Comparación de biomarcadores de primer trimestre en gestantes normotensas según su grado de obesidad en el tercer trimestre

IntroductionThis study aims to improve the efficiency of aneuploidy screening in the first trimester of pregnancy by creating predictive models that serve to identify pregnant women at risk of becoming overweight or obese in the third trimester and to using them to implement preventive measures of obesity.MethodsAn ambispective, observational, primary care study was conducted in which a total of 380 records corresponding to as many pregnancies were collected. Samples were collected from patients of 6 health centres, in order to determine the following variables: age at gestation, pregnancy-associated plasma protein A (PAPP-A) (mU/ml), human chorionic gonadotropin (b-HCG) (ng/ml), sample collection week for first trimester screening, body mass index at 12 and 28 weeks gestation (BMI), TSH at 12 weeks gestation, and systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MBP, respectively) at 12 and 28 weeks gestation. The BMI variable was recoded at 28 weeks, classifying pregnant women as normal weight (BMI < 25), overweight (BMI 25-29.99), or obese (BMI ≥ 30). The recoded BMI at 28 weeks was the variable resulting from the ordinal logistic regression model. An ANOVA study of several factors was used to discern differences between arterial pressures. A 5% alpha error was accepted.ResultsThe PAPP-A and b-HCG medians measured in the first trimester are progressively lower in the groups of pregnant women with normal weight, overweight, and obesity observed in the third trimester. These values are predictors of the weight in the third trimester (ordinal logistic regression) (PAPP-A: P = .022; b-HCG: P = .002). No pregnant woman developed pre-eclampsia. The SBP, DBP, and MBP in the third trimester were significantly different (ANOVA in several factors; P < .05).DiscussionThe ordinal logistic regression demonstrates that the decrease in the observed values of PAPP-A and b-HCG in the first trimester is a predictor of the level of significant and gradual obesity in a sample of normotensive pregnant women. An ordinal regression model including the 12-week BMI was not made due to the internal collinearity that it would provide if the result variable was based on it. The predictive effect of b-HCG is more homogeneous than that of PAPP-A for the level of overweight and obesity.     

First trimester screening of serum soluble fms-like tyrosine kinase-1 and placental growth factor predicting hypertensive disorders of pregnancy

ObjectiveTo assess the accuracy of first trimester soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in predicting pregnancy hypertension and pre-eclampsia; and compare with the accuracy of routinely collected maternal and clinical risk factors.Study designIn this population-based cohort study, serum sFlt-1 and PlGF levels were measured in first trimester in 2,681 women with singleton pregnancies in New South Wales, Australia.Main outcome measuresPrediction of pregnancy hypertension and pre-eclampsia.ResultsThere were 213 (7.9%) women with pregnancy hypertension, including 68 (2.5%) with pre-eclampsia. The area under the curve (AUC) for both sFlt-1 and PlGF was not different from chance, but combined was 0.55 (P = 0.005). Parity and previous diagnosed hypertension had better predictive accuracy than serum biomarkers (AUC = 0.64, P < 0.001) and the predictive accuracy for all maternal and clinical information was fair (AUC = 0.70, P < 0.001 for pregnancy hypertension and AUC = 0.74, P < 0.001 for pre-eclampsia). Adding sFlt-1 and PlGF to maternal risk factors did not improve the ability of the models to predict pregnancy hypertension or pre-eclampsia.ConclusionsMaternal first trimester serum concentrations of sFlt-1 and PlGF do not predict hypertensive disorders in pregnancy any better than routinely collected clinical and maternal risk factor information. Screening for sFlt-1 and PlGF levels in early pregnancy would not identify those pregnancies at-risk.     

A cross-sectional study of female sexual function and dysfunction during pregnancy

IntroductionAlthough women may undergo changes in sexual function during pregnancy, there are limited studies correlating possible sexual function changes to androgen blood levels during the pregnancy.AimTo search for a possible correlation, we performed a cross-sectional observational study to assess sexual function scores and androgen blood levels of women during pregnancy.Materials and MethodsA total of 589 healthy pregnant women were recruited to the present cross-sectional study. Of these patients, 116 (19.6%), 220 (37.3%), and 253 (42.9%) were in their first, second, and third trimesters, respectively. They were evaluated with a detailed medical and sexual history, including IFSF questionnaire. In addition, maternal serum androgen levels (testosterone, dehydroepiandrosterone sulphate, free testosterone) were determined in each trimester during regular follow-ups.Main Outcome MeasuresAssessment of Index of Female Sexual Function (IFSF) domains and serum androgen levels in each trimester.ResultsThe mean age of the three groups were similar (P > 0.05). Overall, total IFSF scores of women in the first and second trimesters were 21.4 ± 10.1 and 22.3 ± 10, respectively, while it was 15.9 ± 12.3 during the third trimester (P < 0.05). The most common sexual dysfunction symptom was diminished clitoral sensation, observed in 94.2% of the patients, followed by lack of libido in 92.6% and orgasmic disorder in 81%. No correlation was detected between total IFSF score and serum androgen levels.ConclusionsIn this cross-sectional study, we noted lower sexual function scores in women in the third trimester of their pregnancies compared with those in their first two trimesters of pregnancy. These lower sexual function scores in the third trimester were not associated with lower androgen levels. We plan to perform a future prospective study to better assess both the change in sexual function and also its possible relation to androgen levels in pregnant women. Erol B, Sanli O, Korkmaz D, Seyhan A, Akman T, and Kadioglu A. A cross-sectional study of female sexual function and dysfunction during pregnancy.     

The l-arginine/nitric oxide pathway is impaired in overweight/obese pregnant women

ObjectiveTo evaluate the l-arginine/NO system and its role in insulin signaling and endothelial function during the pregnancy of women of different BMI categories.Study designTwelve women with BMI ⩾ 25 were compared with 10 normal-weight women in a fasting condition after the infusion of l-arginine (20 g in 3 h) and after the evaluation of the flow-mediated vasodilation (FMD) of the brachial artery between the 9th–12th and 24th–27th weeks. Blood samples for insulin and nitrite/nitrate (NOx) were collected at baseline and after 1, 2 and 3 h after initiating the infusion.ResultsIn both trimesters, the baseline NOx levels were similar among groups. In the 1st trimester of the lean women, there was a NOx increase in response to l-Arg (AUC: 1328; 3, 3173), which had increased by the 2nd trimester (AUC: 3884; 1905, 7686); in overweight/obese women, no responses to l-Arg were found in the 1st or 2nd trimesters. In the 1st trimester, the insulin levels were significantly reduced in both groups after l-Arg infusion. Although the insulin levels in all BMI categories were higher in the 2nd trimester, such levels during weeks 24–27 were suppressed only in normal-weight women after l-Arg infusion. The FMD was higher during both trimesters in the lean controls and was impaired in the overweight/obese subjects.ConclusionsNO availability is impaired in overweight/obese women during pregnancy, which affects endothelial functioning and interferes with insulin regulation. These mechanisms could be involved in the development of hypertensive disorders and glucose intolerance in this population.     

Association of NT-proBNP with plasma renin activity and plasma aldosterone concentration in women with singleton pregnancy

ObjectiveTo determine the association of the N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP) levels with plasma renin activity (PRA) and plasma aldosterone concentration (PAC) in singleton pregnancies.DesignSerum NT-proBNP levels, PRA and PAC were determined in 215 blood specimens from 139 women with singleton pregnancies, including 34 and 105 women who did and did not develop hypertensive disorders in pregnancy, respectively. Twenty-five blood specimens were obtained from 25 women who later developed hypertension (systolic BP ⩾ 140 mmHg and/or diastolic BP ⩾ 90 mmHg), but were normotensive at the time of blood sampling.ResultsThe serum NT-proBNP levels [pg/ml, median (range), 32 (5–142)] did not change in normotensive women, but increased significantly to 97 (23–436) after the development of hypertension (D/H). The PRA [ng/ml/h, median (range), 7.1 (1–20)] did not change in normotensive women, but decreased significantly to 1.9 (1–16) after D/H. PAC (pg/ml) increased significantly from 397 (94–1750) to 667 (123–2010) between the 2nd and 3rd trimesters in normotensive women. However, as PAC of hypertensive women did not change significantly before and after D/H, PAC [293 (116–1720)] after D/H was significantly lower than that [667 (123–2010)] of the 3rd trimester in the normotensive women. The serum levels of NT-proBNP were significantly and negatively correlated with both PRA and PAC.ConclusionsThe renin-angiotensin-aldosterone system is suppressed in pregnant women with cardiac conditions associated with higher NT-proBNP levels.     

Maternal serum CA-125 level is elevated in severe preeclampsia

AimThe aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity.MethodsWe evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n = 34) and those with mild pre-eclampsia (n = 24). Females with healthy pregnancies (n = 31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index.ResultsThe CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p < 0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r = 0.489, p = 0.000), systolic blood pressure (r = 0.503, p = 0.018), and diastolic blood pressure (r = 0.532, p = 0.000). In contrast, CA-125 was negatively correlated with birth weight (r = 0.266, p = 0.012) and gestational age at birth (r = 0.250, p = 0.018).ConclusionsCA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.     

Higher plasma AOPP is associated with increased proteinuria excretion and decreased glomerular filtration rate in pre-eclamptic women

BackgroundAdvanced oxidation protein products (AOPP) as a novel biomarker of oxidative stress has been demonstrated in chronic kidney disease (CKD) patients. The research was to investigate the plasma AOPP level in pre-eclamptic pregnant women and its correlation with 24-h proteinuria collection, cystatin C(CC), uric acid(UA) and creatinine(Cr).MethodsFifty pre-eclamptic women, including 22 mild and 28 severe preeclampsia were enrolled. Twentyfive healthy singleton pregnant women were selected as control. Blood samples were obtained from all groups to measure the levels of AOPP, CC, UA, Cr and other biochemical parameters at admission. Total protein in the 24 h urine collection was measured. Pearson correlation was performed to evaluate the associations between plasma AOPP level and 24-h proteinuria collection, plasma cystatin C, uric acid and creatinine.ResultsThe means of AOPP levels were significantly different among severe, mild pre-eclampsia and normotensive pregnant women (88.6 ± 10.0 μmmol/L, 72.1 ± 11.1 μmmol/L and 48.7 ± 11.3 μmmol/L). The means of cystatin C levels were significantly different among severe, mild pre-eclampsia and normotensive pregnant women (1.8 ± 0.6 μmmol/L, 1.2 ± 0.3 μmmol/L and 1.0 ± 0.2 μmmol/L). Mild, severe pre-eclampsia and control groups did not differ significantly from each other with respect to uric acid and creatinine. Significant positive correlation between AOPP and 24-h proteinuria excretion in preeclamptic pregnant women was found in mild and severe preeclamptic pregnant women (r = 0.792). Significant positive correlation between AOPP and cystatin C was found in normal and preeclamptic pregnant women (r = 0.521).ConclusionPlasma AOPP level had a significant positive correlation with 24-h proteinuria excretion and cystatin C. Further research about the relevance between the level of AOPP and the onset of preeclampsia was needed in order to have a profound prospective in oxidative stress and preeclampsia.     

Valores de referencia de hormonas tiroideas en la población de gestantes en Lugo

Background and objectiveThe complex physiology of thyroid function during pregnancy requires a hormonal evaluation according to reference values for each trimester, each area, and with the techniques of each laboratory. The objectives of this study were to analyse thyroid function in the three trimesters of pregnancy and to establish the reference values of hormones in pregnant women in this health area (Lugo).MethodsA total of 831 pregnant women were included in the study (median age: 33 years, age range: 16-47 years). Once the exclusion criteria were applied, the sample consisted of 641 pregnant women, a size that can be considered representative of the reference population.ResultsThe reference intervals were as follows: TSH first trimester, 0.10-3.74 mIU/L; second trimester, 0.45-3.77 mIU/L; and third trimester, 0.36-4.15 mIU/L. For Free T4 in the first trimester, 0.87-1.34 ng/dL; second trimester, 0.78-1.20 ng/dL; and third trimester, 0.78-1.23 ng/dL. For Free T3 in the first trimester, 2.52-3.78 pg/mL; second trimester, 2.22-3.21 pg/mL; and third trimester, 2.17-3.14 pg/mL. The presence of thyroid autoimmunity was confirmed in 109 women (13.1%), who presented with higher TSH values than pregnant women without thyroid autoimmunity.ConclusionThe reference intervals for TSH, Free T4, and Free T3 obtained in this study are below those used in the non-pregnant adult population in this laboratory. This should help to identify more accurately a possible thyroid dysfunction in pregnant women in the study area, avoiding an underdiagnosis of subclinical hypothyroidism and reducing the possible associated perinatal complications.     

Evaluation of coagulation abnormalities among women with vaginal bleeding in the first trimester of pregnancy

ObjectiveTo compare blood coagulation parameters between pregnant women with vaginal bleeding in the first trimester of pregnancy and pregnant women with normal pregnancy in the first trimester.MethodsA prospective controlled study of 98 women in the first trimester of vital pregnancy was conducted at the University Medical Centre Maribor, Slovenia. The study group comprised women with vaginal bleeding (n = 50) while the control group women with normal pregnancy, admitted for artificial abortion (n = 48). Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen concentration, number of platelets, hemogram, coagulation factor VIII (FVIII) and von Willebrand factor (VWF) activity were compared between the 2 groups.ResultsNo significant between-group differences were detected in mean PT, fibrinogen concentration, FVIII, and VWF activity. Mean aPTT was significantly higher in the control group than the study group (32.47 versus 30.46 seconds; P < 0.05). The mean number of platelets was significantly lower in the study group than the control group (181.69 versus 203.52 × 10⁹/L; P < 0.05). All measured coagulation parameters, except VWF activity, were within normal ranges.ConclusionCoagulation abnormalities are rarely the cause of vaginal bleeding in the first trimester of pregnancy among women with no previous symptoms of bleeding disorders.     

Pre-eclampsia and gestational hypertension are less common in HIV infected women

ObjectiveTo determine whether pre-eclampsia and gestational hypertension are less common in HIV infected women.MethodsThis prospective cohort study was performed in the Western Cape province of South Africa. HIV negative and positive pregnant women without chronic renal or chronic hypertensive disease were continuously recruited. During the study period HIV positive patients received either mono- or triple (HAART) antiretroviral therapy for prevention of vertical transmission or maternal care. Only routine clinical management was performed. The development of hypertensive disease during pregnancy was recorded.Results1093 HIV positive and 1173 HIV negative cases were identified during pregnancy and evaluated again after delivery. Significantly fewer cases of pre-eclampsia n = 35 (3.2%) were recorded in the HIV positive group than in the HIV negative group, n = 57 (4.9%) (p = 0.045; OR 0.65 95% CI 0.42–0.99). There were also significantly fewer cases of gestational hypertension recorded in the HIV positive group compared to the HIV negative group (p = 0.026; OR 0.53 95% CI 0.30–0.94). Multiple logistic regression analysis confirmed the reductive effect of HIV on pre-eclampsia and gestational hypertension.ConclusionPre-eclampsia and gestational hypertension are less common in HIV infected women being managed with mono- or triple anti-retroviral therapy.     

A case–control study of placental lesions associated with pre-eclampsia

ObjectiveTo investigate gross and microscopic placental lesions associated with pre-eclampsia and to determine which lesions are most strongly linked to serious pregnancy complications.MethodsA retrospective case–control study of 173 placentas from women with pre-eclampsia and 173 placentas from healthy normotensive women was conducted.ResultsThe mean placental weight in the pre-eclampsia group was lower than that recorded for the control group (280 g vs 360 g; P < 0.001). Infarcts (65.9% vs 13.2%; P < 0.001) and placental abruption (P < 0.001) were most frequent among women with pre-eclampsia. Microscopic findings showed the following lesions to be associated with pre-eclampsia: hypermature villi, defined by absence of intermediate villi (72% vs 16%; P < 0.001), excessive syncytial knots (90% vs 9%; P < 0.001), decidual vasculopathy (51% vs 8%; P < 0.001), villous fibrosis (6% vs 0%; P < 0.001), erythroblastosis (11% vs 4%; P < 0.01), and avascular terminal villi (9% vs 3%; P < 0.05). Increased syncytial knots, infarcts, basal decidual vasculopathy, hypermature villi, and placental erythroblastosis were still associated with pre-eclampsia after logistic regression modeling.ConclusionPlacental lesions most strongly associated with pre-eclampsia were all causes or expressions of placental hypoxia or ischemia, which appears as the primary mechanism of pre-eclampsia.     

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.     

Risk of first trimester spontaneous miscarriage among singleton gestations following ICSI and its relation to underlying cause of infertility

Study objectiveTo assess the association between the first trimester miscarriage rates among women undergoing intracytoplasmic sperm injection (ICSI) and underlying etiology of infertility.DesignProspective cohort study.SettingAin Shams University maternity hospital.Materials and methodsThe study included women who became pregnant with singleton pregnancy following ICSI as a treatment for different causes of infertility. Women were followed up throughout the first trimester of pregnancy up to 12 weeks’ gestation (10 weeks after the day of embryo transfer).Main outcome measureFirst trimester miscarriage rate.ResultsTwo hundred and thirty four pregnant young women were included in the study, 164 (70.9%) women miscarried. The causes of infertility among these women were as follows: 41 (25%) mild male factor infertility, 40 (24.4%) severe male factor infertility, 45 (27.44%) tubal factor, 7 (4.27%) polycystic ovarian syndrome, 3 (1.83%) endometriosis, 20 (12.19%) unexplained and 8 (4.87%) multifactorial. Stepwise logistic multi-regression analysis showed that both maternal age (>31 years) and tubal block were the most sensitive discriminators for the prediction of first trimester spontaneous miscarriage among the study population (P < 0.01).Major conclusionsFirst trimester spontaneous miscarriage rates among pregnant women with singleton pregnancy following ICSI were related to maternal age >31 years and/or the presence of tubal block.     

Placental Release of Distinct DNA-associated Micro-particles into Maternal Circulation: Reflective of Gestation Time and Preeclampsia

BackgroundThe aim of this study was to determine whether DNA-associated micro-particles (MPs) in maternal plasma express fetal-derived human leukocyte antigen-G (HLA-G) or placental alkaline phosphatase (PLAP) and whether the levels differ between women with normotensive pregnancies and preeclampsia.MethodsDNA-associated MPs expressing HLA-G or PLAP were examined in the plasma of normal pregnant women and preeclamptic patients using flow cytometric analysis.ResultsDNA-associated HLA-G⁺ MPs were significantly increased in maternal plasma compared to plasma from non-pregnant controls (p < 0.005), with highest levels found in the first and second trimesters. DNA-associated PLAP⁺ MPs were also increased in maternal plasma compared to plasma from non-pregnant controls (p < 0.006), with highest levels in the second and third trimesters. Term preeclamptic women had higher levels of DNA-associated MPs than control pregnant women. HLA-G⁺ MPs from the plasma of preeclamptic women had more DNA per MP than HLA-G⁺ MPs from the plasma of normal pregnant women (p < 0.03).ConclusionsHLA-G⁺ and PLAP⁺ MPs increase in maternal circulation at different times during gestation. DNA amounts per HLA-G⁺ MP increase in preeclamptic women which might indicate dysfunctional extravillous cytotrophoblasts.     

Left ventricular remodeling and diastolic function in chronic hypertensive pregnant women

Hypertension during pregnancy is a problem that impacts maternal morbidity and mortality. Dyspnea and edema are common symptoms, often secondary to physiological changes, but may raise doubts as to ventricular dysfunction.ObjectiveTo evaluate the ventricular geometry pattern and diastolic function in chronic hypertensive pregnant women (HPW).MethodsProspective, cross-sectional study on 62 pregnant women over a 29-month period, from March 2009 to July 2011, in Brazil was done. Thirty-one HPWs and 31 normotensive pregnant women (NPW) underwent clinical and cardiovascular evaluations, and were subjected to transthoracic echocardiogram.ResultsLV mass (HPW: 220.9 ± 43.3 vs. NPW: 192.9 ± 39.8 g, p = 0.01), posterior wall thickness (HPW: 9.9 ± 1.1 vs. NPW: 9.2 ± 0.9 mm, p = 0.005), mitral flow A wave velocity (HPW: 0.60 ± 0.16 vs. NPW: 0.52 ± 0.10 m/s, p = 0.02), tissue Doppler A′ wave velocity (HPW: 10 ± 2 vs. NPW: 8.9 ± 1 cm/s, p = 0.02), and E/E′ ratio (HPW: 6.8 ± 2.2 vs. NPW: 5.5 ± 1.6, p = 0.01) were higher in HPWs. Septal and lateral walls E′ wave velocities (HPW: 13 ± 2 vs. NPW: 15 ± 3 cm/s, p = 0.001), and E′/A′ ratio (HPW: 1.26 ± 0.38 vs. NPW: 1.77 ± 0.49, p = 0.00003) were lower in HPWs. There was a positive linear correlation between body mass index (BMI) and ventricular mass, A wave, systolic, diastolic blood pressures, and a negative correlation between BMI, E′ wave and E′/A′ ratio.ConclusionVentricular remodeling showed a direct relationship with body weight, and both groups showed a predominant pattern of eccentric ventricular hypertrophy. The LV diastolic function was abnormal in HPWs.     

Body mass index and hypertensive disorders of pregnancy

ObjectivesWe compared the incidence of the hypertensive disorders of pregnancy in obese women with women of a normal body mass index (BMI).Study designProspective observational study in which BMI was calculated accurately early in pregnancy. Women were enrolled after a sonographic confirmation of an ongoing pregnancy. To reduce confounding variables the study was confined to white European women with a singleton pregnancy.Main outcome measuresIncidence of pre-eclampsia and gestational hypertension.ResultsIn 2230 women, 16.8% were obese. Pre-eclampsia was diagnosed in 3.3% (n = 74) and gestational hypertension in 3.0% (n = 67). Both pre-eclampsia (p = 0.01) and gestational hypertension (p < 0.01) were common in obese women compared with normal weight women. Overall 13.1% of obese women developed a hypertensive disorder during pregnancy. When analysed by parity pre-eclampsia occurred in 2.1% of primigravidas and 0.3% of multigravidas. Pre-eclampsia was increased in obese multigravidas (p = 0.001), but not obese primigravidas, suggesting that parity is more influential than obesity in the development of pre-eclampsia.ConclusionsObese multigravidas are more likely to develop hypertensive disorders in pregnancy and obese primigravidas are more likely to develop gestational hypertension. This is important in clinical practice because maternal weight, unlike parity, is potentially modifiable before or during pregnancy.     

The Role of Serum Testosterone in Early Pregnancy Outcome: A Comparison in Women With and Without Polycystic Ovary Syndrome

ObjectiveHyperandrogenic conditions in women are associated with increased rates of miscarriage. However, the specific role of maternal testosterone in early pregnancy and its association with pregnancy outcome is unknown. The purpose of this study was to compare serum testosterone levels during early pregnancy in women with and without polycystic ovary syndrome (PCOS) who either had successful pregnancies or miscarried.MethodWe collected serum samples from women attending a university-based fertility centre at the time of their first positive serum beta human chorionic gonadotropin pregnancy test. The samples were subsequently assayed for total testosterone level. We used logistical regression modelling to control for PCOS diagnosis, BMI, and age.ResultsTotal testosterone levels were available for 346 pregnancies, including 286 successful pregnancies and 78 first trimester miscarriages. We found no difference in total testosterone levels between women who subsequently had an ongoing pregnancy (mean concentration 3.6 ± 2.6 nmol/L) and women with a miscarriage (mean 3.6 ± 2.4 nmol/L). Using the Rotterdam criteria to identify women with PCOS, we also found no differences in serum testosterone between women who had ongoing pregnancies or miscarriages, either with PCOS (P = 0.176) or without PCOS (P = 0.561).ConclusionsOur findings show that early pregnancy testosterone levels do not predict pregnancy outcome, and they call into question the role of testosterone in causing miscarriage in populations of women with PCOS. Further research is needed to elucidate the normal progression of testosterone levels during pregnancy and to investigate further the relationship between PCOS and miscarriage.     

OS088. First trimester triple vascular test for pre-eclampsia prediction

IntroductionAlthough PE represents a major cause of maternal and fetal morbidity and mortality, the vascular mechanisms underlying this disorder have not been clearly identified. During the past three decades, while numerous clinical, biophysical, and biochemical screening tests have been proposed for the early detection of preeclampsia, maternal circulation changes during early pregnancy have yet to be fully evaluated for their contribution to PE prediction.ObjectivesThe aim of this study was to examine a combination of maternal risk factors, mean arterial blood pressure, uterine artery Doppler, brachial artery flow-mediated dilatation (FMD), and ophthalmic artery Doppler for pre-eclampsia prediction during the first trimester of pregnancy.MethodsProspective study with singleton pregnancies examined at 11–14 weeks of gestation, presenting consecutively for antenatal care in a tertiary Brazilian hospital. The base-cohort population constituted of 487 singleton pregnancies, including 9 case subjects who developed pre-eclampsia (PE) requiring delivery before 34 weeks (early PE) and 22 with late PE, 47 with gestational hypertension, and 409 cases subjects (84%) who were unaffected by PE or gestational hypertension. Maternal history (nulliparity, previous and family history of PE), body mass index (BMI), mean arterial pressure (MAP), uterine artery pulsatility index, brachial artery FMD and ophthalmic artery Doppler were recorded in all of the cases. Univariate and logistic regression analysis was used to derive algorithms for the prediction of hypertensive disorders.ResultsUterine artery percentile of mean PI was higher in the PE than in the control group (p < 0.01). The mean brachial artery FMD was 7.4% ± 8.2% in the control group and 7.3% ± 8.2% in the PE group. Logistic regression analysis determined that FDM was not a predictor of PE (OR = 0.99, CI 95% 0.94–1.04; p = 0.90) and this test was withdrawn from the predictive model. The average of the first diastolic peak velocity in the ophthalmic artery was higher in the PE group compared with controls (24.56 cm/s × 21.13 cm/s; p < 0.01).It was estimated that, with the prediction algorithm for PE, a combination of maternal factors + MAP + uterine artery Doppler or ophthalmic artery Doppler can detect 78% of early-onset PE with 10% false-positive rate.ConclusionMaternal ophthalmic artery Doppler in the first trimester of pregnancy is a novel predictive parameter for PE (especially early-onset PE), it has the same detection rate contribution in a multi-parameter predictive model as would be the case uterine artery Doppler was used instead.     

Vitamin D Insufficiency Is Prevalent among Pregnant African American Adolescents

Study ObjectiveRecent attention has focused on vitamin D insufficiency but few data exist on vitamin D status among pregnant minority youth.DesignA screening study was undertaken in adolescents having prenatal blood samples drawn for other routine tests obtained during the second trimester (18 ± 1.8 week gestation, n = 44) or third trimester of pregnancy (28.4 ± 2.1 week gestation, n = 36). Serum 25- hydroxyvitamin D (25(OH)D) was measured and significant determinants of vitamin D insufficiency in this cohort were identified.SettingUrban prenatal clinic.ParticipantsEighty pregnant African American adolescents (≤ 18 y of age).Main Outcome Measure(s)Vitamin D status, STDs, hemoglobin, season, birth weightResultsSerum 25(OH)D in this group averaged 21.6 ± 8 ng/mL (age 16.5 ± 1.1 y, n = 80), and did not significantly differ between the second (20.95 ± 8.2 ng/mL, n = 44) and third trimester cohorts (22.5 ± 7.9 ng/mL, n = 36). Vitamin D insufficiency (< 20 ng/mL) was evident in 46.25% and vitamin D deficiency (<15 ng/mL) was evident in 21.25% of those studied. Significant predictors of suboptimal vitamin D status included sampling during the winter months (P = 0.004), lower hemoglobin concentration (P = 0.019), and higher second trimester leptin levels (P = 0.018). Inverse associations between 25(OH)D and bacterial vaginosis were evident when controlled for season of sampling (P = 0.02, n = 80).ConclusionsVitamin D insufficiency was prevalent among urban pregnant minority adolescents. Further studies are needed to address the impact of this finding on maternal and neonatal calcium homeostasis and bone health.     

Clinical accuracy of inflationary oscillometry in pregnancy and pre-eclampsia: Omron-MIT Elite

ObjectiveTo evaluate the accuracy of the Omron MIT Elite in pregnancy and pre-eclampsia according to the British Hypertension Society protocol (BHS).DesignProspective observational study.SettingAntenatal clinics and wards at St. Thomas’ Hospital (London, UK).PopulationForty-five pregnant women including 15 with pre-eclampsia.MethodsNine sequential same arm blood pressure (BP) measurements were taken from each woman by trained observers, alternating between mercury sphygmomanometry and the test device.Main outcome measuresGrading criteria of the BHS protocol (A/B grade = pass; C/D = fail).ResultsThe Omron MIT Elite achieved a grade A/A in both pregnancy and pre-eclampsia. The mean difference (SD) between the mercury standard and the device in pregnancy was ?1.1 (5.2) mm Hg and 1.5 (4.8) mm Hg for systolic and diastolic BP respectively compared to 0.2 (5.3) mm Hg and 2.2 (5.5) mm Hg in pre-eclampsia.ConclusionThe Omron MIT Elite can be recommended for use in pregnancy and pre-eclampsia according to the BHS protocol. To date, this is the most accurate automated BP device validated in pre-eclampsia.