Calcium to creatinine ratio in a spot sample of urine for early prediction of pre-eclampsia

Objectives: Based on the fact that urinary calcium excretion decreases in pre-eclampsia, this study was designed to determine the predictive value of calcium to creatinine ratio in a spot urine sample. Methods: The calcium to creatinine ratio was measured in a spot urine sample of 102 normotensive women at 20–24 weeks’ gestation who attended the prenatal care clinic of the Shiraz University of Medical Sciences. The women were followed-up until delivery and grouped according to pre-eclampsia occurrence. The prevalence of pre-eclampsia was measured and compared with the calcium to creatinine ratio. Results: Ninety-four women remained normotensive during pregnancy and eight developed pre-eclampsia. Mean age, gestational age at the beginning of the study, and gestational age at delivery did not differ significantly between the two groups. Mean urinary calcium concentration (15.9±8.5 mg/dl in normotensive vs. 10.2±7.5 mg/dl in pre-eclamptic women), and mean birth weight (3192±336.3 g vs. 2712±468.9 g) were significantly lower in pre-eclamptic patients (P=0.03 and 0.005, respectively). Mean calcium to creatinine ratio was also significantly lower in the pre-eclamptic group (P<0.03). Conclusions: Single urine calcium to creatinine ratio may be an effective method for screening women at greatest risk for pre-eclampsia.     

Soluble Flt-1 as a diagnostic marker of pre-eclampsia

BACKGROUND: Serum levels of soluble fms-like tyrosine kinase (sFlt-1) increase in pre-eclampsia (PE). Aims: To determine whether concentrations of serum sFlt-1 can differentiate PE or superimposed PE (SPE) from gestational hypertension (GH) or chronic hypertension (CH). METHODS: Blood was collected from pregnant women being investigated for hypertension (blood pressure of > 140 and/or 90 mmHg). Normotensive (NP) and pre-eclamptic (PE-C) control ranges were measured. RESULTS: Patients with evolving hypertension in pregnancy eventually fell into four groups: GH (n = 14), PE (n = 7), CH (n = 9) and SPE (n = 9). Patients who later developed pre-eclampsia had a higher sFlt-1 (PE: 2.61 ng/mL and SPE: 2.77 ng/mL, respectively) than GH (P < 0.001) or CH (1.05 ng/mL, P = 0.11). Women with established PE at recruitment (PE-C; (n = 18) (3.13 ng/mL; interquartile range (IQR): 2.14-4.17 ng/mL) had a median sFlt-1 higher than NP (n = 18) (0.47 ng/mL; IQR: 0.11-0.89) (P < 0.0008). Patients with GH compared to NP had a slight increase (1.33 ng/mL, P < 0.003). Using a sFlt-1 cut-off of > or = 1.9 ng/mL yielded a sensitivity of 94% (95% confidence interval (CI) 73-100%) and specificity of 78% (95% CI 64-82%). CONCLUSIONS: sFlt-1 was elevated in women with PE compared to NP. The sFlt-1 also differentiated women destined to develop PE among those who presented with a diagnostic rise in maternal blood pressure. The sFlt-1 test is a useful diagnostic test for PE.     

Human chorionic gonadotropin levels between 16 and 21 weeks of pregnancy and prediction of pre-eclampsia.

OBJECTIVE: To determine whether levels of beta human choriogonadotropin (beta-hCG) during the second trimester are a predictor of pre-eclampsia. METHODS: A prospective study of 784 women was conducted between their 16th and 20th week of pregnancy. Primigravidas and multigravidas were analyzed separately, and the cutoff point was determined using a receiver operating characteristic curve. The accuracy of beta-hCG levels in the prediction of pre-eclampsia was evaluated. The likelihood ratios were calculated for different levels of beta-hCG in both groups. RESULTS: Pre-eclampsia prevalence was 7.1% among primigravidas and 4.6% among multigravidas. The cutoff concentration was 2.0 MoM in both groups. For primigravidas and multigravidas, respectively, the area below the curve was 0.96 and 0.95; sensitivity was 88.5% and 100%; specificity was 92.0% and 85.6%; positive predictive value was 0.46 and 0.25; and negative predictive value was 0.99 and 1.0. With a cutoff concentration of 2.0 MoM of beta-hCG, the positive likelihood ratio was 11.1 in primigravidas and 6.9 in multigravidas. CONCLUSION: This study shows that measuring levels of beta-hCG during the second trimester of pregnancy is useful in clinical practice to identify pregnant women who will develop pre-eclampsia.     

TNF-R1 as a first trimester marker for prediction of pre-eclampsia

Objective: To examine whether the maternal serum concentration of the soluble receptor-1 of tumor necrosis factor-α (TNF-R1) at 11–13?+?6 weeks of gestation is a predictor of development of pre-eclampsia (PE).

Methods: This is a nested case–control study in which the concentration of TNF-R1 at 11?+?0 to 13?+?6 weeks was measured in 426 pregnant women in the first trimester. TNF-R1 values were expressed as multiples of the median (MoM) adjusted for maternal factors. The distributions of log TNF-R1 MoM in the control group and hypertensive disorders (early-PE [ePE], late-PE [lPE] and gestational hypertension [GH]) groups were compared. Logistic regression analysis was used to determine whether maternal factors, TNF-R1 or their combination make a significant contribution to the prediction of PE. Screening performance was determined by analysis of receiver–operating characteristics curves.

Results: Median concentration of TNF-R1 (ng/ml) was higher in ePE (2.62?±?0.67), lPE (2.12?±?0.56) and GH (2.19?±?0.45) compared to controls (2.04?±?0.42), p?=?0.001. Logistic regression analysis demonstrated that the addition of TNFR-1 to maternal factors did not make a significant contribution to the prediction of PE.

Conclusions: The maternal serum TNF-R1 concentration at 11–13?+?6 weeks of gestation was increased in pregnancies which developed hypertensive disorders, however, the addition of TNFR-1 did not improve the detection rate of these conditions compared with maternal factors alone.     

Ophthalmic artery Doppler as a measure of severe pre-eclampsia

OBJECTIVE: To identify differences in orbital flow behavior in mild and severe pre-eclamptic women compared with healthy pregnant women, demonstrated by ophthalmic artery Doppler indexes. METHODS: Ophthalmic artery Doppler indexes of 20 mild and 20 severe pre-eclamptic women were compared with 51 healthy pregnant women. Right and left eye Doppler index means were evaluated and the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic velocity (EDV), and peak ratio (PR) were calculated. RESULTS: Statistically significant differences were observed between PR, PSV, and EDV (P=0.0009, P=0.0020, P=0.0001) ophthalmic artery Doppler in a comparison of women with mild and severe pre-eclampsia. Statistically significant differences were seen between all Doppler indexes of the study group and healthy pregnant women. Ophthalmic PR, PSV, and EDV were significantly higher in severe pre-eclamptic cases but other index parameters did not show any difference. An elevation of diastolic and systolic flow occurred when pre-eclampsia became severe. CONCLUSION: Orbital vascular impedance reduction with orbital hyperperfusion was present in severe pre-eclamptic women compared with mild pre-eclamptic and healthy pregnant women. Ophthalmic Doppler is a novel parameter that may be useful in the diagnosis of severe pre-eclampsia.     

Accuracy of fibronectin tests for the prediction of pre-eclampsia: a systematic review

The purpose of this study was to review systematically all studies that assessed the accuracy of maternal plasma fibronectin as a serum marker for early prediction of pre-eclampsia. We therefore assessed studies that reported on fibronectin as serum marker for pre-eclampsia before the 25th gestational week. For the selected studies, sensitivity and specificity were calculated and plotted in ROC-space. We included 12 studies, of which only 5 studies reported sufficient data to calculate accuracy estimates, such as sensitivity and specificity. These five studies reported on 573 pregnant women of whom 109 developed pre-eclampsia. At a sensitivity of at least 50%, specificities ranged between 72 and 96% for cellular fibronectin. For total fibronectin, these numbers were 42-94%. Fibronectin seems to be a promising marker for the prediction of pre-eclampsia, however, further studies are needed to determine whether the accuracy of this test is sufficient to be clinically relevant.     

Exploring knowledge of pre-eclampsia and views on a potential screening test in women with type 1 diabetes

Objectiveto explore knowledge of pre-eclampsia and opinions on potential screening tests for pre-eclampsia in women with type 1 diabetes.Designa qualitative study using semi-structured interviews of women planning a pregnancy, currently pregnant or post-partum with experience of pre-eclampsia.Setting, Participants and Methodseleven women with type 1 diabetes were recruited from a pre-pregnancy planning clinic or antenatal clinic. Semi-structured interviews were conducted with the women, asking a series of open-ended questions about their current knowledge of pre-eclampsia and their views on screening for pre-eclampsia. Data analysis was conducted using inductive thematic analysis.Findingsfour main themes were identified: Information, sources of stress, awareness and acceptability of screening. Generally, women's knowledge of pre-eclampsia was limited. Most did not appear to be aware of their increased risk of developing the disease. Similarly, the majority of women were unaware as to why their blood pressure and urine were checked regularly. The introduction of a screening test for pre-eclampsia was favoured, with only a small number of women raising concerns related to the screening tests.Conclusionshealth care professionals need to raise awareness of pre-eclampsia in this high risk group. The introduction of a screening test for pre-eclampsia appears to be acceptable in this population, however, further research is required to validate these findings and also to explore the views of women in other high risk groups.     

Tea consumption during pregnancy and the risk of pre-eclampsia

Objective

To examine the effects of tea consumption during pregnancy on the risk of pre-eclampsia.

Methods

A case-control study was carried out among nulliparous pregnant women in Quebec between January 2003 and March 2006. Data were collected using a structured study questionnaire. A total of 92 women with pre-eclampsia and 245 controls were analyzed. Univariate analysis and multivariate regression were performed to examine the association between tea consumption and pre-eclampsia.

Results

Compared with non-tea drinking during pregnancy, the crude odds ratio (OR) and adjusted OR (aOR) of pre-eclampsia for tea drinking were 1.34 (95% CI, 0.80-2.25) and 1.39 (95% CI, 0.81-2.41), respectively. The OR and aOR of severe pre-eclampsia for tea drinking were 1.39 (95% CI, 0.78-2.46) and 2.14 (95% CI, 1.01-4.54), respectively. The aORs for persistent tea consumption in pre-eclampsia and severe pre-eclampsia were 1.88 (95% CI, 1.01-3.51) and 1.95 (95% CI, 1.06-3.57), respectively.

Conclusion

Persistent tea drinking during pregnancy may be associated with an increased risk of pre-eclampsia.     

Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

OBJECTIVE: To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). METHOD: Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. RESULTS: Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR (P<0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. CONCLUSION: Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.     

早发型重度子痫前期孕妇期待治疗中不良妊娠结局的危险因素分析

目的 探讨早发型重度子痫前期孕妇实施期待治疗过程中发生不良妊娠结局的危险因素.方法 选择2007年1月至2008年6月在首都医科大学附属北京妇产医院住院的早发型重度子痫前期并实施期待疗法的孕妇136例.按照妊娠结局分为良好结局组101例和不良结局组35例.采用回顾性分析方法,分析两组孕妇人院时的一般资料、妊娠结局、尿常规、血流动力学及血常规指标、肝肾功能,另分析不良妊娠结局的危险因素.结果 (1)一般资料:良好结局组与不良结局组孕妇入院时出现子痫前期症状的发生率(分别为35.6%及57.1%)比较,差异有统计学意义(P<0.05).两组孕妇年龄、孕次、孕前体质指数、入院时并发症发生率及规律产前检查率比较,差异均无统计学意义(P>0.05).(2)妊娠结局:良好结局组孕妇期待疗法平均天数为(6.5±8.2)d,不良结局组平均为(6.8±10.0)d,两组比较,差异无统计学意义(P>0.05).不良结局组孕妇主要并发症为胎盘早剥13例,心功能衰竭及肺水肿10例,溶血、肝酶升高和低血小板计数(HELLP)综合征5例,胎死宫内5例,无子痫发生.良好结局组孕妇均无以上并发症发生.(3)期待疗法中发病孕周及分娩孕周、血压及尿蛋白比较:良好结局组的发病孕周及分娩孕周[分别为(33.0±4.9)及(34.0±3.6)周]明显晚于不良结局组[分别为(31.3±3.4)及(32.1±3.0)周],收缩压及尿蛋白定量明显低于不良结局组.良好结局组中尿蛋白定性(+++)比例明显低于不良结局组.以上指标两组比较,差异均有统计学意义(P<0.05).(4)血流动力学及血常规:良好结局组孕妇血液黏度[(4.6±0.4)mPa·s]明显低于不良结局组,两组比较,差异有统计学意义(P<0.05).而心输出量、心脏指数、外周阻力及血管顺应性等指标在两组孕妇中比较,差异均无统计学意义(P>O.05).良好结局组孕妇血小板计数[(189±69)×10~9/L]明显高于不良结局组,而红细胞计数[(3.9±0.5)×10~(12)/L]和红细胞压积(0.34±0.05)却明显低于不良结局组.两组比较,差异均有统计学意义(P<0.01).(5)肝肾功能:良好结局组孕妇丙氨酸氨基转移酶[ALT,(18±12)U/L]、天冬氨酸氨基转移酶[AST,(24±9)U/L]、乳酸脱氢酶[LDH,(175±53)U/L]及尿素氮[BUN,(4.6±1.8)mmol/L,]水平明显低于不良结局组.两组比较,差异均有统计学意义(P<0.05).而血浆总蛋白(TP)、血浆白蛋白(Alb)、尿酸(UA)及血肌酐(cr)水平在两组中比较,差异均无统计学意义(P>0.05).(6)不良结局的危险因素分析:进入logistic回归方程的自变量分别为红细胞计数(OR值为3.68,P=0.000),血小板计数(OR值为0.99,P=0.006)及分娩孕周(OR值为0.87,P=0.001).显示红细胞计数越高,则在期待疗法中越有可能出现不良妊娠结局;血小板计数越低、分娩孕周越早,则提示期待疗法中愈易出现不良妊娠结局.结论 红细胞计数升高、血小板计数降低及分娩孕周过早,是早发型重度子痫前期孕妇实施期待疗法过程中发生不良妊娠结局的危险因素.     

2D-ultrasound and endocrinologic evaluation of placentation in early pregnancy and its relationship to fetal birthweight in normal pregnancies and pre-eclampsia

Objectives

To study the relationships between 2D ultrasound measurements of placentation and maternal serum (MS) levels of PAPP-A, inhibin A and fβhCG in early pregnancy and subsequent fetal growth in pregnancies with a normal and abnormal outcome.

Study design

Prospective population-based cohort study of 301 pregnancies with a normal outcome, 18 with a pregnancy complicated by pre-term delivery (PTD) and 14 with subsequent pre-eclampsia (PE).

Main outcome measures

Basal placental surface area, placental thickness, ellipsivity and volume; MS PAPP-A and fβhCG at 11–13 + 6 weeks, MS inhibin A at 15–22 weeks and birthweight centile at delivery.

Results

In the normal group, the basal surface area showed a significantly (P < 0.001) positive correlation with placental thickness and placental ellipsivity. With the exception of placental ellipsivity, all other placental ultrasound parameters were significantly related with birthweight centile. Inhibin A showed a significant (P < 0.005) correlation with birthweight centiles. The basal plate surface area and MS PAPP-A were significantly (P < 0.01 and P < 0.001, respectively) lower and MS inhibin A significantly (P < 0.01) higher in PE than in controls. No changes were found in pregnancies complicated by PTD.

Conclusion

The basal plate surface area at 11–14 weeks reflects indirectly normal and abnormal placentation and development of the definitive placenta. Combined with MS PAPP-A and/or inhibin A levels this parameter could be useful in identifying from the end of the first trimester, pregnancies subsequently complicated with PE.     

早发型重度先兆子痫的临床界定及保守治疗探讨

目的　探讨早发型重度先兆子痫的临床界定及保守治疗的临床意义。方法　回顾分析1988年9月至2004年4月,北京大学第三医院收治的255例无严重并发症及合并症的重度先兆子痫患者的临床资料,按重度先兆子痫发病孕周分为4组:A组<28周, 24例; B组28~31周, 50例;C组32~33周, 34例;D组≥34周, 147例。主要分析指标包括:发病孕周、终止妊娠孕周、孕周延长时间、严重并发症发生情况、胎儿及新生儿死亡率和小于孕龄儿发生率。结果　(1)A组保守治疗时间平均为(9 ±8)d,B组为(11±8)d,C组为(8±6)d,D组为(5±4)d,D组保守治疗时间与前3组比较, 差异有统计学意义(P<0 .01 )。而A、B、C各组间的保守治疗时间比较,差异无统计学意义(P>0. 05)。A、B、C各组孕妇并发症发生率比较,差异也无统计学意义(P>0 .05 ),但与D组比较,差异有统计学意义(P<0 .01);A、B组胎儿及新生儿死亡率、胎死宫内发生率与C、D组比较,差异均有统计学意义(P<0 .01),而C、D两组间比较,差异无统计学意义(P>0 .05)。(2)多因素logistic回归分析显示,重度先兆子痫发病孕周,是影响孕妇并发症发生率的重要因素,而与保守治疗时间无相关性。终止妊娠孕周是影响胎儿及新生儿死亡率的主要因素,其次为发病孕周。(3)以32孕周为界值进行多因素分析显示,终止妊娠孕周     

Haemodynamic assessment in pregnancy and pre-eclampsia: A Guytonian approach

ObjectivesHypertensive disorders of pregnancy continue to be amongst the leading causes of maternal morbidity and mortality. There is debate about the optimal monitoring and treatment for these women, particularly in regard to circulatory and fluid management. A restrictive fluid strategy is advocated, which conflicts with the prevailing view that the circulating volume is contracted in pre-eclampsia. This belief has been erroneously reinforced by use of the central venous pressure (CVP) as a measure of the volume state.MethodsWe used a Guytonian model of the circulation involving the mean systemic filling pressure (Pms) to review published data using a cohort of normal pregnant/post partum women and a pre-eclamptic cohort. The Pms is the pressure left in the circulation when the heart is stopped, arguably the true volume state measure. An analogue of the Pms (Pmsa) can be calculated using commonly measured haemodynamic variables.ResultsOur results show the Pmsa to be elevated in normal pregnancy versus post partum (10.79 vs. 9.58, a 12.6% difference) and elevated further in pre-eclamptic pregnancy (13.86, 29% higher than the normal pregnant group).ConclusionsThere is scope to challenge the long held belief that the volume state is contracted in pre-eclampsia. This approach indicates that the maternal volume state in pre-eclampsia is often elevated. When viewed in combination with recent echocardiographic insights this model helps to explain some of the haemodynamic management paradoxes that these women present. Most importantly, it provides a sound physiological basis for the restrictive fluid strategy that is currently recommended.     

Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia

Objective

To assess whether supplementation with Coenzyme Q10 (CoQ10) during pregnancy reduces the risk of pre-eclampsia.

Methods

Women at increased risk of pre-eclampsia were enrolled in a randomized, double-blind, placebo-controlled trial. Women were assigned to receive 200 mg of CoQ10 or placebo daily from 20 weeks of pregnancy until delivery. The primary outcome was rate of pre-eclampsia. Statistical analyses were by intention-to-treat.

Results

Of the 235 women enrolled in the trial, 118 were randomized to receive CoQ10 and 117 received a placebo. A total of 197 (83.8%) women were followed-up. The overall rate of pre-eclampsia was 20% (n = 47). Thirty women (25.6%) in the placebo group developed pre-eclampsia compared with 17 women (14.4%) in the CoQ10 group, and this reduction was significant (P = 0.035) (relative risk [RR] 0.56; 95% confidence interval [CI], 0.33-0.96).

Conclusion

Supplementation with CoQ10 reduces the risk of developing pre-eclampsia in women at risk for the condition.     

Risk factors for pre-eclampsia in an Asian population

Objective: To identify the risk factors for pre-eclampsia in an Asian population. Method: We conducted a retrospective cohort study involving 29 375 Taiwanese women who delivered between July 1990 and September 1998, excluding pregnancies complicated by chronic hypertension or fetal malformations. Result: Four hundred and fifteen women had pre-eclampsia (1.4%). Women who had a history of pre-eclampsia (OR 6.3, 95% CI 4.4, 9.2), multiple gestation (OR 3.6, 95% CI 2.4, 5.5), a prepregnancy BMI>24.2 kg/m² (OR 2.4, 95% CI 1.8, 3.1), were>34 years of age (OR 1.8, 95% CI 1.4, 2.4), nulliparous (OR 1.3, 95% CI 1.2, 1.5), had urinary tract infection (OR 4.8, 95% CI 1.5, 15.8), or worked during pregnancy (OR 1.9, 95% CI 1.4, 2.4) were at increased risk of pre-eclampsia. Conclusion: Some of the risk factors for pre-eclampsia among Asian women are the same as those of other ethnic groups, whereas some of the risk factors are different.     

子痫前期患者胎盘组织中松弛素受体的表达

目的 探讨子痫前期患者胎盘组织中松弛素受体LGR7表达与子痫前期发病的关系.方法 应用链霉菌抗生物素蛋白-过氧化物酶连接法和RT-PCR技术检测20例正常孕妇(正常组)及26例重度子痫前期孕妇(子痫前期组)胎盘组织中松弛素受体LGR7蛋白及mRNA的表达.结果 (1)两组孕妇的胎盘组织中均有松弛素受体LGR7表达,主要定位于胎盘绒毛滋养细胞的细胞膜上,在细胞滋养细胞、合体滋养细胞中都有较高的表达水平.(2)正常组胎盘组织中松弛素受体LGR7蛋白的表达水平为0.912±0.003,子痫前期组为0.625±0.037,两组比较,差异有统计学意义(P＜0.01).(3)正常组胎盘组织中松弛素受体LGR7 mRNA表达水平为0.776±0.021,子痫前期组为0.393±0.075,两组比较,差异有统计学意义(P＜0.01).结论 子痫前期患者胎盘组织中松弛素受体表达水平下降,可能与子痫前期的发病有关.     

Soluble adhesion molecule profile in normal pregnancy and pre-eclampsia

Objective: An exaggerated inflammatory response has been implicated as the cause of endothelial cell dysfunction and the maternal syndrome of pre-eclampsia. Adhesion molecules play a central role in the adherence of leukocytes to endothelial cells and the subsequent migration of white blood cells into perivascular tissue. Cellular forms of adhesion molecules mediate specific steps of leukocyte-endothelial cell interaction, and have been implicated in the pathophysiology of pre-eclampsia. Soluble forms of these molecules can be detected in plasma, and their concentrations are thought to reflect the degree of activation of a particular cell type. Elevations in soluble P-selectin (sP-selectin) reflect platelet activation; changes in soluble L-selectin (sL-selectin) suggest leukocyte activation; and an increase in soluble forms of E-selectin (sE-selectin), vascular cell adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule 1 (sICAM-1) and platelet endothelial cell adhesion molecule (sPECAM-1) indicate endothelial cell activation/dysfunction. The objective of this study was to determine whether normal pregnancy and pre-eclampsia were associated with changes in the concentrations of soluble selectins and members of the immunoglobulin superfamily of adhesion molecules. Study design: A cross-sectional study was conducted to determine the plasma concentrations of sL-selectin, sE-selectin, sP-selectin, sVCAM-1, sICAM-1 and sPECAM-1 in peripheral blood obtained from non-pregnant women (n = 20), normal pregnant women (n = 100) and patients with pre-eclampsia (n = 55). Concentrations of soluble adhesion molecules were determined with enzyme-linked immunoassays. Parametric statistics were used for data analysis. Results: Normal pregnancy was associated with a significant increase in the maternal plasma concentration of sP-selectin, a decrease in sL-selectin, and no change in sE-selectin, sVCAM-1, sICAM-1 and sPECAM-1. In contrast, pre-eclampsia was associated with a significant increase in sP-selectin, sE-selectin and sVCAM-1, a decrease in sL-selectin, but no change in sICAM-1 and sPECAM-1 concentrations. Conclusions: The increased concentration of sP-selectin and decreased sL-selectin, as well as the lack of change in endothelial cell-associated soluble adhesion molecules suggest that pregnancy is associated with platelet and leukocyte activation, but not endothelial cell activation. In contrast, pre-eclampsia appears to be characterized by activation of platelets, leukocytes and endothelial cells.     

Trophoblast calcyclin is elevated in placental tissue from patients with early pre-eclampsia

The aetiology of pre-eclampsia is thought to originate from aberrant spiral artery remodelling and invasion evoking cellular oxidative stress. Previously, we discovered differentially expressed proteins in trophoblast cells of pre-eclamptic pregnancies. One of these proteins is calcyclin (S100A6); a Ca²⁺-binding protein associated with cellular stress response.By immunohistochemistry on formalin-fixed paraffin-embedded placental tissue, calcyclin expression was compared between women with early pre-eclampsia (n = 72) and non-hypertensive control patients (n = 66) (χ², p = 0.006) blindly by two observers.Significantly more intense staining was seen in trophoblast cells of pre-eclamptic pregnancies compared to control placentas suggesting that trophoblast calcyclin is elevated in early pregnancy.