Bioimpedance in Pregnant Women with Preeclampsia

To analyze the direct (resistance and reactance) and indirect (intra and extracellular total body water) BIA parameters in preeclamptic women, 51 healthy pregnant women and 65 preeclamptic women were submmited to bioeletric impedance on the thrid trimester of gestation. The significance value adopted was 5%. Preeclamptic women showed lower values for R (448 Ω vs. 542 Ω), Rc (40 Ω vs. 53 Ω) and ICW (49.45% vs. 51%) when compared to control group. They also showed higher values for TBW (49% vs. 47%), TBWcor (41.6% vs. 34%) and ECW (50% vs. 47%). Biolectric impedance allowed differentiating preeclamptic women from health pregnant women, indicating that preeclampsia changes body compartments during pregnancy. This method can help understand the mechanisms involved in preeclampsia and to be a prediction away of preeclampsia.     

Evaluation of Oxidative Stress and Antioxidant Defence in Subjects of Preeclampsia

Objectives

To evaluate the parameters of oxidative stress and anti oxidant defense in preeclampsia and thereby find any etiological correlation.

Methods

Study was carried out on pregnant and non pregnant women attending or admitted in the Obstetrics and Gynecology Department of SSG Hospital, Baroda between 1st June 2007 to 31st May 2008. Each serum sample from different groups was evaluated for malondialdehyde (MDA), a product of lipid peroxidation process as a marker for oxidative stress and reduced Glutathione, Superoxide Dismutase, and Catalase for antioxidant enzyme activity and a comparison drawn and analyzed using t-test and χ² test.

Results

The levels of MDA (a lipid peroxidation product) increased significantly in pregnancy compared to non-pregnant females and further significantly increased in preeclampsia compared to normal pregnant females. The superoxide dismutase levels, catalase levels and vit-E levels were found to be increased in preeclamptic females as compared to normal pregnant females.

Conclusion

Preeclampsia is found to be a condition with markedly increased oxidative stress as is evidenced by highly significantly increased levels of MDA, a marker of lipid peroxidation. Levels of antioxidant enzymes, viz. reduced glutathione, superoxide dismutase, catalase and vitamin E have been found to be increased in preeclampsia as compared to normal pregnant females. This may be a compensatory mechanism for handling the increased oxidative stress.     

Increased Endothelial Monolayer Permeability is Induced by Serum from Women with Preeclampsia but not by Serum from Women with Normal Pregnancy or that are not Pregnant

Objective. To determine if endothelial monolayer permeability could be altered by serum from preeclampsia (PE). Methods. Confluent normal endothelial cells (ECs) were incubated with 20% serum from nonpregnant females, normal and PE pregnancies or combined with antioxidant superoxide dismutase (SOD) for 8 hr. Confluent PE ECs were incubated with 20% serum from normal pregnancies. EC barrier function of monolayer permeability was accessed by measuring EC electrical resistance (ER) and the leakage of horseradish peroxidase (HRP) passing through EC filters. Plasma concentrations of IL‐8 and lipid peroxides by MDA were also measured. We determined 1) if serum from PE could affect EC permeable function; 2) if antioxidant and serum from normal pregnancies could preserve PE EC barrier function; 3) if lipid peroxides and cytokine IL‐8 were increased in PE blood samples. Data are presented as mean±SE. ANOVA was used for statistical analysis. A p level less than 0.05 was considered statistically different. Results. 1) ER was significantly decreased and HRP passage was significantly increased in ECs incubated with serum from PE compared to serum from non‐pregnant and normal pregnant females (ER: 36.30±2.60 vs. 51.30±4.00 and 53.90±5.80 Ω·cm², p<0.01; HRP: 0.100±0.020 vs. 0.014±0.002 and 0.022±0.007 ΔOD470 nm, p<0.01, respectively). 2) ER was improved in PE ECs incubated with serum from normal pregnancies compared to controls, 52.28±3.13 vs. 34.50±3.80 Ω·cm², p<0.01. 3) SOD attenuated decreased EC ER induced by PE serum, 55.58±3.61 Ω·cm² (SOD+PE serum) vs. 42.34±3.24 (control) and 35.46±2.44 (PE serum), p<0.01, respectively. 4) Both MDA and IL‐8 concentrations were higher in plasma or serum samples from PE than those in samples from nonpregnancies and normal pregnancies, MDA: 28.65±1.45 vs. 22.40±1.47 and 25.53±0.89 μmol/mL, p<0.01; IL‐8: 5.35±1.08 vs. 1.69±0.47 and 2.28±0.73 pg/mL, p<0.05, respectively. Conclusions. 1) Sera from PE but not from nonpregnant women or normal pregnancies increase EC monolayer permeability. 2) Increased lipid peroxides and IL‐8 are candidates altering EC barrier function. 3) Antioxidant SOD preserves increased EC monolayer permeability induced by PE serum, suggesting that EC oxidative stress may be associated with altered EC barrier function in preeclampsia.     

Interactions Between Inflammatory and Oxidative Stress in Preeclampsia

Objective: Oxidative stress and a generalized inflammatory state are features of preeclampsia (PE). The objective of this study was to compare the levels of products of inflammatory reaction and oxidative stress markers in patients with PE, and to determine the relationship between oxidative stress and inflammation in PE. Methods: Plasma concentrations of high-sensitive C-reactive protein (hs-CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), and 8-isoprostane were measured in 53 women with PE and 20 age- and BMI-matched normotensive women. Results: The plasma concentrations of hs-CRP, IL-6, TNF-α, and 8-isoprostane were significantly higher in women with PE than in those with normotensive pregnancies, and these parameters, except for 8-isoprostane, were markedly elevated in those with severe PE (SPE), rather than mild PE (MPE). Moreover, plasma levels of 8-isoprostane, not MDA, were significantly correlated with the plasma levels of hs-CRP, IL-6, and TNF-α in patients with PE. Conclusions: These findings suggest that oxidative stress and inflammatory reaction are closely associated with PE, and the interactions between them may participate in the pathogenesis of PE.     

Utilization of Health Care Services of Pregnant Women Complicated by Preeclampsia in Ontario

Objective: To assess the utilization of health care services by pregnant women affected by preeclampsia (PE). Design: Population-based study. Setting: Perinatal partnership hospitals in Ontario. Population: Obstetric deliveries in 2005 Canadian province of Ontario (about 95% of births). Methods: For each PE case, four subjects without PE matched by age, parity, plurality, and hospital at childbirth were chosen as the controls. We compared the utilization of intra-partum care services and infant outcomes between the two groups. We also estimated the extra costs to the health care system in Ontario for caesarean delivery and caring of extremely low birth weight infants attributable to PE during the neonatal period and in the first 2 years of life. Main Outcome Measures: Cesarean delivery, hospital stay, extremely low birth weight infants, cost. Results: Of the 120,611 obstetric deliveries included in this analysis, 1240 (1.3%) were diagnosed with PE. Patients with PE and matched controls were similar in maternal age, parity, and other demographic characteristics. Compared with study subjects without PE, those with PE had increased uses of spinal anesthesia, maternal transfer, Cesarean delivery, labour induction, neonatal transfer, newborn resuscitation, longer hospital stay for childbirth, and higher rates of preterm births and low birth weight. The extra costs to the health care system for cesarean delivery and caring of extremely low-birth-weight infants attributable to PE during the neonatal period and in the first 2 years of life in Ontario were $0.5 millions, 3.1 millions, and $5.1 million per year, respectively, if we use the reported PE rate in this database. Conclusion: PE is associated with substantially increased costs to the health care system.     

Advanced Glycation End Products in Pregnancies Complicated with Diabetes Mellitus or Preeclampsia

Objective: Preeclampsia (PE) and diabetes mellitus (DM) are associated with oxidative stress. DM is complicated with formation of advanced glycation end products (AGEs), which are associated with oxidative stress. We hypothesized that elevated serum AGE would be found in pregnancies complicated by PE or DM. Methods: Circulating AGEs, 8-isoprostane, vitamin E, and antioxidant capacity were analyzed from study patients. Results: Serum AGE was elevated both in patients with type 1 DM and gestational DM, but not in PE, compared with controls. 8-isoprostane was elevated in patients with type 1 DM and PE compared with controls. Conclusion: AGEs and 8-isoprostane are not elevated in parallel in pregnancies complicated with PE or DM, suggesting biological heterogeneity.     

Cytokines Profiles in Sudanese Women with Preeclampsia

Background.?Cytokine imbalance in preeclampsia may be one of the etiological factors for preeclampsia.?Objectives.?The study was conducted to investigate interferon gamma (IFN-γ), interleukin-4 (IL-4) and interleukin-10 (IL-10) in preeclampsia. Enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of these three pro-inflammatory cytokines in sera from 33 Sudanese women with preeclampsia (at presentation and 7 days later) and 32 women with normal pregnancy as a control group.?Results.?The levels of IFN-γ and IL-4 were slightly—not statistically significant— higher in the women with preeclampsia. IL-10 was significantly higher in the women with preeclampsia. Women with preeclampsia had significantly lower levels of IFN-γ and IL-4 and significantly higher levels of IL-10 7days later in comparison with the presenting levels.?Conclusion.?Thus, the significantly raised levels of IL-10 in women with preeclampsia suggest its role in pathogenesis of preeclampsia, and further research is needed.     

Effect of Peroxynitrite Scavenging on Endothelial Cells Stimulated by Plasma from Women with Preeclampsia: A Proteomic Approach

Hypothesis: Increased peroxynitrite formation in endothelial cells incubated with plasma from women with preeclampsia alters the expression of specific endothelial proteins.?Methods:?We used a proteomic approach to examine the effect of a peroxynitrite scavenger (FeTPPS, 5 μmol/L) on the expression of endothelial proteins in response to plasma from women with preeclampsia. After treatment, cells were subjected to two-dimensional gel electrophoresis and proteins were identified using mass spectrometry. Results: Peroxynitrite scavenging decreased the expression of structural proteins, cytokeratin, actin-γ-1, and moesin, and the calcium-binding protein, calumenin. Conclusions: This study has identified novel proteins that are regulated by peroxynitrite in response to plasma from women with preeclampsia.     

Ischemia Modified Albumin in Normal Pregnancy and Preeclampsia

Objective. Ischemia-modified albumin (IMA) has emerged as a new biomarker of myocardial ischemia. Currently, no information is available on maternal IMA levels during normal and complicated pregnancy. Preeclampsia is associated with ischemia and increased formation of free radicals in the placenta. We therefore hypothesized that production of IMA may occur in women with preeclampsia. Methods. Serum IMA and albumin concentrations were assessed in 12 patients with preeclampsia, 12 normal pregnant controls, and 12 nonpregnant controls. IMA levels were compared between groups and corrected for albumin by multivariate regression analysis. Results. Mean IMA levels were elevated in normal pregnant controls (107.3 U/mL; 95% CI, 102.5 to 112.01), compared with nonpregnant controls (94.5 U/mL; CI, 89.4 to 99.6; p = 0.015). In patients with preeclampsia, IMA levels were similar to those in normal pregnant controls (109.7 U/mL; CI, 102.2 to 117.2; p = 0.65). Also, no difference in IMA levels was observed between women with preeclampsia who delivered small-for-gestational-age (SGA) infants (99.0 U/mL; CI, 87.9 to 110.1; p = 0.13) and women with preeclampsia but without SGA. Conclusion. Serum IMA, which has been advocated as a clinical marker of cardiac ischemia, appears to be elevated during normal pregnancy. We found no significant relationship between IMA levels and preeclampsia, in women with or without SGA infants.     

Comparison of Serum Levels and the Placental Expression of Resistin Between Patients with Preeclampsia and Normal Pregnant Women

Objective. The aim of this study was to evaluate serum resistin levels in women with preeclampsia compared to those in normal pregnant women and normal non-pregnant women, and to examine placental resistin expression. Methods. Serum resistin levels were measured by enzyme-linked immunosorbent assay and placental resistin expression was determined by immunohistochemistry. Results. Serum resistin levels were significantly elevated in women with preeclampsia compared to normal pregnant women and non-pregnant women. There was no significant difference in placental resistin expression. Conclusion. The placenta may not be the origin of the resistin that contributes to increased serum levels in women with preeclampsia.     

Preeclampsia,Placenta, Oxidative Stress,and PMCA

Objective: The aim of this study is to summarize the reported evidence on the possible relationship between preeclampsia, placenta, oxidative stress and plasma membrane Ca-ATPase (PMCA) activity, responsible for fine control of intracellular calcium concentration. Methods: Literature search was conducted in MEDLINE/PubMed and several unpublished results from our laboratory were included. Results: Lipid peroxidation in placental and red blood cell plasma membranes during preeclampsia and a concomitant diminution of their PMCA activity are described. Conclusions: Uteroplacental hypoperfusion raises lipid peroxidation by-products in the blood plasma that could alter structure and functionality of the cell membranes of the endothelium and several tissues.     

Resibufogenin Administration Prevents Oxidative Stress in a Rat Model of Human Preeclampsia

Background and Objectives. Marinobufagenin (MBG) is a cardiotonic steroid that is increased in preeclampsia. An analog of MBG, resibufogenin (RBG), prevents the development of preeclampsia in a rat model. Oxidative stress is a concomitant of endothelial dysfunction in the latter disorder. The objective of the current studies was to evaluate the status of oxidative stress in a rat model of preeclampsia. Methods. We measured the aortic AT₁ receptor expression and urinary excretion of 8-isoprostane (8IP) in rats rendered “preeclamptic” and compared the findings to those obtained in normal pregnant animals, pregnant rats injected with MBG, and preeclamptic rats treated with RBG. Results. Aortic AT₁ receptor expression and the urinary excretion of 8IP were significantly augmented in “preeclamptic” and MBG-injected pregnant rats compared to normal pregnant animals. RBG prevented evidence of oxidative stress in “preeclamptic” rats. Conclusion. MBG is involved in the causation of oxidative stress in our rat model and RBG attenuates this change.     

Fibrinogen Concentration and Factor VIII Activity in Women with Preeclampsia

Objective: To compare fibrinogen concentration and factor VIII activity obtained from pregnant women with preeclampsia with those obtained from women with either normal pregnancies or with complications unrelated to preeclampsia. Materials and Methods: Fibrinogen concentration and factor VIII activity were measured in the following groups: normal pregnancy, consisting of women at routine 16- to 28-week antenatal visits or after admission at term for elective cesarean section; women with non-preeclampsia (non-PE) related conditions, including women with threatened abortion, cholestasis, systemic lupus erythematosus (SLE), and previous deep venous thrombosis (DVT); and women with preeclampsia as defined by the Australasion Society for the Study of Hypertension in Pregnancy (ASSHP) criteria. Blood was collected from 44 women in each group. Fibrinogen concentration and factor VIII activity were measured. Results: Fibrinogen concentrations and factor VIII activities were higher in women with preeclampsia compared with those from women with either normal or complicated pregnancies (p < 0.05). It was twice as likely that a woman with preeclampsia would have a raised fibrinogen and factor VIII levels. The ranges for each analyte did, however, show overlap. Women with preeclampsia were more likely to have both a raised fibrinogen concentration and increased factor VIII activity than other pregnant women (p < 0.001). Conclusion: This study has shown a novel increase in both fibrinogen concentration and factor VIII activity in pregnant women with preeclampsia compared with values obtained from women with normal or non-preeclampsia complicated pregnancies, with women with preeclampsia twice as likely to have a raised fibrinogen concentration and increased factor VIII activity. These changes may contribute to the hypercoagulability seen in preeclampsia.     

血清胱抑素C水平与早发型子痫前期发生和不良妊娠结局关系探讨

目的:研究孕妇发生早发型子痫前期及其出现不良妊娠结局与血清胱抑素C(CC)水平变化趋势关系。方法:选取2009年7月至2011年7月在南方医科大学南方医院妇产科住院治疗并分娩的早发型子痫前期患者69例,其中轻度15例(早发轻度组),重度54例(早发重度组),分析血清CC水平和子痫前期发生及母儿结局的关系。并同期选择产前检查正常的妊娠孕妇100例,检测其孕中期和孕晚期血清CC水平作为对照。结果:①正常妊娠孕妇孕中期和孕晚期时血清CC分别为0.81±0.12mmol/L和1.01±0.18mmol/L。早发轻度组血清CC(1.15±0.39mmol/L)和早发重度组血清CC(1.69±0.68mmol/L),分别与正常妊娠孕妇的孕中期和孕晚期比较,差异均有统计学意义(P<0.05)。②早发重度组的血清CC水平高于早发轻度组(P<0.05);早发重度组收缩压、舒张压、尿酸、肌酐和24小时尿蛋白水平均明显高于早发轻度组(P<0.05);早发重度组的羊水过少、胎儿生长受限、胎死宫内、低蛋白血症、胎盘早剥和HEELP综合征等不良妊娠的发生率高于早发轻度组。③早发重度组中出现不良妊娠结局患者中的CC水平高于未出现不良妊娠结局患者(P<0.05)。结论:子痫前期患者在妊娠中期血清CC水平已高于正常妊娠妇女,可能与子痫前期的发生和不良妊娠结局的出现相关。     

In Vitro Plasma-Induced Endothelial Oxidative Stress and Circulating Markers of Endothelial Dysfunction in Preeclampsia: An Observational Study

Objective:?To investigate plasma-induced endothelial reactive oxygen species (ROS) production in vitro and its relation to endothelial dysfunction in preeclampsia (PE).?Methods:?Plasma was drawn from 17 PE patients, 17 matched healthy pregnant (HP) women, 17 matched non-pregnant healthy volunteers (NP), and 10 septic shock (SC) patients. In vitro plasma-induced ROS production was assessed in cultured human endothelial cells. In vivo endothelial activation and injury were assessed through measurements of plasma von Willebrand factor (vWF) and soluble thrombomodulin (sTM) concentrations, respectively.?Results:?Endothelial ROS production was not induced by PE, HP, and NP plasmas. However, it was significantly increased in SC compared to other groups (p < .005). Pregnancy (PE and HP) was associated with higher vWF compared to NP. Among pregnancies, vWF was higher in PE compared to HP women (p < .05). sTM was unchanged between PE, HP and NP. In SC, vWF and sTM were significantly increased compared to other groups (p < .01). Simultaneously, endothelial ROS production and sTM concentration were correlated (p = .673; p < .05).?Conclusion.?Plasma does not induce in vitro endothelial ROS production in PE women for which endothelial dysfunction is limited to activation but not injury. By contrast, SC patients demonstrate both endothelial activation and injury, closely related to plasma-induced endothelial oxidative stress.     

The Evaluation of the Oxidative State of Low-Density Lipoproteins in Intrauterine Growth Restriction and Preeclampsia

Objective. To evaluate the oxidative state of lipoproteins in pregnancies complicated by intrauterine growth restriction (IUGR) in comparison to preeclampsia (PE) and healthy pregnant control subjects (CN). Methods. Maternal serum of 20 PE, 29 IUGR, and 29 gestational age-matched CN were analyzed. Total cholesterol (TC), low-density lipoprotein (LDL)-bound cholesterol (LDL-C), and oxidized LDL (oxLDL) concentration were measured once between 25 and 34 weeks of gestation. Statistical estimates were performed by Student's t-test. Results. Serum concentrations of LDL-C and TC were significantly reduced in IUGR [LDL-C: CN – mean = 146 mg/dL, SD = ± 40.1; IUGR – mean = 102 mg/dL, SD = ± 27.3 (p < 0.0001); PE – mean = 130 mg/dL, SD = 38.8 mg/dL; TC: CN – mean = 259/dL, SD = ± 46.8; IUGR – mean = 218 mg/dL, SD = ± 35.0 (p < 0.001); PE – mean = 244 mg/dL, SD = 48.2]. There was no significant difference in oxLDL/LDL-C ratio within the three groups (CN: mean = 0.76, SD = 0.24; IUGR: mean = 0.74, SD = 0.12; PE: mean = 0.77, SD = 0.22). Conclusion. Our results show a lower maternal LDL-C and TC concentration in IUGR pregnancies. These data contribute to the hypothesis of a decreased cholesterol supply to the fetus in IUGR. However, we could not confirm the hypothesis of an altered oxidative state in neither IUGR nor PE.     

Reported Calcium Intake is Reduced in Women with Preeclampsia

Objective: The purpose of this trial is to investigate the relationship between dietary calcium content and incidence of preeclampsia, comparing diet calcium content in normotensive and preeclampsia patients. Dietary calcium was measured by a dietary interview conducted at the day after delivery. Methods: This is a prospective cross-sectional study involving 1092 patients who delivered at Hospital de Clínicas de Porto Alegre – Brazil. Results: The average diet calcium content in the studied population was 1038 mg. The average calcium intake in the normotensive group was 1057 mg, in chronic hypertension group was 962 mg, in transient hypertension group was 963 mg, in mild preeclampsia was 902 mg and in severe preeclampsia group was 755 mg. The results of this study show that pregnant women who develop severe preeclampsia have a significant lower diet calcium intake when compared to normotensive women (P = 0.018). Conclusion: The results of the present study can provide the foundations for prospective trials, including randomised clinical trials involving only patients with a low content of calcium in their diet.     

Low Socioeconomic Status Negatively Affects Sleep in Pregnant Women

ObjectiveTo evaluate the effect of socioeconomic status on measures of sleep quality, continuity, and quantity in a large cohort of pregnant women.DesignProspective, longitudinal study.ParticipantsOne hundred seventy (170) pregnant women at 10–20 weeks gestation.MethodsSleep quality was assessed with the Pittsburgh Sleep Quality Index. Sleep duration and continuity (sleep fragmentation index [SFI]) were assessed with actigraphy at 10–12, 14–16, and 18–20 weeks gestation. Because sleep did not significantly differ across time, averages across all three time points were used in analyses. Socioeconomic status (SES) was defined by self‐reported annual household income. Linear regression analyses were used to model the independent associations of SES on sleep after adjusting for age, race, parity, marital status, body mass index (BMI), perceived stress, depressive symptoms, and financial strain.ResultsOn average, women reported modestly poor sleep quality (M = 5.4, SD= 2.7), short sleep duration (391 [55.6] min) and fragmented sleep (SFI M = 33.9, SD = 10.4. A household income < $50,000/year was associated with poorer sleep quality (β = –.18, p < 0.05) and greater sleep fragmentation (β = –.18, p < 0.05) following covariate adjustment.ConclusionsLow SES was associated with poorer sleep quality and fragmented sleep, even after statistical adjustments. Perceived stress and financial strain attenuated SES‐sleep associations indicating that psychosocial situations preceding pregnancy are also important to consider.     

Physicians' Knowledge of Future Vascular Disease in Women with Preeclampsia

Objective. Preeclampsia, a hypertensive disorder of pregnancy, affects 5–8% of women. Large studies demonstrate a strong association between preeclampsia and future cardiovascular disease (CVD). Despite CVD being the leading cause of mortality for women, there has been little education for internal medicine physicians or obstetrician-gynecologists (ob-gyns) about this association; published guidelines do not include preeclampsia as a risk factor for future CVD. Therefore, women with a history of preeclampsia may not receive adequate risk-reduction counseling for CVD. It is unclear whether primary care physicians are aware of the association; thus, we sought to determine whether primary care providers at our institution were aware of preeclampsia's association with future CVD and whether they were providing appropriate counseling. Methods. An anonymous online survey was sent to all internists and (ob-gyns) at our hospital. Results. Although most internists (95%) and (ob-gyns) (70%) provide routine cardiovascular risk-reduction counseling, a substantial proportion of them were unaware of any health risk associated with a history of preeclampsia. Many internists were unsure or did not know whether preeclampsia is associated with ischemic heart disease (56%), stroke (48%), and decreased life expectancy (79%). The corresponding proportions for (ob-gyns) were 23, 38, and 77%, respectively. Only 9% of internists and 38% of obstetrician-gynecologists were providing cardiovascular risk-reduction counseling to women with a history of preeclampsia. Conclusion. There is limited knowledge of the association between preeclampsia and future CVD; this deficiency may limit the application of this risk factor to clinical care.     

Connexin Expression is not Altered in Omental Resistance Vessels from Women with Preeclampsia

SNOMED CT® (Systematized NOmenclature of MEDicine Clinical Terms) is a standardized multilingual healthcare terminology. It was developed to meet the needs of our electronic world so that care can be documented and clinicians can retrieve and transmit data in electronic format. It is anticipated that SNOMED CT® will provide the core general terminology for electronic health records and, as such, replace existing classification systems such as the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). At present, there is no special interest group for the hypertensive disorders of pregnancy (HDP) within the SNOMED CT® initiative. We believe that members of the ISSHP, and others interested in the HDP, should take a leadership role in this regard for a number of reasons.