Urinary PGE2 levels in toxemia of pregnancy

Urinary PGE2 levels in urine collected over 24 hours were measured by radioimmunoassay after chloroform extraction. In normal pregnancy, urinary PGE2 levels did not change during pregnancy. After 36 gestational weeks, urinary PGE2 levels in severe hypertensive pregnancy (616 +/- 91 ng/day (mean +/- S.E., n = 18)) were significantly decreased compared to those of normal pregnancy (1,039 +/- 85 ng/day, n = 13, p less than 0.005) and mild hypertensive pregnancy (1,025 +/- 140 ng/day, n = 8, p less than 0.03). We then analyzed the urinary PGE2 levels by noting clinical symptoms and their severity. Urinary PGE2 levels in the severe blood pressure group were significantly decreased compared to those of the mild group. There was a significant negative correlation between urinary PGE2 and mean blood pressure, systolic pressure and diastolic pressure. Diastolic pressure in particular had the most significant negative correlation with the urinary PGE2 level (n = 33, r = -0.593, p less than 0.001). Urinary PGE2 levels in the severe proteinuria and edema groups were significantly decreased compared to those in the mild group. These results suggested that renal synthesis of PGE2 may be decreased in severe hypertensive pregnancy and closely related to blood pressure, especially to diastolic pressure, and also related to the occurrence of edema.     

Epidermal growth factor in urine of pregnant women and in amniotic fluid throughout pregnancy

To investigate the role of epidermal growth factor (EGF) in feto-placental development, we measured the urinary and amniotic fluid EGF levels throughout pregnancy. Thirty urinary samples of non-pregnant women, 85 of normal pregnant women, 21 of women with toxemic pregnancy, 17 of postpartum women and 30 of newborns, and 55 amniotic fluid samples of pregnant women with a variety of conditions necessitating amniotomy and amniocentesis at 25-39 weeks of gestation were collected. EGF concentrations were measured by double-antibody radioimmunoassay. Urinary EGF levels of pregnant women reached their peak (24.6 +/- 6.7 ng/mg creatinine) at 19-22 gestational weeks; after that, they slightly decreased. Although there is no significant difference between the urinary EGF levels of non-pregnant women (19.0 +/- 5.1) and those of pregnant women (18.1 +/- 3.2), the EGF levels of toxemic women (12.2 +/- 1.5) were lower than those of normal pregnant women. The levels in puerperium women were similar to those found during pregnancy. However, the neonates had higher urinary EGF concentrations than those in pregnant women. On the other hand, EGF levels in amniotic fluid were higher according to gestational weeks and the levels of intrauterine growth retardation (IUGR) cases lower compared with normal pregnancy. Furthermore, EGF concentrations in amniotic fluid have a significant correlation with the creatinine levels in amniotic fluid. These data suggest that EGF plays an important role in fetoplacental development and it is possible that the measurement of amniotic fluid EGF might become available for the clinical assessment of fetal maturation.     

Angiotensin II levels in hypertensive and normotensive pregnancies

We measured circulating angiotension II by radioimmunoassay in women with pregnancy-induced hypertension (n = 54), and compared these values with those obtained in women with normal pregnancy (n = 18) and in non pregnant women (n = 20). Pregnant women had statistically significantly higher plasma angiotensin II [mean (SD): 41.3 (12.6) pg/ml] than non-pregnant women [29.2 (11.3) pg/ml; P less than 0.004]. Angiotensin II concentrations in women with pregnancy-induced hypertension [mean (SD): 31.7 (16.2) pg/ml] were, on average, 25% lower than in normal pregnancy (P less than 0.003) and resembled those obtained in non-pregnant women. The lowest angiotensin II levels were found in women with more severe forms of pregnancy-induced hypertension, such as proteinuric or superimposed pregnancy-induced hypertension. Review of the published studies on angiotensin II and our data suggest that the conflict among studies on angiotensin II levels in pregnancy-induced hypertension is largely due to the heterogeneity of the study populations in the various reports.     

PRORENIN CONCENTRATION IN THE HYPERTENSIVE DISORDERS IN PREGNANCY

Objective: To evaluate the plasma prorenin levels during the three trimesters of normal pregnancy, their prognostic value, and their correlation with hypertensive disorders of pregnancy.

Design: A prospective study in which plasma prorenin and renin levels were measured in 55 healthy pregnant women and 66 who developed gestational hypertension or preeclampsia. The patients were classified as mild preeclampsia (mild PE), severe preeclampsia (severe PE), chronic hypertension and superimposed preeclampsia upon chronic hypertension (superimposed PE).

Method: Venous blood samples were collected in the first, second and third trimesters and during delivery or cesarean. Plasma renin concentration (PRC) was measured by radioinmmunoassay before and after incubation with trypsin solution. The difference gave plasma prorenin concentration (PProRC).

Results: PRC and PProRC were significantly higher in pregnant women compared with healthy non-pregnant. PRC was significantly increased in the first trimester in the chronic hypertension group and a lower value was found in the first trimester in the superimposed PE compared with those in healthy pregnant women. No differences in other groups were found. PProRC showed a significant lower value in the first and third trimesters in the severe PE group. In the superimposed PE a low value of PProRC similar to those of non-pregnant women was found.

Conclusions: The results show that the different types of hypertension in pregnancy have different profiles of PProRC and PRC in relation to development of preeclampsia. The absence of increase of PProRC in the first trimester of superimposed PE may have a prognostic value.     

妊娠高血压综合征患者血浆神经肽Y水平变化的相关性研究

目的　探讨妊娠高血压综合征(妊高征)患者血浆神经肽Y(NPY)水平的变化及其与妊高征发病的关系。方法　采用放射免疫分析法测定了30例妊高征患者(妊高征组)产前及产后、23例正常妊娠妇女(正常妊娠组)和20例正常育龄未孕妇女(正常非孕组)血浆NPY水平。结果　妊高征组产前血浆NPY水平［(164.16±68.32)ng/L］明显高于正常非孕组［(86.60±20.65)ng/L］和正常妊娠组［(82.42±12.46)ng/L］(P<0.01)。妊高征组轻、中、重患者之间,产前血浆NPY水平有显著差异,分别为(88.66±25.69)ng/L、(145.15±18.72)ng/L、(235.05±33.60)ng/L(P<0.01)。妊高征组中、重度患者产前与产后血浆NPY水平分别为(80.04±28.70)ng/L及(130.43±37.38)ng/L,两者比较,差异有显著性(P<0.01);重度患者产后NPY水平仍明显高于正常妊娠组(P<0.01)。结论　妊高征患者血浆NPY水平增高,NPY参与了妊高征的发生和发展。     

Serum adiponectin levels in normal and hypertensive pregnancy.

OBJECTIVE: The aim of this study was to quantify adiponectin levels in women with normal and hypertensive pregnancies to determine whether there is an independent association, while controlling for body fat and insulin sensitivity. METHODS: A cross-sectional study was conducted in the following categories: 12 normotensive non-pregnant women, 10 normotensive, 12 gestational hypertensive, 13 essential hypertensive, and 12 preeclamptic women. All subjects underwent measurements of body fat by bio-impedance analysis and blood sampling. RESULTS: Percentage of body fat and insulin resistance were greater in all pregnant groups compared with non-pregnant women. Adiponectin concentrations were significantly lower in women with normal pregnancies (18.6 +/- 1.4 microg/mL, p = 0.02) compared with non-pregnant women (24.0 +/- 1.5 microg/mL). However, adiponectin levels were not significantly different among normal pregnancy, gestational hypertension (19.0 +/- 3.1 microg/mL), essential hypertension (24.0 +/- 3.7 microg/mL) and pre-eclampsia (22.4 +/- 2.5 microg/mL) groups. Adiponectin levels were inversely related to percent body fat and insulin resistance. When adiponectin levels were corrected for percent body fat and insulin resistance, no significant differences were seen among the study groups. CONCLUSIONS: Adiponectin levels are decreased in normal pregnancy, however this difference disappears when adiponectin levels are corrected for the pregnancy-related increases in body fat and insulin resistance. Adiponectin levels are not altered significantly in states of hypertension in pregnancy compared with normal pregnancy.     

Prolactin in severe toxemia of pregnancy

Plasma PRL levels were measured in 111 normal pregnant women and in 21 patients with severe toxemia of pregnancy. Twelve of 21 patients with severe toxemia of pregnancy showed high PRL levels in zone A (greater than mean value + 1 S.D. of PRL values in normal pregnancy). These 12 were significantly lower (P less than 0.02) in the Ccre rate, at 70.2 +/- 19.2 ml/min, than 5 toxemia patients (101.4 +/- 26.7 ml/min) in zone B (mean + 1 S.D. approximately mean) and 4 toxemia patients (110.0 +/- 35.3 ml/ml) in zone C (mean approximately mean -1 S.D.). Also, BUN, proteinuria and uric acid levels in zone A patients were higher than in those in zone B and C. However, no correlation was found between PRL levels and mean diastolic and systolic blood pressure. These results suggest that high PRL concentrations in toxemia of pregnancy may be associated with renal dysfunction.     

Neutrophil activation in pregnancy-induced hypertension

Human neutrophil elastase may be a major mediator of vascular damage and could contribute to the vascular damage seen in women with pregnancy-induced hypertension (PIH). Elevated plasma levels of this substance will reflect neutrophil activation in vivo. To determine neutrophil activation in PIH, we studied 30 normal non-pregnant women, 32 women with normal pregnancies, 19 with mild/moderate PIH and 16 with severe PIH between 28 and 39 weeks gestation. Plasma neutrophil elastase was measured by radioimmunoassay. There was a significantly higher concentration of plasma neutrophil elastase in both mild/moderate and severe PIH than in normotensive pregnancies and this may contribute to the vascular lesion associated with PIH. Concentrations were also significantly higher in normal pregnancy than in non-pregnant women which suggests that neutrophil activation and degranulation are increased in normal pregnancy.     

Angiotensin II levels in hypertensive and normotensive pregnancies

Summary. We measured circulating angiotension II by radioimmunoassay in women with pregnancy-induced hypertension (  n = 54  ), and compared these values with those obtained in women with normal pregnancy (  n = 18  ) and in non pregnant women (  n = 20  ). Pregnant women had statistically significantly higher plasma angiotensin II [mean (SD): 41.3 (12.6) pg/ml] than non-pregnant women [  29.2 (11.3) pg/ml; P < 0.004  ]. Angiotensin II concentrations in women with pregnancy- induced hypertension [mean (SD): 31.7 (16.2) pg/ml] were, on average, 25% lower than in normal pregnancy (   P < 0.003  ) and resembled those obtained in non-pregnant women. The lowest angiotensin II levels were found in women with more severe forms of pregnancy-induced hypertension, such as proteinuric or superimposed pregnancy-induced hypertension. Review of the published studies on angiotensin II and our data suggest that the conflict among studies on angiotensin II levels in pregnancy-induced hypertension is largely due to the heterogeneity of the study populations in the various reports.     

Thrombin-antithrombin III complex levels in normal pregnancy with hypertensive disorders and after delivery

The plasma concentration of the thrombin-antithrombin III-complex (TAT) was investigated during uncomplicated pregnancy in 15 women in the first, 22 in the second and 46 in the third trimester, and in 19 women with hypertensive disorders between 25 and 40 weeks gestation. Eight women at term after a normal pregnancy were studied before the onset of labour and within 60 min and 24 h after delivery. A comparison group of 16 healthy, non-pregnant women was investigated. The mean TAT concentration in normal pregnancies increased significantly in the second and third trimester compared with values in the first trimester and in non-pregnant women. In the group with hypertensive disorders during pregnancy TAT levels were significantly higher than in uncomplicated pregnancies. Within 60 min after delivery a distinct increase of TAT concentrations occurred compared to levels before the onset of labour but the levels had returned to normal by 24 h after delivery. Our findings suggest that an activation of the coagulation system occurs in normal pregnancy. A further activation takes place immediately after delivery. The significantly increased TAT levels in pregnancies with hypertensive disorders suggest a state of chronic disseminated intravascular coagulation leading to an enhanced consumption of and a decreased plasma concentration of antithrombin III.     

Thrombin-antithrombin III complex levels in normal pregnancy with hypertensive disorders and after delivery

Summary. The plasma concentration of the thrombin-antithrombin III-complex (TAT) was investigated during uncomplicated pregnancy in 15 women in the first, 22 in the second and 46 in the third trimester, and in 19 women with hypertensive disorders between 25 and 40 weeks gestation. Eight women at term after a normal pregnancy were studied before the onset of labour and within 60 min and 24 h after delivery. A comparison group of 16 healthy, non-pregnant women was investigated. The mean TAT concentration in normal pregnancies increased significantly in the second and third trimester compared with values in the first trimester and in non-pregnant women. In the group with hypertensive disorders during pregnancy TAT levels were significantly higher than in uncomplicated pregnancies. Within 60 min after delivery a distinct increase of TAT concentrations occurred compared to levels before the onset of labour but the levels had returned to normal by 24 h after delivery. Our findings suggest that an activation of the coagulation system occurs in normal pregnancy. A further activation takes place immediately after delivery. The significantly increased TAT levels in pregnancies with hypertensive disorders suggest a state of chronic disseminated intravascular coagulation leading to an enhanced consumption of and a decreased plasma concentration of antithrombin III.     

妊高征患者血浆内源性一氧化碳与内皮素—1水平的变化

目的：探讨妊高征患者血浆内源性一氧化碳（CO）与内皮素（ET－1）浓度的变化。方法：采用Chalmers联二亚硫酸盐还原法和放射免疫法分别测定61例妊高征患者、20例正常晚期妊娠妇女及20例健康非孕妇女（对照组）的血浆CO与ET－1浓度。结果：正常妊娠组血浆CO浓度较对照组显著升高（P＜0．01）,重度妊高征患者血浆CO浓度显著低于正常妊娠组（P＜0．01）;正常妊娠组血浆ET－1浓度较对照组降低,妊高征各组血浆ET－1浓度显著升高,且随病情程度加重显著增加（P均＜0．05）;妊高征各组血浆CO与ET－1浓度呈显著负相关。结论：内源性CO可能在妊高征发病中具有重要的生理及病理意义;内源性CO与ET－1在妊高征发病中起相互拮抗作用。     

Placental isoferritin: a new serum marker in toxemia of pregnancy

The serum concentrations of placental isoferritin and normal ferritin were determined in 20 patients with preeclamptic toxemia of pregnancy and were compared with the level measured in normal pregnant women at the third trimester and in labor at term. The mean serum concentration of placental isoferritin for the women with preeclamptic toxemia was found to be low: 7.5 +/- 23 U/ml compared with 81.6 +/- 89.3 U/ml in normal pregnancy during the third trimester and 54.8 +/- 53 U/ml in term delivery. In comparison, there was no significant difference in the serum levels of normal ferritin in both pregnant women with toxemia and in those without toxemia. These results suggest that placental isoferritin may be a useful marker for preeclamptic toxemia of pregnancy.     

Gall bladder volume and serum bile acids in cholestasis of pregnancy

Summary. Gall bladder volume was measured by ultrasound in eight patients with cholestasis of pregnancy, in 21 normal pregnant women and in 14 non-pregnant women, and at the same time serum cholic and nodeoxycholic acid levels were estimated. The gall bladder volume was 60% larger in cholestasis than that in normal pregnancy and more than two times larger in normal pregnancy than in non-pregnant women. The serum cholic and chenodeoxycholic acid concentrations were significantly higher in cholestasis of pregnancy than those in normal pregnancy.     

Serum Adiponectin Levels in Normal and Hypertensive Pregnancy

Objective: The aim of this study was to quantify adiponectin levels in women with normal and hypertensive pregnancies to determine whether there is an independent association, while controlling for body fat and insulin sensitivity. Methods: A cross-sectional study was conducted in the following categories: 12 normotensive non-pregnant women, 10 normotensive, 12 gestational hypertensive, 13 essential hypertensive, and 12 preeclamptic women. All subjects underwent measurements of body fat by bio-impedance analysis and blood sampling. Results: Percentage of body fat and insulin resistance were greater in all pregnant groups compared with non-pregnant women. Adiponectin concentrations were significantly lower in women with normal pregnancies (18.6 ± 1.4 μg/mL, p = 0.02) compared with non-pregnant women (24.0 ± 1.5 μg/mL). However, adiponectin levels were not significantly different among normal pregnancy, gestational hypertension (19.0 ± 3.1 μg/mL), essential hypertension (24.0 ± 3.7 μg/mL) and pre-eclampsia (22.4 ± 2.5 μg/mL) groups. Adiponectin levels were inversely related to percent body fat and insulin resistance. When adiponectin levels were corrected for percent body fat and insulin resistance, no significant differences were seen among the study groups. Conclusions: Adiponectin levels are decreased in normal pregnancy, however this difference disappears when adiponectin levels are corrected for the pregnancy-related increases in body fat and insulin resistance. Adiponectin levels are not altered significantly in states of hypertension in pregnancy compared with normal pregnancy.     

Inhibin-A levels and severity of hypertensive disorders due to pregnancy

OBJECTIVE: To evaluate the use of 3rd trimester inhibin-A levels as an adjunct to assess severity of hypertensive disorders due to pregnancy in women evaluated for preeclampsia. METHODS: Serum inhibin-A concentration was measured in a consecutive series of women evaluated for preeclampsia in the third trimester of pregnancy. RESULTS: Inhibin-A levels were significantly associated with the severity of proteinuric hypertensive disease due to pregnancy. Women with gestational hypertension or those with chronic hypertension without superimposed preeclampsia had levels comparable with normotensive women. The sensitivity to detect proteinuric hypertension was 16%. CONCLUSION: Although inhibin-A levels rise with increasing severity of disease, due to considerable overlap of normal and abnormal serum levels in women with and without preeclampsia, inhibin-A is not a useful adjunct for the classification of hypertensive disorders due to pregnancy.     

Platelet adhesiveness in toxemia of pregnancy

Indices of platelet adhesiveness in vitro were obtained from 10 nonpregnant women, 25 normal pregnant women, 10 with essential hypertension, 10 with mild pre-eclampsia, and 10 with severe pre-eclampsia. Platelet adhesiveness in normal pregnancy was slightly greater than in the nonpregnant state but lacked statistical significance. No alteration was found in patients with essential hypertension, but in toxemia of pregnancy the indices were significantly higher than in normal pregnancy. There appears to be a direct relationship between the severity of the disease and the platelet adhesiveness index. Increased platelet adhesiveness has been interpreted as evidence of slight platelet damage. It has been suggested that platelet damage in toxemia may be caused by damaged placental trophoblast, and that it is related to a slowly progressive, low grade process of disseminated intravascular coagulation in pre-eclampsia.     

SERUM ANTIBODIES TO OXIDIZED LOW-DENSITY LIPOPROTEIN IN PREGNANT WOMEN WITH PREECLAMPSIA AND CHRONIC HYPERTENSION: LACK OF CORRELATION WITH LIPID PEROXIDES

Objectives: To evaluate the circulating levels of antibodies to oxidized low-density lipoprotein (LDL) and their correlation with the lipid peroxide/vitamin E ratio in pregnant women with preeclampsia and chronic hypertension.

Methods: Antibodies to oxidized LDL were measured by enzyme-linked immunoassay, lipid peroxides (malondialdehyde), and vitamin E were measured by high-pressure liquid chromatography. Patients were 25 healthy pregnant women, 20 previously nonhypertensive women diagnosed with preeclampsia, and 20 women with uncomplicated chronic hypertension.

Results: Serum levels of antibodies to LDL in preeclamptic patients were similar to controls, whereas women with chronic hypertension showed a trend for increased mean levels. Lipid peroxides in serum were significantly increased and vitamin E levels were significantly decreased in preeclampsia with respect to nonhypertensive pregnancy, but no differences were observed for chronic hypertensive women.

Conclusions: Our results suggest that preeclampsia is not accompanied by increased levels of antibodies to oxidized LDL. By contrast, and according to previous studies in nonpregnant patients, chronic hypertensive patients showed a trend for elevated levels.     

Neutrophil activation in pregnancy-induced hypertension

Summary. Human neutrophil elastase may be a major mediator of vascular damage and could contribute to the vascular damage seen in women with pregnancy-induced hypertension (PTH). Elevated plasma levels of this substance will reflect neutrophil activation in vivo. To determine neutrophil activation in PIH, we studied 30 normal nonpregnant women, 32 women with normal pregnancies, 19 with mild/moderate PIH and 16 with severe PIH between 28 and 39 weeks gestation. Plasma neutrophil elastase was measured by radioimmuno-assay. There was a significantly higher concentration of plasma neutrophil elastase in both mild/moderate and severe PIH than in normotensive pregnancies and this may contribute to the vascular lesion associated with PIH. Concentrations were also significantly higher in normal pregnancy than in non-pregnant women which suggests that neutrophil activation and degranulation are increased in normal pregnancy.     

妊高征患者血清一氧化氮、超氧化物歧化酶和过氧化脂质的变化

目的探讨一氧化氮（NO）超氧化物歧化酶（SOD）和过氧化脂质（LPO）在妊高征发病中的作用。方法随机选择妊高征患者60例（妊高征组）、正常晚期妊娠妇女30例（正常妊娠组）、正常非妊娠妇女30例（对照组），分别采用Greiss反应法、放射免疫法和荧光测定法测定血清NO、SOD和LPO水平。结果正常妊娠组血清NO、SOD和LPO及NO／LPO比值均明显高于对照组（P＜0．001；P＜0．01），但SOD／LPO比值无显著差异（P＞0．05）。妊高征组血清NO／LPO比值和SOD／LPO比值明显降低（P＜0．001）。结论妊娠期机体氧化和抗氧化平衡失调及NO合成减少可能与妊高征的发病过程有关。