High DHEAS/free testosterone ratio is related to better metabolic parameters in women with PCOS

Abstract

Aims: To demonstrate the effects of DHEAS/free testosterone (DHEAS/FT) ratio on metabolic parameters in women with and without polycystic ovary syndrome (PCOS).

Methods: The data of 91 women with PCOS and 66 women in the control group were collected retrospectively.

Results: DHEAS/FT of the control group was higher than that of PCOS group (684.93?±?300.54 to 517.2?±?300.8, p?<?0.001). DHEAS/FT correlated with BMI (r?=??0.352, p?=?0.001), WHR (r?=??0.371, p?=?0.0219), LDL (r?=??0.227, p?=?0.031), HOMA-IR (r?=??0.36, p?=?0.001) and FAI (r?=??0.639, p?=?0.001) negatively and with HDL (r?=?0.344, p?=?0.001) and SHBG (r?=?0.646, p?=?0.001) positively. In the control group, DHEAS/FT correlated with BMI (r?=??0.334, p?=?0.007), CRP (r?=??0.297, p?=?0.016) and FAI (r?=??0.399, p?=?0.01) negatively.

Conclusions: High DHEAS/FT ratios are related to a better metabolic phenotype in women with PCOS and low levels can be used to detect women with PCOS that have a higher risk of metabolic problems.     

Circulating galanin and IL-6 concentrations in gestational diabetes mellitus

Objective: The aim of this study is to compare galanin and IL-6 levels in pregnant women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT). Also association of insulin resistance markers, galanin and IL-6 was investigated.

Materials and Methods: The study registered 30 pregnant women with GDM and 30 pregnant women with NGT. Fasting venous blood samples were collected from all patients. Galanin and IL-6 levels were measured by an enzyme-linked immunosorbent assay.

Results: Galanin and IL-6 levels were found higher in pregnant women with GDM (p?r?=?0.240, p?=?0.065), insulin (r?=?0.681, p?r?=??0.644, p?r?=?0.783, p?r?=?0.745, p?r?=?0.058, p?=?0.662), body mass index (r?=??0.019, p?=?0.886).

Conclusion: Galanin and IL-6 were found to be significantly associated with insulin resistance markers in GDM, thus may play important roles in regulation of glucose hemostasis.     

Serum irisin concentration in women with gestational diabetes

Irisin is a novel myokine and adipokine which induces an increase in total body energy expenditure, improving insulin sensitivity and glucose tolerance in experimental animals. In the present study, serum irisin concentration was measured by an enzyme immunoassay in 130 women with gestational diabetes mellitus (GDM) and 140 BMI-matched patients with normal glucose tolerance (NGT). Median irisin level was significantly lower in the patients with GDM than in the NGT subjects (1703.3 [1354.8–2097.9?ng/ml] versus 1873.8 [1519.8–2294.8?ng/ml], p?=?0.01); however, 3 months after childbirth its concentrations did not differ markedly between the two groups (1165.9 [872.1–1497.5] ng/ml versus 1139.0 [984.0–1376.7] ng/ml). In the whole group, irisin concentration correlated negatively with 2?h glucose level (R?=??0.14, p?=?0.03). In the women with NGT, irisin concentration correlated positively with IS_OGTT (R?=?0.22, p?=?0.04) and the disposition index (DI₁₂₀) (R?=?0.24, p?=?0.03), as well as negatively with 2?h insulin level (R?=??0.23, p?=?0.03) and HOMA-IR (R?=??0.24, p?=?0.02). Multiple regression analysis revealed that 2?h glucose and DI₁₂₀ were the only variables significantly influencing serum irisin (β?=?0.158, p?=?0.03 and β?=?0.159, p?=?0.02, respectively). Our results suggest that serum irisin concentration increases markedly in pregnant women, but this increase seems to be significantly lower in patients with GDM.     

Possible effects of lipoprotein-associated phospholipase A2 single-nucleotide polymorphisms on cardiovascular risk in patients with preeclampsia

Purpose: Lipoprotein lipase-associated phospholipase A2 (Lp-PLA2) is a vascular inflammatory marker associated with cardiovascular diseases (CVD). Women with preeclampsia (PE) have elevated vascular inflammation and at higher CVD risk in the later life. We hypothesize that vascular inflammation related genetic variations increase the risk for developing future cardiovascular disease in women with PE. To test this hypothesis, we studied PLA2G7 gene polymorphisms, Lp-PLA₂ mass, activity, index, and other cardiovascular risk factors in women with preeclampsia.

Methods: A total of 200 pregnant women were included into the study. We stratified the PE group: early (28.7?±?3.0 weeks) and late onset (36.0?±?1.4 weeks). Serum Lp-PLA2 mass in the early PE and the late PE group were significantly higher than the control group (p?=?.000). Lp-PLA2 index, Hs-C-reactive protein (CRP), serum amyloid A (SAA), calprotectin, and PTX3 levels were higher in early and late PE (p?=?.000). Single-nucleotide mutations of PLA2G7 rs1805017 (r?=??0.228, p?r?=?0.216, p?Conclusions: Lp-PLA2 genetic variability with vascular inflammatory markers might contribute the incidence of future cardiovascular events.     

Maternal cardiovascular profiling in the first trimester of pregnancies complicated with gestation-induced hypertension or fetal growth retardation: a pilot study

Abstract

Objective: In this study, we determine whether maternal cardiovascular (CV) profiling can detect first trimester differences between women with uncomplicated pregnancies (UP) and those who will develop gestational hypertensive disorders (GHD) or normotensive fetal growth retardation (FGR).

Methods: Cardiac, arterial, and venous function were evaluated in 242 pregnant women around 12 weeks of gestation, using impedance cardiography (ICG) and combined electrocardiogram – Doppler ultrasonography. After postnatal determination of gestational outcome, first trimester measurements were compared between groups using Mann–Whitney U test for continuous data or Fisher’s Exact test for categorical variables (SPSS 20.0).

Results: Compared to UP, first trimester aortic flow velocity index [71?±?0.96 versus 61?±?4.91 1/1000/s (p?=?0.016)], acceleration index [133?±?2.25 versus 106?±?11.26 1/100/s² (p?=?0.023)] and Heather index [23.1?±?0.35 versus 19.2?±?1.70?Ω/s² (p?=?0.019)] were lower in GHD pregnancies, and first trimester stroke volume [77?±?1.16 versus 67?±?3.97?ml (p?=?0.033)] and cardiac output [7.3?±?0.10 versus 6.2?±?0.31?l/min (p?=?0.025)] were lower in FGR pregnancies.

Conclusions: Maternal CV function in the first trimester of pregnancy differs between UP and those destined to develop GHD or FGR. This can be assessed with non-invasive maternal CV profiling, opening perspectives for the application of this technique in early gestational screening for GHD and FGR.     

Lowered serum total L-carnitine levels are associated with obesity at term pregnancy

Abstract

Objective: This study aims to compare the serum total l-carnitine concentrations of obese and non-obese pregnant women and to identify the role of l-carnitine in both maternal and fetal weight gain during pregnancy.

Method: This study reviews 118 healthy women with singleton term pregnancy (≥37 weeks). The characteristics of the recruited subjects were analyzed according to their pre-pregnancy body mass index (BMI).

Results: The women with pre-pregnancy BMI?<?18.5?kg/m² had significantly higher serum l-carnitine levels whereas the women with BMI?>?29.9?kg/m² at term pregnancy had significantly lower serum l-carnitine levels (p?=?0.001 for both). The neonates born to women with BMI?>?29.9?kg/m² at term pregnancy had significantly longer height and wider head circumference (p?=?0.001 for both). Serum total l-carnitine levels correlated significantly and negatively with pre-pregnancy body weight, pre-pregnancy BMI, pregnancy body weight, pregnancy BMI and serum triglyceride levels (r?=??0.397, p?=?0.001; r?=??0.357, p?=?0.001; r?=??0.460, p?=?0.001; r?=??0.463, p?=?0.001 and r?=??0.216, p?=?0.019, respectively). There was a significant and positive correlation between l-carnitine and HDL values (r?=?0.243, p?=?0.008).

Conclusions: The crucial role of l-carnitine in pregnancy metabolism suggests that nutritional supplementation of this amino acid can be offered to women who are either overweight or obese at the beginning of the pregnancy.     

Correlation of nuchal translucency and thyroxine at 11–13 weeks of gestation

Abstract

Objective: Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. Here, we investigated the association between NT thickness and thyroid related hormones.

Methods: NT thickness was measured with transabdominal ultrasound in 643 pregnant women between 11 and 13 weeks of gestation. Maternal thyroxine (T4), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were evaluated. Bivariate correlations were assessed and thyroid profile was subcategorized with regard to the calculated reference ranges.

Results: An inverse relation was found between serum levels of maternal T4 with NT thickness (r?=??0.128, p?=?0.001) and CRL (r?=??0.168, p?<?0.001). TSH and hCG were also found to be correlated (Spearman’s correlation coefficient?=??0.092, p?=?0.019). Prevalence of maternal hypothyroidism and subclinical hypothyroidism were 1.1% and 3.7%, respectively.

Conclusion: Thyroid function tests are found to independently influence NT measurements in the first trimester. Assessment of hormones such as thyroxine could optimize the interpretation of screening tests for pathological conditions during pregnancy.     

Serum hepcidin is associated with parameters of glucose metabolism in women with gestational diabetes mellitus

Abstract

Objectives: Hepcidin is considered a major regulator of iron metabolism. Despite previous studies showing elevated ferritin and hepcidin levels in type 2 diabetes mellitus (DM), no study has investigated hepcidin levels in pregnant women with gestational DM (GDM).

Methods: A case-control study was conducted in 30 cases of GDM, 47 pregnant women with impaired glucose tolerance (IGT) and 72 pregnant women with normal glucose tolerance (control) between April 2009 and July 2011. Serum hepcidin and other iron metabolism parameters were analyzed in all groups.

Results: Serum ferritin and serum iron were significantly elevated in the GDM group compared to controls (p?=?0.014, p?=?0.018, respectively) and to the IGT group (p?=?0.021, p?=?0.008, respectively). Hepcidin levels were elevated significantly in the diabetic patients compared to the IGT group (p?=?0.011) and controls (p?=?0.002). We found no correlation between hepcidin and other iron metabolism parameters (Hb, serum iron and ferritin), whereas positive correlations were found between hepcidin and parameters of glucose metabolism (fasting blood glucose, fasting insulin level and glucose value response to glucose challenge test).

Conclusions: Serum hepcidin concentrations were increased in pregnant women with IGT and GDM and this was not related to inflammation parameters.     

Maternal circulating levels of irisin in intrahepatic cholestasis of pregnancy

Objective: Intrahepatic cholestasis of pregnancy (ICP), the most common liver disease in pregnancy, is characterized by elevated serum total bile acid levels and pruritus. It has become clear that bile acids are no longer labeled as simple detergent-like molecules, but also represent complex hormonal metabolic regulators. ICP has also been associated with increased incidence rates of gestational diabetes mellitus. Irisin is a newly discovered myokine that is able to regulate glucose and lipid levels, thus improving insulin sensitivity. In this study, maternal serum irisin levels were analyzed in order to provide a new perspective on the pathogenesis of ICP.

Materials and methods: In this controlled cross-sectional study, 58 consecutive pregnant women with ICP (30 with mild and 28 with severe disease) and 30 healthy women with uncomplicated pregnancies (as the control group) were examined. The maternal irisin, fasting blood glucose, fasting insulin and homeostatic model assessment of insulin resistance levels of the two groups were compared.

Results: Serum irisin levels were significantly higher in the severe ICP group than in the mild ICP and control groups (p?=?0.005 and p?<?0.001, respectively). At the best cut-off level of 908.875?pg/ml, irisin accurately predicted ICP [AUC?=?0.827 (95% CI: 0.745–0.909; p?<?0.001)] with sensitivity and specificity rates of 72.5 and 86.8%, respectively. There was a significant negative correlation between irisin and fasting blood glucose levels (r?=??0.399; p?=?0.021).

Conclusion: The results of this study indicate that serum irisin levels were significantly higher in women with ICP compared to healthy pregnant controls. However, it is difficult to infer whether high irisin level is a cause or effect of ICP.     

The influence of placental perfusion on birthweight in women with gestational diabetes

Objective: To evaluate the influence of both uterine and umbilical arteries Doppler pulsatility indexes (PI) and metabolic control on birthweight in pregnant women with gestational diabetes mellitus.

Methods: One hundred sixty-nine women with gestational diabetes were evaluated. Doppler measurements of umbilical artery and mean uterine arteries PI were recorded and the corresponding Z-score values by gestational age calculated. Maternal pregestational body mass index (BMI) and the levels of glycosylated hemoglobin were also recorded. The relationships between these studied variables and customised birthweight centiles according to sex and gestational age were analyzed using Spearman’s correlation coefficient and linear regression.

Results: There was a significant correlation between birthweight centiles and Z-score values of the umbilical artery PI (r?=??0.25, p?=?0.001), but not with the Z-score values of the uterine artery PI (r?=??0.12, p?=?0.43). Third trimester maternal glycosylated hemoglobin was also positively correlated to birthweight (r?=?0.29, p?=?0.01). When using stepwise linear regression both maternal glycosylated hemoglobin and the Z-score of umbilical artery PI were included as independent variables in the predictive model of birthweight centile (p?=?0.0002, p?=?0.001 respectively, R^2?=?0.27).

Conclusions: Umbilical artery PI predicts birthweight in women with gestational diabetes. However, metabolic control is the only important determinant of fetal macrosomia in these mothers.     

Maternal C-reactive protein concentrations during pregnancy and birth weight in a prospective cohort in Rio de Janeiro,Brazil

Objective: To evaluate the association between maternal C-reactive protein (CRP) concentrations during pregnancy and birth weight (BW) Z-score.

Methods: A prospective cohort of pregnant women were followed at 5–13 (n?=?203), 20–26 (n?=?181), and 30–36 (n?=?181) gestational weeks and at 30–45 d postpartum. Maternal CRP concentrations were assessed three times during pregnancy using immunoturbidimetric methods (ultra-sensitive kits). BW Z-score and newborns classified as small for gestational age (SGA) were evaluated according to Intergrowth-21st curves. Statistical analyses included SGA rates, BW Z-score means (SD) and a two-stage procedure: (1) a linear mixed-effect model (LME) to predict CRP intercept (mean exposure level) and slope (trend of change during pregnancy); and (2) a multiple linear regression model with BW Z-score as the outcome and CRP intercept and slope exposures.

Results: A total of 4.4% (n?=?9) women delivered SGA newborns. The mean BW was 3282.0 (37.3) g, and the mean gestational age at delivery was 38.8 (0.1) weeks. Women in the third tertile of the CRP rate of change gave birth to infants with a mean BW Z-score that was lower than those in the first/second tertiles (0.226 versus 0.381; p?=?0.324). For the adjusted baseline CRP (β?=?0.08; 95% CI: 0.03–0.14), the CRP trend of change was inversely associated with the BW Z-score (β=??3.77; 95% CI: ?5.45 to ?2.10).

Conclusions: The maternal CRP trend of change during pregnancy was negatively associated with BW Z-score.     

Serum and follicular fluid levels of IGF-II,IGF-binding protein-4 and pregnancy-associated plasma protein-A in controlled ovarian hyperstimulation cycle between polycystic ovarian syndrome (PCOS) and non-PCOS women

Objective.?To investigate the difference of serum and follicular expression patterns for IGFα, IGFBP4 and PAPP-A in COH cycle between PCOS and non-PCOS women.

Methods.?COH was performed for total 30 sterile women (20 with PCOS and 10 with normal ovarian function). The serum and follicular fluid (FF)from dominant follicles levels of IGFα, IGFBP4 and PAPP-A before COH, day of hCG, and were measured using an ELISA.

Results.?The PCOS women had significantly higher day 3 serum PAPP-A, day of hCG serum IGFBP-4, and ff IGF-II levels compared to the normoovulatory subjects. Serum levels of IGF-II and IGFBP-4 in PCOS women had increased after gonadotropins stimulation, and yet PAPP-A was decreased. Within the PCOS women, day of hCG serum IGFBP-4 was strongly correlated with BMI (r?=?0.777; P?=?0.000), day of hCG IGF II (r?=??0.573, p?=?0.008), ff IGF II (r?=??0.573, p?=?0.008) and ff PAPP-A (r?=??0.461, p?=?0.041) was inversely related to diameter >16?mm follicle number and day 3 PAPP-A correlated to diameter?>16?mm follicle number (r?=?0.474; p?=?0.035).

Conclusions.?Ovarian IGF system on the gonadotropin response to differences in the PCOS and non-PCOS women in COH cycle, and may indicate a inordinate IGF system that might disturb folliculogenesis in PCOS women.     

Evaluation of neutrophil–lymphocyte ratio,platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy

Objective: Acute pancreatitis (AP) is a state of inflammation. It has been widely known that neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and red blood cell distribution width (RDW) to platelet ratio (RPR) reflect systemic inflammation. The aim of this study is to investigate whether these inflammatory markers could be used as reliable markers in early prediction of AP in pregnancy and if there is a relationship between disease severity and these markers.

Methods: The study group consisted of 14 patients, who developed AP in ongoing pregnancy, and the control group consisted of 30 healthy pregnant women. NLR, PLR and RPR were calculated for both the groups.

Results: NLR was significantly elevated in the AP group when compared with the controls (p?=?0.00), but there was no statistically significant difference in terms of PLR and RPR (p?>?0.05). ROC curve analysis results for NLR showed that there was a significant prediction power of NLR for AP (R²?=?0.842; p?<?0.001). For NLR parameter, if cut-off value is chosen to be 4.1030, then sensitivity is 71.4% and specificity is 100.0%. There was statistically significant and positive correlation between C-reactive protein (CRP) and glucose with NLR (p?=?0.001, p?=?0.043). It was seen that Ranson was close to be significant (p?=?0.051).

Conclusion: NLR might be used as an early marker of AP and may have a role in prediction of disease severity.     

Maternal cytokines and disease severity influence pregnancy outcomes in women with rheumatoid arthritis

Objectives: To assess the influence of maternal cytokine levels, disease activity and severity on preterm delivery, small for gestational age (SGA) and cesarean delivery in pregnant women with rheumatoid arthritis (RA).

Methods: A prospective study in 47 pregnant women with RA and 22 healthy pregnant controls. The main outcome measures were birth weight in relation to maternal serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and RA activity and severity at three different time points: preconception and during the first and third trimesters.

Results: During the third trimester, IL-10 was detectable in 23.4% of patients with RA, IL-6 in 76.6%. Mean birth weight born to mothers with RA was higher when IL-10 level was high compared with low (p?=?0.001), and lower when IL-6 was high compared with low (p?=?0.035). Also increase in disease activity score-28 (in 60.1%, p?=?0.001), Health Assessment Questionnaire–Disability Index (in 87.5%, p?=?0.013), and pain score (56.9?±?11.4, p?=?0.003) associated with increased risk of SGA. High patient’s global scale was associated with unfavorable pregnancy outcome (preterm, SGA, and cesarean).

Conclusion: High maternal IL-10 levels are associated with higher birth weight and high IL-6 levels are associated with lower birth weight (SGA). Among women with RA, disease activity and severity are predictive of unfavorable pregnancy outcomes suggesting that better disease management early in the pregnancy could improve pregnancy outcomes.     

Cord blood netrin-1 and -4 concentrations in term pregnancies with normal,restricted and increased fetal growth

Abstract

Objective: To determine levels of the possible angioregulatory molecules netrin-1 and -4, in intrauterine-growth-restricted (IUGR), large for gestational age (LGA) (both groups characterized by altered angiogenic mechanisms) and appropriate-for-gestational-age (AGA) pregnancies.

Methods: Cord blood (UC) netrin-1 and -4 concentrations were measured in 30 IUGR, 30 LGA and 20 AGA infants and their mothers (MS).

Results: Netrin-1 and -4 concentrations did not differ in all groups. UC netrin-4 increased with gestational age (b?=?0.075, 95% CI 0.029–0.121, p?=?0.002). In the IUGR group, MS netrin-4 decreased as birth-weight centiles increased [b?=??0.058, 95% CI ?0.112 to ?0.004, p?=?0.036]. In the LGA group, MS netrin-1 decreased with advanced gestational age [b?=??0.063, 95% CI ?0.105 to ?0.022, p?=?0.004]. In all cases, MS netrin-1 positively correlated with MS netrin-4 (r?=?0.299, p?=?0.007), while UC netrin-1 negatively correlated with UC netrin-4 (r?=??0.239, p?=?0.033).

Conclusions: Increased UC netrin-4 levels with advancing gestational age may reflect its effect on fetal development. Decreased maternal netrin-1 levels in the LGA group possibly represent a negative feedback mechanism against increased angiogenesis. Increased maternal netrin-4 levels in IUGR neonates may reflect in utero hypoxia, while the negative correlations between fetal netrin-1 and -4 levels may exert the dynamic balance between their angio- and anti-angiogenic properties.     

Investigating the relationship between 25-hydroxyvitamin D and thyroid function in second-trimester pregnant women

This study aims to explore the correlation between serum 25-hydroxyvitamin D and thyroid hormones during the second trimester. In total, 277 pregnant women at 13–28?weeks of gestation were enrolled. According to the level of thyrotropic-stimulating hormone, they were divided into a reduced TSH group, a normal TSH group and an elevated TSH group. In this study, we found that the prevalence of vitamin D deficiency was as high as 94.58%. The 25-hydroxyvitamin D level in the reduced TSH group was lower than that in the normal thyroid function group (p?=?.0005), and the 25-hydroxyvitamin D level in the elevated TSH group was higher than that in normal TSH group (p=.0339). A positive correlation was observed between 25-hydroxyvitamin D and thyrotropic-stimulating hormone (r?=?0.3034, p?=?.0000). Furthermore, 25-hydroxyvitamin D was negatively correlated with the free thyroxine level (r?=??0.1286, p?=?.0323) as well as the free triiodothyronine level (r?=?0.1247, p?=?.0380). These data suggest that the relationships between 25-hydroxyvitamin D and thyroid parameters were characterized during the second trimester. Pregnant women in the second-trimester who are diagnosed with transient hyperthyroidism should be evaluated for the possibility of vitamin D deficiency.     

Relationship between the body iodine status and menopausal symptoms during postmenopausal period

Abstract

Aim: The aim of this study was to assess the effect of body iodine status on hot flashes and cardiovascular disease risk in postmenopausal women.

Methods: Two hundred and ten consecutive postmenopausal women without known any risk factor for cardiovascular disease risk or systemic disorder were recruited for the study. All participants underwent serum screening consisted of lipid profile including lipoprotein-a (Lp(a)) and urinary iodine excretion. Participants were also asked for the frequency and the duration of hotflashes. All parameters were assessed for the association between urine iodine excretion and other parameters.

Results: Urine spot iodine level was significantly correlated with Lp(a) (r?=??0.287, p?<?0.001), low-density lipoprotein cholesterol (LDL-C) (r?=??0.187, p?=?0.006), cholesterol level (r?=??0.573, p?<?0.001), TG level (r?=??0.211, p?=?0.02), frequency of hot flashes per a day (r?=??0.467, p?<?0.001), durations of hot flashes (r?=??0.424, p?<?0.001), fasting glucose level (r?=?0.331, p?<?0.001), and fT3 level (r?=?0.475, p?<?0.001). In multivariate analysis, Lp(a) levels were significantly associated with the urine iodine level (beta coefficient?=??0.342, p?<?0.001) after adjustment for LDL-C (beta coefficient?=?0.225, p?<?0.001), glucose (beta coefficient?=?0.303, p?<?0.001), and age (beta coefficient?=?0.146, p?<?0.017).

Conclusion: Body iodine status during postmenopausal period is associated with the menopausal symptoms and lipid profile including Lp(a).     

Obstetric outcome of second trimester antenatal bleeding

Objective: To evaluate the clinical significance of vaginal bleeding in pregnant women between 14th and 22th gestational weeks.

Methods: This retrospective case–control study was conducted between September 2010 and December 2013. Two-hundred nineteen pregnant women with vaginal bleeding between 14th and 22th gestational weeks were compared with 325 pregnant women without vaginal bleeding for their maternal and early neonatal outcomes.

Results: Mean gestational age and birth weight of study group were significantly different from those of the control group respectively (37.9?±?2.8 versus 38.9?±?1.4 and 3071?±?710 versus 3349?±?446 for groups p?<?0.001). Vaginal bleeding between 14th and 22th gestational weeks had increased risk of having preterm birth (PB) and preterm premature rupture of membranes (PPROM) (OR: 10.8, 95% CI: [4.5–26.1]; OR: 12.0, 95% CI: [3.5–40.6], respectively). Gestational diabetes mellitus (GDM) and polyhydramnios ratio in the study group was significantly higher than the control respectively (4.1% versus 1.2%, p?=?0.031; 1.9% versus 0%, p?=?0.025).

Conclusion: Pregnant women with vaginal bleeding was a significantly risk factor for PB, PPROM, GDM, and polyhydramnios. Consequently, these pregnancies should be closely followed up for maternal and fetus complications.     

Maternal and fetal circulating sKL and ET-1 levels as function of normal labor at term

Objectives.?To determine whether labor is associated with alterations of the levels of soluble c-kit ligand (sKL) and endothelin-1 (ET-1) in maternal plasma and umbilical cord blood.

Methods.?The sKL and ET-1 levels were investigated in umbilical cord and maternal plasma on the day of delivery in 18 pregnant women with vaginal delivery during labor, 18 non-pregnant women and 9 pregnant women before cesarean delivery, using an ELISA assay.

Results.?Umbilical cord plasma sKL levels were significantly higher than the maternal plasma in both types of delivery (p?=?0.0001, p?<?0.0001, respectively). However, maternal plasma ET-1 levels in the presence of labor were significantly higher than the cesarean delivery group (p?<?0.0001). No difference was noted for sKL and ET-1 in umbilical cord vessels of both groups. Furthermore, a highly significant inverse correlation was documented between the individual levels of cord plasma ET-1 and the levels of cord plasma sKL (r?=??0.6269, p?=?0.0054).

Conclusions.?The sKL levels found in umbilical cord plasma are consistent with the pleiotropic effects of sKL in facilitating the transition of the fetus to the neonatal stage. The reduced ET-1 maternal plasma levels, compared to non-pregnant women, probably are indicative of a putative mechanism for embryo protection from vasoconstriction sequelae. This assumption is strengthened by the corresponding ET-1 levels in umbilical cord plasma.     

Maternal serum cytokine levels in pregnancies complicated with threatened preterm labour

Objective: To investigate serum inflammatory markers in singleton gestations complicated with threatened preterm labour (TPL).

Methods: Pregnant women complicated with TPL (n?=?61) were recruited to measure maternal serum levels of a panel of cytokines and C-reactive protein and then compared to controls without TPL, matched for gestational age (n?=?64) and term pregnancies in the prodromal phase of labour (PPL) (n?=?31). In addition, baseline cytokine levels were compared among cases and controls according to the outcome.

Results: Women with TPL displayed higher CRP and white blood counts levels together with lower granulocyte macrophage colony-stimulating factor (GMC-SF) compared to both controls without TPL and to term gestations in the PPL. Also, interleukin 10 (IL-10), IL-6, IL-7, IL-8 and tumour necrosis alpha (TNF-α) levels were found significantly higher in TPL cases as compared to controls without TPL and term women in the PLL. Baseline cytokine levels (except IL-10) were higher among TPL cases who later delivered preterm. TPL cases delivering preterm displayed lower GMC-SF levels as compared to those delivering at term. Multivariate analysis found that gestational age at birth positively correlated with cervical length and inversely with CRP, IL-6 and TNF-α levels (p?<?0.0001).

Conclusions: TPL and preterm birth were related to inflammatory changes in the maternal side that correlate with cervical shortening and the initiation of uterine contractions.