Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

Background: Pregnant women represent a vulnerable population at higher risk of complications of infectious diseases. Data regarding the consequences of the emerging pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy are scarce. Recent evidence suggests that pregnant women might be at higher risk of severe disease, while exposed fetuses and newborns could suffer from preterm birth, growth restriction and neonatal infections.Methods: We developed an international web registry to allow structured data collection. Pregnant women at any stage during gestation tested for SARS-CoV-2 infection were enrolled. Maternal, obstetrical and neonatal outcomes were recorded.Findings: 1033 pregnant women tested for SARS-CoV-2 were included, among which 926 tested positive and 107 tested negative. Positive pregnant women were at higher risk of severe maternal outcomes compared to negative women [aRR 5.6, 95% CI 1.4-22.7]. Risk factors for severe maternal outcomes among positive women were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. No difference in term of obstetrical and neonatal outcomes were observed between positive and negative women. Positive pregnant women with severe maternal outcomes were at higher risk of cesarean sections [70.7% (n=53/75)], preterm deliveries [62.7% (n= 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n=31/75)]. A positive neonatal SARS-CoV-2 test was observed in 2.9% (n=11/384) of newborns with an available test at birth.Interpretation: Pregnant women, particularly those with associated comorbidities, seem to be at higher risk of severe complications of SARS-CoV-2 infection. Preliminary data regarding obstetrical and neonatal outcomes among women with a mild disease are reassuring.Funding Statement: None.Declaration of Interests: The authors declare that we have no conflicts of interest.Ethics Approval Statement: The study was approved by both the Swiss Ethical Board (CER-VD-2020-00548) and the local ethics boards at each participating center.

•First series of antiviral therapy in pregnancy to reduce risk of congenital CMV.•Prenatal Valacyclovir may reduce CMV transmission rate at amniocentesis.•We advise to continue prenatal treatment until delivery.

Selective toxicity refers to the ability of a chemical or drug to target cells or sites that are relatively specific to a biological system or the ability of a toxic agent to cause injury or eradicate one species without adversely affecting another species, particularly humans, even if the two species are in close association. Mechanisms that account for selective toxicity between and among organisms in response to chemicals are introduced in this chapter. The chapter will give examples of chemicals/drugs that serve a useful purpose for humans that do so by influencing the function of a limited number or types of cells or systems. Detailed examples are given of the antibiotics that selectively target bacterial cells without causing toxicity to human cells due to selection of target sites that are unique to the microorganism or simply more essential to survival of the microorganism than to the host. Additionally, examples of selective toxicity of pesticides are given, whereby the pesticide is toxic to the pest but with limited or no adverse effects to the host. Selective toxicity due to chemical/drug translocation, biotransformation, and receptor-mediated mechanisms are also discussed.

We read with interest the article by Lim et al. published in June 2017 (Congenital cytomegalovirus - who, when, what-with and why to treat?). 1 Lim Y. Lyall H. Congenital cytomegalovirus - who, when, what-with and why to treat?. J Infect. 2017; 74: S89-S94 Abstract Full Text PDF PubMed Scopus (27) Google Scholar

Objectives To report on the prenatal ultrasonographic diagnosis of spina bifida (SB) and its natural history, treatment and long-term outcome in a large tertiary referral center. Methods All cases of SB diagnosed between February 1980 and December 2015 in the Obstetric Prenatal Diagnosis Day Unit of the Obstetrics and Gynecology Department at the Catholic University of the Sacred Heart, Rome, were reviewed. All infants with an open defect were delivered by elective Cesarean section and underwent early repair of the spinal defect. A ventriculoperitoneal (VP) shunt and/ or third ventriculostomy was performed when needed. Complete postnatal follow-up was carried out by our multidisciplinary team in the majority of cases. The cohort was analyzed in two groups: Group 1 included patients referred between February 1980 and December 1999; Group 2 included patients referred between January 2000 and December 2015. Results There was a total of 222 cases of SB with a prenatal diagnosis rate of 94.6% (n=210), with the majority of defects being meningomyeloceles (n=142 (64.0%)), affecting the lumbosacral level (n=110 (49.5%)) and being =2 cmin size (n=163/ 195 (83.6%)). There were 174 (78.4%) live births, with more terminations in Group 2 (26.1%) than in Group 1 (10.8%; P=0.003). Postnatal surgical repair was conducted in 157 cases (99.4% of eligible cases), with death of an infant who was operated on occurring more often in Group 1 (14.1%) than in Group 2 (4.2%; P=0.03). VP shunt placement was required in 60.3% of infants operated on after January 2000. Long-term follow-up was available for 136 children (111 with open defects and 25 with closed defects). Infants born since 2000 with an open defect had normal ambulation or a mild defect in 50% of cases and normal or mild deficit of sphincter function in 37.8% of cases. An intelligence quotient of =70 was observed in the majority of children (81.4%; 35/ 43 cases). Worse motor function was associated with progressive prenatal ventriculomegaly, level of lesion and VP shunt placement. Conclusions We describe the prenatal diagnosis, natural history and long-term outcome of a large contemporary cohort of SB fetuses and infants. In an era of pioneering fetal surgical techniques for in-utero SB repair, it is important to acknowledge that advances in conventional neonatology and pediatric neurosurgery have allowed increased life expectancy and improved quality of life in patients with SB. Copyright (c) 2018 ISUOG. Published by John Wiley & Sons Ltd.

BACKGROUND: The objective of the present study is to review the literature regarding the management of fertile patients under lithium treatment for bipolar disorder and to report the experience of our Thratology Information Service over the past thirteen years in managing women treated with lithium during preconception, pregnancy and breastfeeding. METHODS: This research focuses on a selective review of the literature and a retrospective survey has been carried out on fertile women under lithium treatment who called our service at A. Gemelli University Hospital in Rome from May 2002 to December 2015. RESULTS: A total of 140 women under lithium treatment called our TIS. A complete follow-up has been performed on 34 patients: 29 called during pregnancy and 5 called during preconception. None of the patients called during breastfeeding, while half of the patients were taking concomitant drugs during pregnancy. One major cardiac malformation (hypoplastic left heart syndrome) has been reported. No minor malformations have been detected. Twenty-one patients delivered a living child, with one premature neonate. Two patients underwent voluntary interruption of pregnancy and six patients had early spontaneous abortion. In one patient, intrauterine growth retardation occurred, but with no adverse neonatal outcomes. Four neonates experienced transient respiratory distress at birth. Two children developed mild to severe language delay, but normal motor development. CONCLUSIONS: Lithium treatment in fertile women is a very delicate topic, where risks and benefits of discontinuing therapy when women plan to become pregnant should be accurately evaluated. Thorough peri-conceptional counselling is crucial for the outcome of pregnancy and for maternal health status during preconception, gestation and breastfeeding.

BACKGROUND:Obstetricians usually prescribe supplements during pregnancy without actual indication. The use of selenium during pregnancy has increased, due to its function in several antioxidant mechanisms.CASE:A pregnant woman received 200,000 micrograms (μg) per day of a selenium galenic formulation, since gestational week (g.w.) 7 to 12, due to a prescription error. The patient experienced nausea, vomiting, hand and foot paresthesia, followed by fatigue, loss of fingernails and hair. The woman was referred to our Fetal and Maternal Medicine Unit for surveillance. The mother's blood selenium levels went back to normal 13 weeks after arrest and the baby was born at term, without complications. Clinical evaluation and imaging studies were normal at one month of age.CONCLUSION:This is the first case of severe chronic selenium intoxication during the first trimester of pregnancy. In the present case, no consequences of congenital defects or pregnancy complications occurred. However, since vitamins, minerals, and food supplements may be harmful and prescription errors occur, obstetricians should avoid prescribing supplements in the absence of maternal deficiency.

BACKGROUNDThere are many contradictions about pregnancy and fetal/neonatal outcomes after topical use of timolol alone or timolol in combination with other antiglaucoma medications.METHODSSeventy-five pregnant women exposed to antiglaucoma medications were followed prospectively by phone interviews. 27 women used timolol as monotherapy, 48 women used timolol as a part of multidrug therapy. We selected a control group of 187 healthy pregnant women.RESULTSTopical use of timolol alone or timolol in combination with other antiglaucoma medications does not influence pregnancy or fetal/neonatal outcomes.CONCLUSIONBeta-blocker is the first choice treatment for glaucoma in pregnancy but, when necessary, multidrug therapy should not to be excluded.

ABSTRACT Maternal infectious diseases are frequent complications of pregnancy and can cause negative outcomes. Perinatal infections can cause serious damage to fetal central nervous system (CNS), but incidence of symptomatic congenital infections at birth is low. Complete and multidisciplinary (obstetric, infectologist, microbiologist, neonatologist/pediatrician, psychologist) evaluation of the pregnant women is crucial to define fetal prognosis. The ultrasound (US) surveillance has an irreplaceable role in identifying serious fetal damage and complications. Complete evaluation of the fetus in selected cases needs to be integrated with invasive prenatal diagnosis, particularly amniocentesis, which has optimal predictive values in excluding vertical transmission, and fetal magnetic resonance imaging (MRI), which can add important anatomical detail when fetal CNS damage is suspected. Congenital infections, furthermore, need to be considered in differential diagnosis of some common abnormal CNS findings at prenatal US. With the present review, we intend to provide an overview of the major perinatal infections and the role of US diagnosis in their assessment to recognize fetal CNS damage. We highlight the most recognizable syndromes due to congenital infections by linking etiopathogenesis with pathology and imaging. In particular, we focus on US diagnostic and prognostic values in relation to other invasive and noninvasive prenatal diagnosis options and summarize up-to-date recommendations on US evaluation of most common findings. Cytomegalovirus (CMV) is the most common cause of congenital infection, while Toxoplasmosis is the most preventable cause of infectious CNS damage; rubella, varicella virus, and herpes viruses, even if rarely, may be responsible for extremely serious fetal damage, while Zika virus is an emerging concern on global scale. How to cite this article Masini L, Apicella M, De Luca C, Valentini P, Manfredi R, Lanzone A, De Santis M. Fetal Central Nervous System and Infectious Diseases. Donald School J Ultrasound Obstet Gynecol 2017;11(4):314-327.

Listeria monocytogenes, a Gram-positive bacterium, is responsible for human listeriosis. Infection with Listeria has been associated with the consumption of contaminated and/or inadequately cooked food, particularly dairy products, leafy vegetables, fish, and meat. The main clinical manifestations include diarrhea, nausea and vomiting, which are usually followed by fever and flu-like symptoms. Listeriosis affects pregnant women in about one in seven (14%) cases. They are approximately 10 times more likely to catch the disease than the general population. Although Listeria infection during pregnancy is usually uncomplicated for the mother, fetal and neonatal infection can be severe and fatal. Animal studies have shown a dose-response relationship between L. monocytogenes bacterial load and adverse pregnancy outcome, mainly pregnancy loss. Fetal and neonatal infection occurs through the transplacental passage of the bacterium or through exposure in the perinatal period. In pregnant women Listeria infection was associated with fetal loss, preterm birth, neonatal infection or neonatal death. Blood culture is the principal diagnostic tool and the antibiotic of choice for the treatment of listeriosis is penicillin, with high doses injected intravenously for at least 14 days. In case of suspected or confirmed maternal listeriosis, a program of fetal surveillance should be implemented. Common fetal ultrasound findings in listeria infection include non-immune hydrops, intracranial calcifications, and intrauterine fetal demise. Strategies for the prevention of listeriosis, including avoiding unpasteurized dairy products, uncooked food and leftover food, have significantly decreased the number of cases of infection. Prevention in pregnant women can be achieved by sticking to prophylactic measures and strict diet recommendations.

Context: Many women of reproductive age and pregnant women require diagnostic tests involving ionizing radiation. Fetal exposure to radiation worries both the patient and the obstetricians and could lead to inappropriate termination of pregnancy. Evidence Acquisition: To conduct this review of the literature Pub-med was searched. Retrospective studies, reviews of literature, multicentric epidemiological case control studies were reviewed. Official data base Reprotox and The Teratogen Information System Teris were also consulted. Results: Standard diagnostic X ray tests including those of the lower abdomen imply that the dose absorbed by the uterus is in any case less than 0.05 Sv ( = 5 rad). The majority of the studies in literature estimates that 1-2 rad fetal exposure may increase the risk of leukemia of 1.5 - 2.0 over the natural incidence, meaning that 1 in 2,000 children exposed to ionizing radiation in utero will develop leukemia in childhood. Conclusions: At present, no single diagnostic procedure is able to cause damage to the embryo or fetus. There are possible harmful effects for doses above 0.2 - 0.25 Gy (20-25 rad).

INTRODUCTION:Streptococcus agalactiae (Group B streptococcus [GBS]) is the most common cause of sepsis and meningitis in infants <3 months of age. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing the transmission of GBS to newborns. The Centers for Disease Control and Prevention (CDC) guidelines suggest vaginal and rectal cultures to assess GBS colonization between 35 and 37 weeks' gestation.METHODS:Between July and December 2013, we identified 535 women admitted to the Obstetric and Gynecology Unit of Cardarelli Hospital (Campobasso, Italy) for delivery. We evaluated the indications for IAP, complete execution of IAP, and neonatal outcomes.RESULTS:Our sample included 468 women and 475 live births. Correct screening for GBS was executed in 241 cases (51.5%), the number of women colonized was 96 (30.2%), and 136 women had indications to receive IAP, but only 68 (50%) received adequate treatment.CONCLUSIONS:GBS colonization status should be determined by collecting both vaginal and rectal specimens at 35-37 weeks' gestation. Inadequate screening for GBS and incorrect IAP led to an increased incidence of early-onset disease in newborns. Local public health agencies should promote surveillance and educational programs to prevent neonatal GBS infections.

Historically, the prediction of reproductive and developmental toxicity has largely relied on the use of animals. The adverse outcome pathway (AOP) framework forms a basis for the development of new non-animal test methods. It also provides biological context for mechanistic information from existing assays. However, a single AOP may not capture all events that contribute to any relevant toxic effect, even in single chemical exposure scenarios. AOP networks, defined as sets of AOPs sharing at least one common element, are capable of more realistically representing potential chemical effects. They provide information on interactions between AOPs and have the potential to reveal previously unknown links between biological pathways. Analysis of these AOP networks can aid the prioritization of assay development, whether the goal is to develop a single assay with predictive utility of multiple outcomes, or development of assays that are highly specific for a particular mode of action. This paper provides a brief overview of the AOPs related to reproductive and developmental toxicity currently available in the AOP Wiki (http://aopwiki.org), and gives an example of an AOP network based on five reproductive and developmental toxicity-related AOPs for fish to illustrate how AOP networks can be used for assay development and refinement.

To determine whether pioglitazone will improve menstrual cyclicity in a fetal programming model for polycystic ovary syndrome.Eight prenatally androgenized (PA) and 5 control female rhesus monkeys of similar age, body weight and body mass index received an oral placebo daily for 6–7 months followed, after at least 90 days, by daily oral dosing with pioglitazone (3 mg/kg) for an additional 6–7 months. Blood was sampled thrice weekly to monitor ovulatory function, and a variety of endocrine challenges were performed to quantify changes in ovarian, gonadotropin and glucoregulatory function.Pioglitazone normalized menstrual cycles in 5 out of 8 (62%) PA females (pioglitazone responsive; PioRESP). Pioglitazone increased serum 17α-hydroxyprogesterone responses to an hCG injection in PioRESP PA females, while diminishing serum progesterone, and increasing DHEA and estradiol responses to hCG in PioRESP PA and all normal females.Insulin resistance plays a mechanistic role in maintaining anovulation in a majority of PA female monkeys.