The present sub-study aimed at investigating the immunological ef

The present sub-study aimed at investigating the immunological effects of OPV together with BCG at birth on the developing immune response at 2, 4 and 6 weeks of age, including innate and non-polio specific adaptive responses, non-specific inflammation markers and immune

cell distribution. Our a priori hypothesis was that OPV would dampen the IFN-γ response to PPD. The present immunological study was carried out within a larger RCT investigating Tariquidar chemical structure the effects of providing OPV0 with BCG at birth on infant survival. The trial was conducted from July 2008 to October 2011 at the Bandim Health Project (BHP), a health and demographic surveillance system site covering six suburban districts of Bissau, the capital of Guinea-Bissau, West Africa. The trial has been described elsewhere (Lund, submitted; NCT00710983). find more In brief, newborns with no overt illness or malformations, weighing ≥ 2.5 kg at enrolment and living in the BHP study area were eligible for recruitment. Mothers received oral and written information. Provided consent, the mother drew a randomisation number allocating her infant

to receive OPV0 together with the BCG (OPV0 + BCG) or BCG alone (BCG). The BCG (Danish strain 1331, Statens Serum Institut, Copenhagen, Denmark) was given intra-dermally in the upper left deltoid region while the trivalent OPV was administered as two drops orally. ADP ribosylation factor From 27 May 2009 to 7 April 2010, infants delivered on weekdays at the maternity ward at the Simão Mendes National Hospital and randomised within the first 7 days of life were invited to participate in the present immunological sub-study, excluding infants delivered by caesarean section or twins. During the synchronised West African Polio Immunisation Campaigns in March and April 2010 some infants were not included (n = 32) ( Fig. 1). Informed consent was obtained according to the same procedure as the main trial. Measurements of weight, length,

circumferences of abdomen, head and mid-upper-arm and axillary temperature of the infant, and axillary temperature of the mother were obtained at enrolment. Subsequently, the infants were randomised to a follow-up visit at home at 2, 4 or 6 weeks after enrolment. Infants who received other vaccines before blood sampling were excluded from the study (Fig. 1). At the follow-up visit at 2, 4 or 6 weeks a blood sample was collected, the mother was interviewed about the health of her infant; the mid-upper-arm circumference and axillary temperature of the infant were measured; formation of scar or local reaction at the site of BCG vaccination was recorded (yes or no). Additionally, the main trial also recorded the presence and size of BCG scar at 2, 6 and 12 months after enrolment on the same infants.

The chloroform fraction of alcoholic extract was most active as c

The chloroform fraction of alcoholic extract was most active as compared to hexane, n-butanol and aqueous selleck fractions. The aqueous fraction was least effective. The data also showed that there was enrichment of

activity in the chloroform fraction from alcoholic extract. The results of the fraction further indicated that the active constituents are non-polar and present in chloroform fraction. In second phase of our investigation the effects of Cuscuta reflexa extracts and fractions against in vivo tumor model and our in vivo studies indicated that the alcoholic extract and its chloroform fraction have anticancer potential. The positive control 5-Fulorouracil (FU) was used to compare the anticancer potential of extract and fraction Crizotinib of the plant. The 5-FU at 22 mg/kg significantly decreases the solid tumour growth in comparison to the solid tumor growth of the control group, where the weight of the tumor was progressing each day. Whereas, the decrease in tumor weight was observed by the test group treated with alcoholic extract as well as significant tumor growth suppression was observed by the test group treated by the chloroform fraction was found ( Table 1). Here, the fraction at 10 mg/kg showed better activity than the extract at 40 mg/kg clearly indicates the enrichment of activity in the chloroform fraction. On the

basis of the above results it can be concluded that the chloroform fraction of alcoholic extract possess significant anticancer activity studied by in vitro and in vivo models. The study also provides a strong evidence for the use of the whole plant of Cuscuta reflexa in folklore treatment as anticancer agent. The activity may be due to the presence of one or more phytochemical constituents present in the extract/fraction. Further studies warranted, for isolation of the constituents responsible for the activity and also to

explore the exact mechanism of action of the activity. All authors have none to declare. Authors are grateful to National Centre for Cell Science, Pune (India) and National Cancer Institute, Frederick, MD, U.S.A for providing human cancer cell lines. The authors are also thankful MycoClean Mycoplasma Removal Kit to D.M. Mondhe for his technical support and guidance. “
“The family Polygonaceae, derived from the Greek word meaning knees referred to the swollen joints of some species. Family Polygonaceae comprises 800 species occurring in 30–40 genera, which are widely distributed in both cold and worm countries. Several Polygonaceae species are grown for ornamental purpose and a few for food production.1 Genus Ruprechtia reported to have several biological activities as antioxidant, cytotoxic, antimicrobial and anti-inflammatory activities, 2, 3, 4, 5, 6 and 7 which are attributed to their terpenoid, tannin and flavonoid contents. 8Ruprechtia includes 37 species among, which are three species cultivated in Egypt, the paucity of phytochemical and biological reports on the R. salicifolia C.A.

We sampled data from a prospective cohort that comprised the pare

We sampled data from a prospective cohort that comprised the parents of children enrolled in the National Child Measurement Programme (NCMP) in five Primary Care Trusts (PCTs, administrative

bodies that had responsibilities for local primary care and public health services) in England, in 2010–2011 (Falconer et al., 2012). The NCMP is a government initiative which aims to measure the heights and weights of children at Selleck IOX1 state primary schools in England, at school entry (age 4–5) and year 6 (10–11) each year. Weight is measured to the nearest 0.1 kg and height to the nearest millimetre. After the measurement, written feedback is mailed to parents informing them of their child’s body mass index (BMI) category; cut-offs at the 2nd, 91st and 98th BMI centiles of the UK 1990 growth curves (Cole et al., 1995) define underweight, healthy weight, overweight and obese (described to parents as ‘very overweight’), respectively. Parents of non-healthy weight children are provided with information CH5424802 in vitro about the health risks associated with their child’s weight status. Feedback also includes information about healthy lifestyles and local health and leisure services. Parents

of the following children were invited to participate in the study: all children enrolled in the NCMP in Redbridge, Islington, and West Essex PCTs, children aged 10–11 in Bath and North East Somerset (BANES) PCT, and children aged 4–5 in Sandwell PCT (n = 18,000). Parents completed self-administered questionnaires about perceptions of their child’s weight and health, lifestyle and health-related behaviours, and socio-demographic characteristics before the NCMP feedback (baseline, February–July 2011) and at one month and six months after feedback. The questionnaires were those developed for the study with input from experts in health-related behaviour and evaluation. The study was approved by the London School of Hygiene and Tropical Medicine

ethics committee. Parents of children identified as overweight or obese by the NCMP who completed questionnaires at baseline and at least one follow-up were included in this study. Primary outcomes were selected to correspond to the contemplation and action stages of the transtheoretical model: 1) intention to change health-related behaviour at one month after feedback, and 2) positive change in health related-behaviour at one or six months after feedback. Intention to change health-related behaviour was defined as parental intention to make changes to any of the following at one month: child’s diet, physical activity, or use of health or leisure services (doctor, nurse, pharmacist, weight management clinic or leisure services).

The crystals were harvested by centrifugation and then evaporated

The crystals were harvested by centrifugation and then evaporated at 37 °C. CaOX crystals were used at a final concentration of 0.8 mg/ml, buffered with Tris 0.05 mol/L and NaCl 0.15 mol/L at pH 6.5. Experiments were conducted at 37 °C in the absence or presence of the plant extract after stopping the stirring. The percentage aggregation inhibition rate (Ir) was then calculated by comparing the turbidity in the presence of the extract with that obtained in the control using following formula30: Ir=(1−Turbiditysample/Turbiditycontrol)×100Ir=(1−Turbiditysample/Turbiditycontrol)×100 Fig. 1 showed CaOx crystallization without the addition of extract (control) while Fig. 2 showed CaOx

crystallization in the presence of extract in the concentration SKI 606 of 100, 200, 300, 400 and 500 μg/ml respectively. The % inhibition of turbidity (aggregation) in the presence of herb extracts was lower than in the control, showing that crystals were less aggregated. The inhibited aggregation associated with the extract increased with concentration. This inhibition was greatest with aqueous extract of root when compared to petroleum ether, chloroform and methanol extracts of leaf and stem (Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 and Fig. 8).

Kidney stone function is a complex process that results from a succession of several physico-chemical events including supersaturation, nucleation, growth, aggregation GSK1120212 order and retention within renal tubules.31 Thus if supersaturation or later steps in crystallization

can be prevented, then lithiasis should be avoided. Indeed, several measures are usually taken to reduce supersaturation, e.g. increasing fluid intake and medical therapy. In India, as in many less developed areas, phytotherapy is a common method of primary health care because pharmaceutical products are expensive and the ‘folk’ pharmacopoeia provides apparently effective remedies for many diseases. These results could be considered positives because the herb extracts inhibits crystallization and prevents stone formation. The main findings of the present study were that extracts from plants inhibited the crystallization of CaOx in solution, there were less and smaller particles with increasing concentrations Thymidine kinase of extract as shown in various microphotographs i.e. Figs. 1 and 2. Fig. 1 showed maximum number and largest size of crystals as it was without plant extracts while Fig. 2 showed comparatively less number and smaller size of crystals. The increasing concentration of plant extracts (100, 200, 300, 400 and 500 μg/ml) had inhibited the CaOx crystal growth (Fig. 2). These results were also supported by the Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7 and Fig. 8. The extract of plant causes fewer numbers of crystals in solution, thereby reduced supersaturation and the size of the particles.

Such morphology might be attributed to the plasticisation effect

Such morphology might be attributed to the plasticisation effect exerted by POL, resulting in the reduction of crystallinity and subsequent enhancement in overall amorphous fraction of the extrudates.11 FT-IR spectrum

of ACT (Fig. 2) showed N H stretching doublet of N H bands at 3180.0 cm−1 and 3096.2 cm−1 resulting from symmetrical and asymmetrical stretching, a medium VRT752271 purchase intensity, free C O stretching band at 1681.7 cm−1, a medium intensity band at 1402 cm−1 and a broad, medium intensity band in the range 800–666 cm−1 corresponding to C N stretching and plane N H wagging, respectively, a strong band at 3302.5 cm−1 due to a C H stretching vibration. Characteristic bands in the range of 1100–900 cm−1 pointed towards crystalline

polymorphic form A of ACT.12 For EPO (Fig. 2), the characteristic bands were observed at 1147.7, 1238.3, 1269.2, 1730.2 cm−1 corresponding to the ester groups, at 1388.8, 1450–1490 and 2949.3 cm−1 corresponding to the CHx vibrations and at 2769.9 and 2820.0 cm−1 corresponding to the dimethylamino groups. It could be observed from the FT-IR spectra of ACEU and ACEL (Fig. 2) that the principal bands were broadened and weaker in intensity compared to those observed in the spectrum TSA HDAC cost of ACT. Also a broad and less intense band at about 3600 cm−1 suggested intermolecular hydrogen bonding in solid dispersions. Lowered frequency of C O stretching band suggested

involvement of a carbonyl group of amide in hydrogen bonding. Such pattern of FT-IR spectra of solid dispersions also provided a slight hint of formation of amorphous system.13 ACT was found to decompose at about 240 °C as evidenced by significant weight loss (12.14%) Non-specific serine/threonine protein kinase during TGA analysis (Fig. 3). DSC analysis of ACT (Fig. 3) showed a sharp endotherm of enthalpy 511.5 J/g in the range of 258–262 °C corresponding to its melting, which was accompanied by decomposition as indicated by the exothermic peak. It was apparent from the TGA analysis (Fig. 3) that ACEU began to decompose at about 208 °C, exhibiting rather a sharp weight loss compared to ACT. DSC thermograms of ACEU(1:1) and ACEU(1:2) in Fig. 3 exhibited decreased enthalpy values (66.9 and 36.6 J/g, respectively) suggesting a partial loss of crystallinity of ACT and lowered onset temperature (about 205 °C) suggesting occurrence of an intramoleular hydrogen bonding between EPO and ACT. In systems comprising POL, the DSC thermograms (Fig. 3) showed presence of only one Tg with much decreased enthalpy. Such pattern and visual inspection of the extrudates suggested that incorporation of a plasticiser to the blend of ACT and EPO formed a single phase system on melt extrusion. In other words, the components were completely miscible on a molecular basis.

18 An ecologic proof of the fetal safety of the pyridoxine-doxyla

18 An ecologic proof of the fetal safety of the pyridoxine-doxylamine combination was published, showing that the withdrawal of the drug from the US market was not associated with decreased rates of major congenital malformations in general, or of any specific malformation.19 In addition, the pyridoxine-doxylamine combination is one of very few drugs that have safety information on selleck inhibitor the neurodevelopment of children exposed in utero. A prospective controlled cohort study of mother-child pairs was conducted to determine the

effects of NVP and its treatment with the pyridoxine-doxylamine combination on child neurodevelopment. Three groups of children were studied at 3-7 years of age: 45 born to mothers who had NVP and were exposed to the pyridoxine-doxylamine combination, 47 with find more mothers who had NVP but no pyridoxine- doxylamine was used, and 29 born to mothers not experiencing NVP, and mothers were assessed for IQ and socioeconomic status. The results showed

that the pyridoxine-doxylamine combination does not appear to adversely affect fetal brain development and can safely be used to treat NVP.20 In 1989, a report on the safety of the pyridoxine/doxylamine combination for use in the management of NVP was prepared by a panel of Canadian and American experts for the Special Advisory Committee on Reproductive Physiology to the Health Protection Branch of Health Canada (currently called the Health Products and Food Branch). They concluded that “numerous studies in animals and in humans that have been reported in the scientific and medical literature demonstrate that Bendectin is not a teratogen…The safety of the pyridoxine-doxylamine combination in the management of nausea and vomiting of pregnancy has been established by its use in many thousands of pregnant women.”21 These conclusions are similar to those leading the FDA to approve this combination in 2013.2

Similarly, reputable teratogen reference guides concluded that the pyridoxine-doxylamine combination is not associated with an increased risk for adverse pregnancy outcomes.22 and 23 Because of the extensive fetal safety data that exist, the pyridoxine-doxylamine combination received a FDA Pregnancy Category A classification, indicating that adequate and well-controlled Resminostat studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy and there is no evidence of risk in later trimesters.2 The clinical effectiveness of the delayed-release combination of doxylamine and pyridoxine has been documented over a span of 50 years by several randomized, controlled trials as well as in open postmarketing studies. In addition, several placebo-controlled clinical trials have been published, the results of which have confirmed the effectiveness of this combined agent (Table).

There are plausible mechanisms related to mechanical and immunolo

There are plausible mechanisms related to mechanical and immunological changes that may render women more vulnerable to respiratory infections during pregnancy [4] and [5]. The European Centre for Disease Prevention and Control (ECDC) has concluded that vaccination of pregnant women could reduce the number of influenza-related hospitalizations and deaths in this group and potentially the burden of influenza in children younger than six months [6]. The WHO SAGE committee has referred to “compelling evidence of substantial risk of severe disease in

this group…” [7], and WHO has subsequently recommended pregnant women as the highest priority group for vaccination against seasonal influenza. However, a recent systematic review [8] concluded that pregnancy as a risk factor for seasonal influenza, as opposed to pandemic influenza including A(H1N1)pdm09, is not sufficiently studied. Furthermore, Gefitinib ECDC has concluded that European studies of the disease

burden of seasonal influenza in pregnant women are needed [6]. Whereas an increased risk of influenza-associated Pexidartinib deaths for pregnant women has been documented during pandemics [9], [10], [11], [12] and [13], deaths in pregnant women due to inter-pandemic influenza have only been described in occasional case reports [14], [15] and [16], suggesting that this outcome is unusual. Moreover, the evidence of an increased risk of severe disease for healthy pregnant women due to seasonal, inter-pandemic influenza mainly consists of observational studies of health Isotretinoin service utilization in USA and Canada [17] and [18]. Albeit healthcare utilization often being applied as an indicator of disease severity, it should be interpreted

with caution since healthcare utilization may be context dependent. For example, despite similar symptoms and severity, there may be differences in healthcare seeking behaviour, access to healthcare or medical recommendations. Furthermore, the relative risk does not inform on burden of hospitalization, and a sufficient absolute risk is needed to motivate vaccination. Hospitalization rates of 15 and 25 per 10,000 pregnant women or third trimester women have been found in Canada and USA, respectively [17] and [18], and in a study set in the UK the rate was estimated to 13 per 10,000 pregnant women [19]. Since these rates may be context dependent and estimates in a European setting are sparse, it was deemed that a national estimate for Sweden was necessary for policy purposes. Therefore we conducted a study of hospitalizations due to seasonal, inter-pandemic influenza or respiratory infection attributable to inter-pandemic influenza among pregnant women in Sweden and assessed the number needed to vaccinate (NNV) to prevent one such hospitalization. We conducted a retrospective, register-based study of inter-pandemic seasons, using ICD-10 codes that indicate influenza hospitalizations.

FMDV is a single-stranded, positive-sense RNA virus (Genus Aphtho

FMDV is a single-stranded, positive-sense RNA virus (Genus Aphthovirus, family Picornaviridae). The viral genome is about 8.3 kb long, enclosed within a protein capsid. The capsid is composed of 60 copies each of four different structural proteins (VP1-4); VP1-3 are surface exposed while Apoptosis Compound Library supplier VP4 is entirely internal. Crystallographic studies have identified the structure of the FMDV capsid [1] and [2]

and immunological epitopes have been mostly found on surface-oriented interconnecting loops between structural elements. Studies employing monoclonal antibodies (mAb) have identified antigenic sites by sequencing mAb neutralisation resistant (mar) mutants [3], [4], [5], [6], [7], [8] and [9]. Of the five antigenic sites reported so far for the most extensively studied serotype O, site-1 (G-H loop) is

linear and trypsin-sensitive whereas the others are conformational and trypsin-resistant. Equivalent selleck chemicals neutralising antigenic sites (except site 3) have also been identified for serotype A, with critical residues present in equivalent positions [3], [4], [5], [6] and [9]. Serotype A viruses are present on all continents where FMD is reported, and is antigenically diverse [10] often exhibiting poor cross-protection [11]. In the Middle East (ME), a new variant, A-Iran-05, was identified in samples collected from Iran in 2003 and subsequently spread to neighbouring countries [10] and North Africa [12]. This genotype replaced the A-Iran-96 and A-Iran-99 genotypes that were previously circulating in the region; did not cross-react with A/Iran/96 vaccine antisera and shared

a closer antigenic relationship with the older A22/Iraq vaccine strain (v/s) [10]. However, many samples isolated after 2006 did not even match with A22/Iraq v/s and so a new v/s, A/TUR/2006 was introduced. From sequence data, Jamal and colleagues indicated candidate amino acid (aa) substitutions in the capsid that might have contributed to these antigenic changes Liothyronine Sodium [13]. More recently, there is evidence that viruses from the region now exhibit lower cross-reactivity with the A/TUR/2006 antisera. The aim of this study was to investigate the molecular basis of the antigenic variation in these viruses using capsid sequences and their corresponding antigenic relationship (r1) values. Fifty-seven serotype A viruses from the ME submitted to the Food and Agriculture Organisation’s World Reference Laboratory for FMD (WRLFMD) at the Pirbright Institute were used in this study (Supplementary table). Two are the v/s A22/IRQ/24/64 (A22/Iraq) and A/TUR/2006 that were originally isolated in Iraq and Turkey, in 1964 and 2006 respectively; the 55 other viruses were isolated over a fifteen year period (1996–2011).

Nunes et al Bobigny, France Cardiac sarcoidosis C  Chapelon-Abri

Nunes et al. Bobigny, France Cardiac sarcoidosis C. Chapelon-Abric, Paris, France Neurosarcoidosis: clinical manifestations, diagnosis and treatment K. Nozaki, Charleston, USA and M.A. Judson, Albany, USA Ocular sarcoidosis B. Bodaghi et al., Paris, France Skin manifestations

of sarcoidosis J. Mañá and J. Marcoval, Barcelona, Spain “
“L’approche quantitative de la vaccination. Une approche qualitative de la vaccination. “
“La méningite bactérienne est de diagnostic difficile et a une importante morbi-mortalité. Les délais de prise en charge ne sont pas toujours conformes aux recommandations. “
“Le ciment est l’agent le plus fréquemment incriminé dans les eczémas professionnels dans le secteur du bâtiment et des travaux publics (BTP). Il établit l’importance et le retentissement socio-économique des EPC dans le secteur du BTP. “
“Les lymphocytes

T coexprimant en Gefitinib mouse surface les molécules CD8+ et CD57+ représentent 1 à 15 % des lymphocytes totaux chez le sujet sain [1]. Leur nombre et leur proportion augmentent progressivement avec l’âge. Ces cellules peuvent prendre l’aspect cytologique de grands lymphocytes à grains (LGL) (figure 1A) ou celui de cellules hyperbasophiles d’un syndrome mononucléosique. Elles s’expandent au cours de maladies comme l’infection par le virus de l’immunodéficience humaine (VIH), certains déficits immunitaires acquis et accessoirement primitifs, certaines affections auto-immunes ou la réaction du greffon contre l’hôte. Elles peuvent alors devenir pathogènes en infiltrant les tissus ou en s’associant

à des cytopénies, en particulier des neutropénies. find more Les fonctions de ces lymphocytes ne sont que partiellement élucidées mais ils pourraient exercer principalement une action immunosuppressive. Ces expansion se distinguent des lymphoprolifération clonales à LGL (ou leucémies à LGL) qui représentent des maladies malignes [2], qui ne sont pas traitées ici. Dans toute situation où cette expansion from est importante ou inhabituelle, son interprétation doit inclure une analyse cytologique (et éventuellement cytogénétique) et une étude de la clonalité, ainsi qu’une analyse du contexte clinique (en cherchant en particulier un déficit immunitaire primitif ou acquis) afin de la distinguer d’une leucémie à LGL et d’orienter le diagnostic étiologique. Cet article a pour objectif de décrire les situations pathologiques au cours desquelles une expansion polyclonale de lymphocytes T CD8+/CD57+ peut être observée et de préciser les indications dans lesquelles la recherche d’une telle expansion peut avoir un intérêt diagnostique et/ou pronostique. CD57 (encore appelé HNK1, LEU-7 ou L2) est une glycoprotéine sulfatée de 110 kDa exprimée à la surface des cellules neurales des vertébrés, des lymphocytes T majoritairement CD8+ et des cellules NK [3], [4] and [5]. Plus rarement, elle est exprimée sur les lymphocytes T CD4+ et exceptionnellement, sur les lymphocytes T double-négatifs (CD4−/CD8−).

Such early intervention has the greatest potential to decrease ea

Such early intervention has the greatest potential to decrease early forms of preeclampsia [211]. Women at ‘low risk’ of preeclampsia have usually been from unselected populations

of nulliparous and multiparous women. 1. Calcium supplementation (of at least 1 g/d, orally) is recommended for women with low dietary intake of calcium (<600 mg/d) (I-A; High/Strong). The effect of alcohol abstention on the incidence of HDPs is unkown, although reduced consumption reduces BP outside pregnancy [212]. There is no proven safe level of alcohol consumption in pregnancy [213]. Low dose aspirin does not decrease preeclampsia incidence in low risk nulliparous women (RR 0.93; 95% CI 0.81–1.08) [204], [214], [215], [216] and [217], although first trimester aspirin initiation is untested in RCTs. Oral calcium supplementation (of at least 1 g/d) decreases the incidence of preeclampsia (RR 0.45, 95% CI 0.31–0.65) and gestational hypertension (RR 0.71, 95% CI 0.57–0.89) [218] and [219]. IAP inhibitor Maternal death or serious morbidity was reduced (RR 0.80; 95% PS-341 concentration CI 0.65–0.97) [220], more than offsetting the possible increase in HELLP (RR 2.67, 95% CI 1.05–6.82);

it is possible that the BP lowering effect of calcium masks progression to HELLP [221]. The benefits of calcium are probably restricted to women with low calcium intake (<600 mg/day) [219]; potential harms (e.g., osteoporosis during lactation) have not been excluded [222]. An alternative to supplementation may be 3–4 dairy servings/day (250–300 mg calcium/serving). Dietary salt restriction does not affect gestational Idoxuridine hypertension or preeclampsia incidence (RR 1.11; 95% CI 0.46–2.66) [223]. Heart healthy diets are untested. Energy or protein restriction diets for overweight women or those with excessive pregnancy weight gain did not decrease gestational hypertension or preeclampsia incidence [224]. Starvation ketosis may adversely alter fetal neurodevelopment [225]. Consuming milk-based probiotics may lower preeclampsia risk (population-based cohort) [226]; no RCT was identified. One RCT found a significant reduction of BP with daily intake of high-cocoa-content chocolate from 11 to 13 weeks until delivery

[227]. Two RCTs are studying the impact of flavanol-rich chocolate on endothelial function and the risk of preeclampsia ( NCT01659060), ( NCT01431443). Periconceptual use of a folate-containing multivitamin is recommended for all women for primary prevention of neural tube and possibly other anomalies [228]. Periconceptual and ongoing regular use of multivitamins may prevent gestational hypertension [229] and preeclampsia in women with a BMI < 25 kg/m2[230]. Moderate-intensity regular aerobic exercise (vs. normal physical activity) during pregnancy did not decrease preeclampsia or other adverse outcomes [231]. Although workload/stress reduction is a common obstetric intervention, no relevant RCTs were identified that tested the impact on preeclampsia incidence.