medications (e.g., glucocorticoids, pentamidine, niacin, and a-interferon). 

Therapeutic applications. PG derivatives are used to induce labor or to interrupt gestation (p. 126) in the therapy of peptic ulcer (p. 168). and in peripheral arterial disease. 

A 22-year-old woman had her first prenatal visit. Her physical examination was normal for a woman at 12 weeks gestation. Both the nontreponemal (Venereal Disease Research Laboratory) and fluorescent treponemal antibody tests were positive. 

---