Elevated second-trimester human chorionic gonadotropin levels in association with poor pregnancy outcome

Objective: Our purpose was to determine whether abnormal pregnancy outcome is associated with elevated maternal serum human chorionic gonad otropin levels.Study Design: Maternal serum a-fetoprotein and human chorionic gonadotropin levels were measured in stored second-trimester serum obtained before scheduled genetic amniocentesis from 126 women with poor pregnancy outcomes, excluding aneuploidy and structural abnormalities (complications group), and 126 matched women with normal outcomes (control group).Results: More women with complications had elevated human chorionic gonadotropin levels (≥2.0 multiples of the median) (14%) than did control women (3%) (p = 0.01). Both elevated human chorionic gonadotropin and maternal serum α-fetoprotein levels were significantly associated with preterm delivery and fetal death. Elevated maternal serum α-fetoprotein was significantly associated with early postamniocentesis complications and fetal growth restriction, whereas elevated human chorionic gonadotropin was associated with preeclampsia.Conclusion: Elevated human chorionic gonadotropin, similar to unexplained elevated maternal serum α-fetoprotein, is significantly associated with abnormal pregnancy outcomes.     

Elevated levels of maternal plasma alpha-fetoprotein after amniocentesis.

An elevation of maternal AFP levels was observed in 11 of 65 cases (17 per cent) after amniocentesis. It is suggested that blood samples in which AFP levels are to be measured should always be collected before and not after amniocentesis.     

Elevated plasma homocysteine levels in gestational diabetes mellitus

OBJECTIVE: This prospective study investigated the occurrence of hyperhomocysteinemia in a population of patients with gestational diabetes. The aim was to determine whether elevated plasma homocysteine is associated with gestational diabetes in Turkish women. STUDY DESIGN: This prospective controlled study was conducted in the Department of Obstetrics and Gynecology of the Baskent University Faculty of Medicine between April 2002 and June 2003, and involved 304 Turkish women with uncomplicated pregnancies who were at 24-28 weeks gestation. The women in the study were assigned to one of three groups according to the results of the 50-g glucose screening and the oral glucose tolerance test (OGTT): group 1 comprised women who had normal glucose levels (< or = 135 mg/dL) after the 50-g challenge; group 2 comprised women with abnormal screening test results (> 135 mg/dL) but normal OGTT results; and group 3 comprised patients with gestational diabetes mellitus (GDM) according to the OGTT. Levels of fasting glucose, homocysteine, vitamin B(12) and folic acid, total cholesterol, high density lipoprotein (HDL) cholesterol, and triglycerides, low density lipoprotein (LDL) cholesterol and very low density lipoprotein (VLDL) cholesterol levels were measured in the three groups. Levels of insulin sensitivity were calculated using the homeostasis model assessment (HOMA) formula. RESULTS: The mean level of homocysteine in group 1 was significantly lower than the levels in groups 2 and 3 (p < 0.001) The mean triglyceride and VLDL levels in group 3 were significantly higher than the corresponding levels in group 1 (p < 0.05 for both). There were no significant differences among the groups with respect to levels of total cholesterol, vitamin B(12), folic acid, creatinine, fasting glucose or insulin. The mean HOMA value in group 3 was significantly higher than that in group 1 (p < 0.05). Only the blood glucose level after the 50-g glucose screening [p = 0.000, 95% confidence interval (CI) 0.009-0.027] had a significant correlation with homocysteine levels. CONCLUSION: In this prospective study of Turkish women, we found that patients with gestational diabetes and women with abnormal screening test results (> 135 mg/dL) but normal OGTT results have higher homocysteine levels than normal pregnant women. This increased level seems to be related to an abnormal 50-g test but not to insulin resistance. Further investigations are needed to follow up for these patients in the postpartum period and later in their life.     

Lowered levels of bicarbonate in seminal plasma cause the poor sperm motility in human infertile patients

Both the adenylate cyclase activity and the motility of human sperm were stimulated by bicarbonate with the same concentration dependency. The correlation between bicarbonate levels in semen and the motility of sperm from the patients with male infertility was investigated. Bicarbonate in semen was found to originate mainly from the seminal vesicles, and a significant positive correlation was observed between bicarbonate levels and volume of semen. The motility of infertile sperm was also found to correlate positively to the seminal levels of bicarbonate. These results suggest that the lowered levels of bicarbonate in semen are at least in part responsible for the poor sperm motility in infertile patients, as a result of the failure in the activation of sperm adenylate cyclase.     

Fibrinopeptide A levels in maternal and newborn plasma

Plasma fibrinopeptide A (FPA), a dynamic measure of intravascular coagulation, was determined in 70 healthy Chinese women during normal pregnancy, labour, delivery and the early puerperium and compared to a group of healthy non-pregnant adult controls. In the normal controls the plasma FPA level (mean ± SD) was 1.43 ± 0.46 ng/ml. During pregnancy and labour, the FPA levels were 3.05 ± 0.98 ng/ml and 11.47 ± 4.43 ng/ml, respectively, and it reached a peak of 32.95 ± 11.66 ng/ml at parturition, then falling to 6.15 ± 2.52 ng/ml in the early puerperium. All these levels were significantly higher (p < 0.001) compared to controls. Fifteen of the 21 mothers with blood sampling during parturition also had umbilical cord blood taken for determination of FPA level. There was no significant difference between the maternal (34.07 ± 10.12 ng/ml) and cord (31.06 ± 12.67 ng/ml) plasma FPA levels. It is concluded that the hypercoagulable state in women during pregnancy and the puerperium is associated with increased intravascular coagulation activity, and that increased intravascular coagulation activity also occurs in the fetus during parturition. This observation may account for the increased risk of thrombotic disorders observed in pregnant and parturient women as well as in the newborn.     

Elevated maternal plasma corticotropin-releasing hormone levels in pregnancies complicated by preterm labor.

OBJECTIVES: We investigated whether maternal plasma levels of the placental hormone corticotropin-releasing hormone are elevated in pregnancies complicated by preterm labor. STUDY DESIGN: Mean maternal corticotropin-releasing hormone levels were studied in women who met specific criteria for preterm labor and in women with normal pregnancies. Levels were also compared in the latent and active phases during term labor. RESULTS: In pregnancies complicated by preterm labor, maternal corticotropin-releasing hormone levels were higher than in normal pregnancies; this elevation occurred before labor was diagnosed clinically (p less than 0.05). When preterm labor was associated with infection, the mean levels were not elevated. Mean plasma levels were similar in latent and active phases during labor at term. CONCLUSION: Maternal plasma corticotropin-releasing hormone levels are elevated in association with preterm labor. This elevation does not appear to be due to labor itself and may reflect an early activation of the placenta before the onset of preterm labor.     

Elevated cardiac oxidative stress in newborn rats from mothers treated with atosiban

Purpose  

The purpose of this study was to evaluate the cardiac and cerebral oxidative stress in the offspings of pregnant rats treated with oxytocin antagonist atosiban.     

Elevated plasma levels of beta-endorphin in a group of women with polycystic ovarian disease

The relationship of endogenous opiates in patients with polycystic ovarian disease (PCOD) and their influence on body weight was studied. The study group consisted of 19 women with PCOD. They were amenorrheic, hirsute, and hyperandrogenic, and their average weight was 124% of the ideal body weight. They had luteinizing hormone/follicle-stimulating hormone ratios greater than or equal to 2. The control group consisted of ten women with regular ovulatory menses. Plasma beta-endorphin (beta-EP) was measured by using a very specific radioimmunoassay. beta-Lipotropin (beta-LPH) was entirely removed from the sample by preincubation of the plasma with rabbit anti-beta-LPH/Sepharose complex (Pharmacia, New Brunswick, NJ). The mean +/- standard deviation of the plasma beta-EP in the control group was 70.18 +/- 18.06 pg/ml, and the mean +/- standard deviation of beta-EP in the study group was 185.6 +/- 93.4 pg/ml, which was significantly higher than the control levels (P less than 0.001). A significant correlation was also found between plasma beta-EP level and the patient's weight in the PCOD group (r = 0.462, P = 0.025). The data from this study suggest that the elevated levels of endogenous opiates may be involved in the pathophysiology of PCOD and be related to inappropriate secretion of gonadotropins influencing body weight.     

Elevated maternal plasma corticotropin releasing hormone levels in twin gestation

The placenta secretes large amounts of the hypothelamic hormone, corticotropin releasing hormone (CRH) into the maternal and fetal circulation during pregnancy. We and other investigators have shown that during normal pregnancy, maternal plasma CRH levels begin to rise in the second trimester with a dramatic increase in CRH levels during the 5-6 weeks preceding the onset of labor. This rise in maternal plasma CRH is parallel to the rise of placental CRH mRNA which has been reported to occur with gestational maturation. Mechanisms underlying the control of CRH secretion by the placenta have not yet been determined. In twin gestation, increased fetal-placental mass has been shown to be associated with elevated maternal levels of several placental hormones as compared to singleton gestation. We measured maternal plasma CRH in both twin and singleton gestation to investigate whether the larger size of the fetal-placental unit in twin gestation is associated with elevated maternal CRH levels. Seventy-six serial venous blood samples were collected from 20 women with twin gestation and 40 samples were obtained from 27 women with uncomplicated singleton gestation. Gestational age was determined by history of a known last menstrual period and first trimester clinical examination and confirmed by ultrasound examination. CRH was extracted from 1-2 ml plasma with SEP-Pak C18 cartridges and eluted with triethylamine-formic-acid propranolol. CRH was measured by radioimmunoassay (RIA) with human CRH standard and antiserum to human CRH raised in our laboratory. Mean CRH levels were calculated for four week intervals. In both singleton and twin gestation, the maternal plasma CRH levels increased with advancing gestational age. After 29 weeks of gestation, maternal plasma CRH levels in twin gestation were significantly higher than those in singleton gestation (p less than 0.01). At 37 to 40 weeks of gestation, mean maternal CRH was 1167 +/- 237 pg/ml in singleton gestation as compared to 6927 +/- 1725 pg/ml in twin gestation (p less than 0.05). In addition, the rapid rise in plasma CRH levels which occurs near term in singleton gestation, occurred earlier in twin gestation. This early rise in maternal CRH levels persisted when the data from twin pregnancies complicated by preterm labor were removed from the analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Luteinizing hormone--releasing hormone levels in human plasma: a radioimmunoassay method.

A sensitive double-antibody radioimmunoassay, developed to measure luteinizing hormone--releasing hormone (LHRH) levels in fetal brain tissues, has been modified to quantitate LHRH in unextracted plasma samples. Pure, synthetic LHRH was iodinated with 125I for tracer and was also used as standard. The antibody utilized was specific for LHRH and did not cross react with other hypothalamic or pituitary hormones. The separation of free from antibody-bound tracer was performed by dextran-coated charcoal. The sensitivity of the assay was 2.5 pg/tube. The intra-assay and interassay coefficients of variation were 5.9 and 6.1% for 50 pg/ml and 11.8 and 14.9% for 25 pg/ml samples. Recovery of known amounts of LHRH added to plasma samples that had no detectable hormone was 96.4 +/- 8.8%. Whether these samples were previously prepared and kept frozen at -20 degrees C or freshly prepared, the recovery of LHRH was consistent and quantitatively stable in each assay. Serial determinations of LHRH in plasma obtained from ovulatory volunteers averaged between 20.5 +/- 2.1 pg/ml in the follicular phase and 19.4 +/- 4.5 pg/ml in the luteal phase. At midcycle, coincident with the luteinizing hormone surge, LHRH levels averaged 17.6 +/- 4.4 pg/ml.     

Elevated serum melatonin levels during human late pregnancy and labour.

Melatonin (MLT) shows an influence on gonadal steroid genesis, and has soporific effects. Serum MLT levels were examined during late pregnancy and 4 days after delivery in 25 women. Circulating levels of melatonin were analysed as integrated values (areas under the curve [AUC]) over 24 hours, 5 to 2 days before and 4 days after delivery. Antepartum AUCs were significantly increased compared with postpartum AUCs. Additionally, MLT levels were measured every 2 hours in a subgroup of 11 women during spontaneous labour between 08.00 and 12.00 h at a time when physiological serum MLT levels were low. Increased MLT levels were determined and compared to MLT levels measured in a previous evaluation of the antepartum AUCs. Elevated serum MLT levels during late-pregnancy and labour may influence the concentration of receptors of gonadal steroids in the gravid uterus at term and the psychic perception of painful uterine contractions during labour.     

Umbilical myiasis in a human newborn.

The new-world screw-worm fly, Cochliomyia hominivorax, is an obligate ectoparasite of domestic and wild animals, and in some cases may affect humans. Myiasis in the human neonatal period is a rare occurrence and almost exclusively found in neotropic areas. Although umbilical myiasis is well-recognized in animals, infestation of human umbilical cord and abdominal tissue is a rare occurrence. Once the diagnosis has been made, the treatment is usually straightforward and uncomplicated. In this article, a newborn infant from an urban area is reported with umbilical myiasis caused by fly larvae of C. hominivorax. The blowfly causing this infestation belongs to the family Calliphoridae (Diptera) and the genus Cochliomyia that usually infests only open wounds of animals.     

Elevated plasma levels of oxytocin in women taking low-dose oral contraceptives. Identification of the plasma oxytocin with high performance liquid chromatography

The aim of the present study was to investigate whether low-dose oral contraceptives affect oxytocin concentrations in plasma. Twenty women participated in an open cross-over study. Six consecutive blood samples were drawn twice, with a 4-week interval, in the luteal phase of the menstrual cycle when the women were/were not taking oral contraceptives. Plasma levels of oxytocin were analysed with a radio-immunoassay specific for oxytocin. A significant increase in oxytocin concentrations was observed following ingestion of oral contraceptives (p less than 0.02). Women with the highest oxytocin levels during a normal menstrual cycle increased their levels the most when on oral contraceptives. Analysis with high performance liquid chromatography demonstrated that immunoreactive oxytocin found in plasma, whether with or without oral contraceptives, co-eluted with synthetic oxytocin standard. An interesting possibility could be that the mental side effects and effects on glucose metabolism occurring after treatment with oral contraceptives might be related to elevated oxytocin levels, since metabolic and CNS effects of oxytocin are known.     

MMP-2 levels are elevated in the plasma of women who subsequently develop preeclampsia.

OBJECTIVE: To determine levels of matrix metalloproteinase (MMP)-2 and MMP-9, and the tissue inhibitors of metalloproteinases (TIMP)-1 and TIMP-2 in the plasma of women destined to develop preeclampsia prior to the onset of clinical disease. STUDY DESIGN: Plasma samples were taken from women whose pregnancies were subsequently complicated by preeclampsia and from normal pregnant women at 22 and 26 weeks and at delivery or diagnosis. Following equal protein loading, MMP-2 and 9 and TIMP-1 and 2 were quantified using zymography and Western blot analysis, respectively. RESULTS: Plasma MMP-2 levels were significantly elevated at 22 weeks (p = 0.02) and at diagnosis (p = 0.003) in the preeclampsia group, but there was no difference at 26 weeks. TIMP-1 levels were significantly reduced in the preeclampsia group at 26 weeks (p = 0.0002), but TIMP-2 levels were not quantifiable. CONCLUSION: At all three gestational time points an imbalance in the MMP-2:TIMP-1 ratio was found in patients who subsequently developed preeclampsia. We speculate that increased net MMP-2 activity may contribute to the endothelial dysfunction that is central to the pathophysiology of preeclampsia.     

Increased ADMA levels are associated with poor pulmonary outcome in preterm neonates

Background: Nitric oxide (NO), synthesized from the amino acid L-arginine by the action of NO synthases (NOS), is a pulmonary vasodilator. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NOS. Preterm infants have higher plasma ADMA concentrations than term infants which could cause inhibition of NO synthesis and deterioration in pulmonary functions. We aimed to investigate the relationship between serum ADMA and L-arginine levels of preterm infants and respiratory distress syndrome (RDS), requirement of surfactant treatment, duration of mechanical ventilation, oxygen treatment, and development of bronchopulmonary dysplasia (BPD).

Methods: A prospective cohort study was conducted including 80 preterm infants born with gestational age (GA) ≤?32 weeks and birth weight (BW) ≤?1500?g. Blood samples were obtained from all infants immediately after birth, and at postnatal 28th day of age. The relationship of first-day serum ADMA and L-arginine levels and surfactant requirement, duration of mechanical ventilation, oxygen treatment was investigated. Serum ADMA and L-arginine levels at 1st and 28th days were compared at patients with and without BPD. The role of serum ADMA levels at postnatal 28th day of age to predict the requirement of oxygen at postmenstrual 36 weeks of age was also investigated.

Results: Eighty preterm infants (42 male, 38 female) were enrolled in the study. Mean BW and GA for the total cohort was 1144.81?±?220.44?g and 28.3?±?1.8 weeks, respectively. Sixty-one infants were diagnosed as RDS and 44 infants treated with surfactant. The first-day ADMA levels were significantly higher in infants with surfactant requirement (1.14?±?0.23 versus 0.86?±?0.37, p?p?>?0.05) but not significantly. Serum ADMA and L-arginine concentrations at first day were not different among infants with and without BPD (p?>?0.05). ADMA concentrations at 28th day was significantly higher in infants with BPD (1.00?±?0.25 versus 0.81?±?0.25, p?Conclus?on: Serum ADMA and L-arginine levels are related to pulmonary morbidities in newborn. The results of this study show that increased ADMA levels are associated with poor pulmonary outcomes in preterm infants.     

Myometrial norepinephrine in human pregnancy. Elevated levels in various disorders leading to cesarean section

Myometrial norepinephrine was measured consecutively with high-performance liquid chromatography in women who delivered by cesarean section. The previously recorded marked reduction in tissue norepinephrine at the end of normal pregnancy was confirmed. When cesarean section was performed because of abruptio placentae/hemorrhage, impending asphyxia, dystocia or preeclampsia, the norepinephrine concentrations were six to ten times higher than in normal pregnancy. When an emergency cesarean section was carried out for premature breech presentation, transverse position of the fetus or prolapse of the umbilical cord (following an otherwise-normal pregnancy), the reduced norepinephrine values were not significantly different from those measured in a control group of women who underwent elective cesarean section. It is possible that the abnormally elevated levels of myometrial norepinephrine are part of the primary pathophysiologic condition associated with sympathetic overactivity, resulting in disturbed myometrial circulation and/or motor activity.