González-Candia Alejandro, Veliz Marcelino, Araya Claudio, Quezada Sebastian, Ebensperger Germán, Serón-Ferré María, Reyes Roberto V, Llanos Aníbal J, Herrera Emilio A
Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile; International Center for Andean Studies (INCAS), Universidad de Chile, Putre, Chile.
Am J Obstet Gynecol. 2016 Aug;215(2):245.e1-7. doi: 10.1016/j.ajog.2016.02.040. Epub 2016 Feb 20.
Intrauterine growth restriction is a condition in which the fetus has a birthweight and/or length <10th percentile for the gestational age. Intrauterine growth restriction can be associated with various causes, among which is low uteroplacental perfusion and chronic hypoxia during gestation. Often, intrauterine growth-restricted fetuses have increased oxidative stress; therefore, agents that decrease oxidative stress and increase utero, placental, and umbilical perfusion have been proposed as a beneficial therapeutic strategy. In this scenario, melatonin acts as an umbilical vasodilator and a potent antioxidant that has not been evaluated in pregnancies under chronic hypoxia that induce fetal growth restriction. However, this neurohormone has been proposed as a pharmacologic therapy for complicated pregnancies.
The aim of this study was to determine the effects of prenatal administration of melatonin during the last trimester of pregnancy on the biometry of the growth-restricted lambs because of developmental hypoxia. Further, we aimed to determine melatonin and cortisol levels and oxidative stress markers in plasma of pregnant ewes during the treatment.
High-altitude pregnant sheep received either vehicle (n = 5; 5 mL 1.4% ethanol) or melatonin (n = 7; 10 mg/kg(-1)day(-1) in 5 mL 1.4% ethanol) daily during the last one-third of gestation. Maternal plasma levels of melatonin, cortisol, antioxidant capacity, and oxidative stress were determined along treatment. At birth, neonates were examined, weighed, and measured (biparietal diameter, abdominal diameter, and crown-rump length).
Antenatal treatment with melatonin markedly decreased neonatal biometry and weight at birth. Additionally, melatonin treatment increased the length of gestation by 7.5% and shifted the time of delivery. Furthermore, the prenatal treatment doubled plasma levels of melatonin and cortisol and significantly improved the antioxidant capacity of the pregnant ewes.
Our findings indicate that antenatal melatonin induces further intrauterine growth restriction but improves the maternal plasma antioxidant capacity. Additional studies should address the efficiency and safety of antenatal melatonin before clinical attempts on humans.
胎儿生长受限是指胎儿出生体重和/或身长低于其孕周的第10百分位数的一种情况。胎儿生长受限可能与多种原因有关,其中包括孕期子宫胎盘灌注不足和慢性缺氧。通常,生长受限的胎儿氧化应激增加;因此,有人提出减少氧化应激并增加子宫、胎盘和脐部灌注的药物可作为一种有益的治疗策略。在这种情况下,褪黑素可作为一种脐血管舒张剂和强效抗氧化剂,而在诱导胎儿生长受限的慢性缺氧妊娠中尚未对其进行评估。然而,这种神经激素已被提议用于治疗复杂妊娠。
本研究的目的是确定妊娠晚期产前给予褪黑素对因发育性缺氧导致生长受限的羔羊生物测量指标的影响。此外,我们旨在确定治疗期间妊娠母羊血浆中褪黑素、皮质醇水平和氧化应激标志物。
妊娠晚期的高海拔妊娠绵羊在妊娠最后三分之一期间每天接受载体(n = 5;5 mL 1.4%乙醇)或褪黑素(n = 7;10 mg/kg⁻¹天⁻¹溶于5 mL 1.4%乙醇中)。在治疗过程中测定母羊血浆中的褪黑素、皮质醇、抗氧化能力和氧化应激水平。出生时,对新生儿进行检查、称重和测量(双顶径、腹径和顶臀长)。
产前给予褪黑素显著降低了新生儿出生时的生物测量指标和体重。此外,褪黑素治疗使妊娠期延长了7.5%并改变了分娩时间。此外,产前治疗使血浆褪黑素和皮质醇水平翻倍,并显著提高了妊娠母羊的抗氧化能力。
我们的研究结果表明,产前给予褪黑素会导致进一步的胎儿生长受限,但可提高母羊血浆抗氧化能力。在对人类进行临床尝试之前,应进行更多研究以探讨产前使用褪黑素的有效性和安全性。