PurposeThe aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country.Materials and MethodsData on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997 - 2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group.ResultsDuring the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score ≤ 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers.ConclusionAddiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Aims: To assess trophoblast apoptosis separately in the cytotrophoblast, syncytiotrophoblast, total villous trophoblast, syncytial knots and syncytial knot formation, and to investigate the expression of apoptotic factors Fas ligand (FasL), Bcl-2 and proliferation marker Ki-67 in the trophoblast of placentas from preeclamptic patients. Methods: The study included placental samples from 25 preeclamptic and 25 normal pregnancies. For the detection of apoptosis and proliferation, antibody M30 and antibody against Ki-67 antigen were used. Expression of FasL and Bcl-2 was assessed using semi-quantitative HSCORE method. Syncytial knots were expressed as the number of syncytial knots per individual villus and as the total number of syncytial knots in each placental sample. Results: Trophoblast apoptosis, number of syncytial knots per individual villus and the total number of syncytial knots in each placental sample were significantly higher in preeclamptic placentas than in control group placentas. FasL expression was significantly less, and Bcl-2 expression significantly greater in the villus trophoblast among the study subjects compared with controls. There was no difference in the trophoblast proliferation between groups. Conclusion: Our findings might suggest that increased apoptosis and syncytial knot formation combined with reduced FasL expression could be involved in pathophysiological mechanisms of preeclampsia.

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There is an increase in apoptosis, proliferation and Fas ligand expression in placentae from women with HELLP syndrome compared with placentae from PE and normal pregnancies. Our findings indicate the possibility of differential mechanisms behind HELLP syndrome and PE.