Inhibin A levels and severity of preeclampsia

Objective  To evaluate the use of third trimester inhibin A levels to assess the severity of preeclampsia. Materials and methods  Blood samples were taken from women diagnosed with mild and severe preeclampsia during the third trimester of pregnancy. Blood samples were collected in plain tubes, centrifuged and stored at −80°C until analyzed. All serum samples were measured for inhibin A levels by enzyme-linked immunosorbent assays. Results  Inhibin A levels were greater in the severe (1,435.9 ± 603.2 pg/mL) than in the mild preeclampsia group (1,021.9 ± 438.8 pg/mL, P = 0.014). Conclusion  Inhibin A levels rise with increasing severity of disease. However, there is considerable overlap of serum inhibin A levels in women with mild and severe preeclampsia. Inhibin A is therefore not a useful adjunct for the classification of preeclampsia. This abstract was presented at the 15th Congress of the Federation of Asia and Oceania Perinatol Societies, Nagoya, Japan.     

Plasma Hemopexin Activity in Pregnancy and Preeclampsia

Objective: Plasma hemopexin activity, associated with increased vascular permeability, was evaluated in healthy pregnant and non-pregnant women and in pre-eclamptic women. Methods: Hemopexin activity and the hemopexin inhibitor, extracellular ATP, were assayed in plasma from pregnant (n?=?10), preeclamptic (n?=?9), and non-pregnant women (n?=?10) using standard methods. Abdominal fascia tissue fragments from preeclamptic and pregnant women were immunohistochemically stained for vascular ecto-apyrase or ecto-5′nucleotidase. Results: The data show significantly enhanced Hx activity exclusively in plasma from pregnant women and significantly enhanced plasma ATP in pre-eclamptic women compared with the other groups. Dephosphorylation of preeclamptic plasma resulted in reactivation of Hx activity. Fascia tissue-samples from preeclamptic women showed reduced ecto-apyrase activity and enhanced ecto-5′nucleotidase activity compared to pregnant women. Conclusion: Enhanced hemopexin activity may be associated with normal pregnancy, but not with preeclampsia. Decreased hemopexin in pre-eclamptic patients may be due to enhanced plasma ATP, which is possibly promoted by diminished activity of vascular ecto-apyrase.     

Acute and Chronic Chlamydia pneumoniae Infection in Pregnancy Complicated with Preeclampsia

Objective. To investigate whether Chlamydia pneumoniae (Cp) infection is more common in women whose current pregnancy is complicated with preeclampsia (PE) as compared to pregnant women without PE. Methods. Thirty pregnant women with PE and 30 pregnant women without PE were studied between 29 and 30 weeks of gestation. The presence of an acute or chronic Cp infection was determined by the estimations of serum IgG, IgM, and IgA Cp antibodies. Results. None of the women were diagnosed as having acute Cp infection. Prevalence of chronic Cp infection was 53 and 66% in the PE and control groups, respectively (X², p = 0.068). Conclusion. Chronic Cp infection is not more common in women whose pregnancy is complicated with PE as compared to pregnant women without PE. Therefore, no association between Cp infection and PE can be established.     

Second Trimester Maternal Serum Cystatin C Levels in Preeclamptic and Normotensive Pregnancies: A Small Case-Control Study

Background/Aims: Cystatin C (CC) is a marker of glomerular filtration rate (GFR) and is elevated in cases of established preeclampsia (PE). It also has widespread presence in extracellular space and high levels in PE might reflect placental ischemia. The aim of this study was to measure CC levels in the second trimester in women who subsequently develop PE and in those who remained normotensive. Methods: Maternal serum taken at time of the anomaly scan from 15 women was analysed for CC and creatinine levels. Six women later developed PE and 9 remained normotensive. Results: Cystatin C levels were significantly higher in women who developed preeclampsia (mean value 0.76 vs. 0.53 mg/L, p =?0.008). However, creatinine levels showed no statistical difference (mean value 76.1 vs. 65.5 umol/L, p?=?0.066). The range of CC was 0.41–0.55 mg/L in normotensive pregnancies and 0.50–1.26 mg/L in pregnancies with PE. Conclusion: This small observational study showed that serum CC is raised as early as the second trimester in women who subsequently develop PE in third trimester. Larger studies are needed to evaluate the potential role of CC as an early marker for the prediction of PE.     

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.     

Changes in Microparticle Numbers and Cellular Origin During Pregnancy and Preeclampsia

Background: Microparticles (MP) are pro-coagulant vesicles derived from various cells. Evidence is accumulating that MP are of pathophysiological relevance in autoimmune, cardiovascular, and thromboembolic diseases and inflammatory disorders. Therefore, their role in the development of preeclampsia was investigated and MP from preeclamptic patients influenced endothelial-dependent vasodilatation. Knowledge about changes in circulating MP numbers during pregnancy and preeclampsia is lacking. We determined this longitudinally and investigated whether these numbers related to the severity of preeclampsia. Methods: Samples were obtained from pregnant women and preeclamptic patients during pregnancy and postpartum. MP were isolated and studied by flow cytometry. Results: During pregnancy, MP were decreased at 12 weeks gestation and then returned to postpartum values. In patients with preeclampsia, MP numbers were reduced at 28 and 36 weeks (both p = 0.04). Monocyte-derived MP were elevated in preeclampsia at 28 (p = 0.007), 32 (p = 0.02), and 36 weeks (p = 0.01), as were erythrocyte-derived MP at 28 weeks (p = 0.04). Placenta-derived MP increased in pregnancy and preeclampsia. During pregnancy, a correlation was present between placenta-derived MP and systolic blood pressure (r = 0.33, p = 0.015). No other correlations were found. Conclusions: During pregnancy, numbers of MP initially decrease and subsequently normalize. Placenta-derived MP increase, possibly because of placental growth. In preeclampsia, reduced numbers of PMP are due to decreased platelet counts. Increased numbers of monocyte-derived MP reflect monocyte activation, which may be an expression of the systemic inflammation in preeclampsia. Lack of correlation between numbers of MP and severity of preeclampsia suggests that MP numbers alone do not explain the reported vascular effects of MP.     

子癎前期患者血清胎盘生长因子的变化及意义

目的:探讨胎盘生长因子与子癎前期发病的关系。方法:检测40例子癎前期患者及20例正常晚期妊娠血清胎盘生长因子(PlGF)的水平及胎盘CD34表达,计数微血管密度(MVD)。结果:轻度子癎前期组血清PlGF为201.25±52.33pg/ml,胎盘MVD计数为45.6±4.2,重度子癎前期组分别为165.83±37.54pg/ml,40.2±3.9,两组均低于正常晚期妊娠组315.76±76.98pg/ml,58.2±4.8,差异有显著性意义(P<0.05)。结论:子癎前期患者血清PlGF及胎盘MVD显著降低,可能与子癎前期的发病有一定关系。     

The Concentrations of Markers of Bone Turnover in Normal Pregnancy and Preeclampsia

Background. The purpose of our study was to investigate the concentrations of markers of bone turnover in normal pregnancy and preeclampsia. Material and Methods. Forty-five pregnant patients with preeclampsia, 78 healthy pregnant women (26 in first, 26 in the second, and 26 in third trimester of pregnancy), and 20 nonpregnant women were included in the study. Serum concentrations of osteoprotegrin (OPG), receptor activator of nuclear factor kappa B ligand (sRANKL), and the markers of bone turnover, osteocalcin and CrossLaps—degradation products of type I collagen, were determined using the ELISA method. Statistical analysis was performed using Mann–Whitney U-test. Results. The concentrations of sRANKL and OPG were significantly higher in the second trimester of normal pregnancy when compared to the first and the third trimesters and to nonpregnant controls. The concentrations of osteocalcin were significantly higher in the first trimester of physiological pregnancy in comparison with nonpregnant women and with second and third trimesters of pregnancy. The concentrations of CrossLaps were significantly higher in the second trimester of normal pregnancy when compared to the first and third trimester. In preeclampsia, the sera concentrations of osteocalcin and CrossLaps were significantly higher when compared to the third trimester of normal pregnancy. Conclusion. The results suggest that the bone formation is increased in the first trimester, whereas the bone resorption is increased in the second trimester of normal pregnancy. Furthermore, the results suggest that the bone turnover is increased in patients with preeclampsia when compared to healthy normotensive pregnant women.     

可溶性CD105与子痫前期

可溶性CD105（sCD105）是一种存在于血液中分子质量为65ku的蛋白质,氨基酸序列对应于CD105蛋白氨基端的可溶性结构,可能是CD105经酶解脱落而成。子痫前期患者循环sCD105显著增高,而且sCD105增高发生在出现子痫前期临床症状前6～10周,其水平与子痫前期发病妊娠周及病情相关。在体外,sCD105可抑制转化生长因子β1（TGF-β1）诱导的人脐静脉内皮细胞的血管生成作用。注射载有sCD105基因的腺病毒可引起小鼠血管通透性增高,导致血管内皮细胞受损,并可使其血压增高,出现蛋白尿和其他类似子痫前期的病理变化。sCD105在子痫前期的变化及其在发病中的作用是子痫前期病因学与病理生理学研究的最新进展之一。     

Accuracy Assessment of the Dinamap ProCare 400 in Pregnancy and Preeclampsia

Objective. To assess the accuracy of the Dinamap ProCare 400 in pregnancy and preeclampsia, according to the British Hypertension Society protocol. Methods. Ethical approval was obtained. Forty-five women were recruited at two large teaching hospitals. Nine sequential same arm measurements were taken from each woman alternating between the Dinamap and mercury sphygmomanometry. Results. The device achieved an A/A grade (pregnancy) and an A/B grade (preeclampsia). Mean difference (SD) were 1.1(5.8)/0.1(5.7) mmHg (pregnancy) and –0.5(5.4)/0.9(9.5) mmHg (preeclampsia) for systolic/diastolic. Conclusion. The Dinamap ProCare 400 is recommended for use in pregnancy and has good accuracy in preeclampsia, although caution is still advised.     

Serum calcium and serum magnesium in normal and preeclamptic pregnancy

Objective The aims of this study were to measure serum levels of calcium and magnesium in preeclamptic pregnancies and to compare them with those in normal pregnancies.Materials and methods We collected venous serum samples from 40 preeclamptic pregnant women and 40 normal pregnant women. The blood samples were analyzed for calcium and magnesium, using a colorimetric analyzer. The data were analyzed using the Student’s t-test, χ ²-test or Fisher exact tests when appropriate.Results The serum calcium concentration in preeclamptic pregnant women is significantly lower than that in normal pregnant women (9.0±0.4 mg/dl vs. 9.7±0.7 mg/dl, p<0.0001). Like serum calcium, serum magnesium concentration in preeclamptic women is significantly lower than that in normal pregnant women (0.77±0.08 mmol/l vs. 0.85±0.09 mmol/l, p=0.001).Conclusion This study shows that both serum calcium and serum magnesium levels in preeclamptic pregnant women are lower than in normal pregnant women. These findings support the hypothesis that hypocalcemia and hypomagnesemia are possible etiologies of preeclampsia.     

抑制素A和激活素A与妊娠

妊娠期间母体血清、羊水、脐血中的抑制素A和激活素A主要来源于胎盘.抑制素A、激活素A的合成分泌可能与胎盘功能有关.在一些妊娠相关疾病,如妊娠滋养细胞疾病、流产、异位妊娠、妊娠期高血压疾病、胎儿缺氧和21三体综合征中,抑制素A和激活素A有不同的变化.测定其在血清、羊水中的表达,可能对这些妊娠相关疾病的预防、诊断、预后评估...     

可溶性CD105与子痫前期

可溶性CD105（sCD105）是一种存在于血液中分子质量为65 ku的蛋白质,氨基酸序列对应于CD105蛋白氨基端的可溶性结构, 可能是CD105经酶解脱落而成。子痫前期患者循环sCD105显著增高,而且sCD105增高发生在出现子痫前期临床症状前6～10周,其水平与子痫前期 发病妊娠周及病情相关。在体外,sCD105可抑制转化生长因子β1（TGF-β1）诱导的人脐静脉内皮细胞的血管生成作用。注射载有sCD105基因的 腺病毒可引起小鼠血管通透性增高,导致血管内皮细胞受损,并可使其血压增高,出现蛋白尿和其他类似子痫前期的病理变化。sCD105在子痫前 期的变化及其在发病中的作用是子痫前期病因学与病理生理学研究的最新进展之一。     

重度子痫前期产妇血清和胎盘组织中脂蛋白脂酶的表达及意义

目的:探讨脂蛋白脂酶(LPL)在重度子痫前期产妇血清和胎盘组织中的表达及意义。方法:收集2008年9月至2009年5月在上海市第六人民医院产科住院并分娩的重度子痫前期产妇26例为子痫前期组,选择同期分娩的正常产妇30例为对照组。用酶法检测血脂浓度,ELISA法检测血清LPL浓度,RT-PCR法和Western blot法检测胎盘组织LPL基因和蛋白的表达。结果:①子痫前期组血脂浓度明显高于对照组(P<0.05)。②子痫前期组血清LPL浓度及胎盘组织LPL基因和蛋白表达水平均明显低于对照组(P<0.05)。③子痫前期组血清LPL浓度与胎盘组织LPL蛋白表达水平呈正相关(r=0.421,P<0.05),与甘油三酯(TG)呈负相关(r=-0.668,P<0.01),与高密度脂蛋白(HDL)呈正相关(r=0.876,P<0.01)。结论:子痫前期患者机体脂蛋白脂酶表达降低,脂蛋白脂酶可能通过参与高血脂代谢在子痫前期发病过程中起着重要作用。     

Locomotion of Human Neutrophils in Response to Plasma and Serum of Women with Preeclampsia

Objective: To examine whether the previously reported neutrophil activation which occurs in the maternal circulation of women with preeclampsia is due to a factor(s) in plasma/serum which increases neutrophil locomotion.

Methods: The locomotory responses of human neutrophils to plasma/serum of women with preeclampsia were compared with normal, pregnant women matched for maternal age and gestational age at blood sampling. Twelve patients from each group were studied. Preeclampsia was defined as persistent diastolic blood pressure > 90 mm Hg, with proteinuria > 0.3 g/24 h, in patients who were normotensive before 20 weeks gestation. A simple microcomputer-based system for real-time, analysis of neutrophil behavior in vitro was used to measure the dynamic parameters of locomotion. Locomotion of human neutrophils in response to plasma, serum (20%), and heat-inactivated serum from both groups of patients was measured. Serum was heat inactivated to destroy complement-derived chemotactic activity.

Main Outcome Measures: Speed, persistence, and diffusion coefficient to describe the behavior of randomly moving cells.

Results: A significant stimulation of neutrophil locomotion in response to plasma, serum (20%), and heat-inactivated serum occurred in both groups compared with control cells incubated with phosphate-buffered saline; however, no significant differences were found in response to these three stimuli between the two groups of patients.

Conclusions: These studies found no evidence of a humoral factor in the plasma/serum of women with preeclampsia which alters the locomotion of human neutrophils. The existence of such a potential factor may be revealed, however, upon examination of subsequent stages of neutrophil activation, namely adhesion to endothelial cells and/or neutrophil metabolic activation.     

Endothelin Converting Enzyme (ECE) Activity in Normal Pregnancy and Preeclampsia

Objective: Enhanced production of endothelin‐1, due to endothelial cell dysfunction has been considered to be the cause of increased plasma levels of endothelin‐1 in preeclampsia. The present study was aimed at analyzing endothelin‐converting‐enzyme activity, (which reflect the production rate of endothelin‐1 (ET‐1) from big endothelin‐1 (big ET‐1)), big endothelin‐1, and endothelin‐1 concentrations from women with preeclampsia compared to normal pregnant women. Moreover, we analyzed plasma levels of these substances longitudinally throughout normal pregnancy. Study design: Twenty‐nine pregnant healthy women were recruited to the study. Blood samples were obtained at 18, 28, and 38 weeks gestation and six weeks postpartum. Twenty‐seven women with preeclampsia were included. Blood samples were taken at diagnosis (average 35 weeks gestation; range 27–39 weeks) and six weeks postpartum. Endothelin‐1 was analyzed by enzyme linked immunoassay (ELISA) and big‐ET‐1 by radioimmunoassay (RIA). Endothelin‐converting‐enzyme activity was measured using big endothelin‐1 as a substrate and thiorphan as an inhibitor of serum neutral endopeptidase. The amount of endothelin‐1 generated during one hour was measured by RIA. Mean ± SEM is given. Results: In normal pregnancy endothelin‐1 concentrations at 38 weeks and postpartum were increased by 30% (p < 0.01) and 50% (p < 0.001), respectively compared with the second trimester values. Endothelin‐converting‐enzyme activity did not change. At diagnosis endothelin‐1 was higher in women with preeclampsia than in the controls at 38 weeks (0.96 ± 0.07 vs. 0.64 ± 0.06 pmol/L; p < 0.001). Likewise, endothelin‐converting‐enzyme activity was higher in the preeclampsia group (222 ± 15 vs. 172 ± 8 pmol ET/ml/h; p < 0.01). This difference remained at six weeks postpartum. Conclusion: Our findings imply enhanced ET‐1 production in preeclampsia. The elevated endothelin‐converting‐enzyme activity postpartum may indicate an inherent endothelial dysfunction predisposing to preeclampsia or that preeclampsia may cause irreversible changes in endothelial function.     

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.     

Factors effective in the prevention of Preeclampsia:A systematic review

Due to the morbidity and mortality of mothers and fetuses developed by preeclampsia, preventive approaches have always been taken into account in high risk individuals. Systematic review studies contribute to make a better decision about the results of such studies. Accordingly, this study strived to systematically study the factors effective in the prevention of preeclampsia. The MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, and Proquest databases were systematically reviewed between January 2000 and May 2019. The quality of the studies was analyzed using the CONSORT checklist. A study was conducted on 29 quality interventional studies; 28 of which were RCT type, and on various factors such as anticoagulants (heparin, enoxaparin, Dalteparin and Nadroparin), aspirin, paravastatin, nitric oxide, yoga, micronutrients Such as l-Arginine, Folic Acid, Vitamin E and C, Phytonutrient, Lycopene and Vitamin D alone or in combination with Calcium. The results of this study showed that low molecular weight heparin, enoxaparin, PETN, yoga, L arginine, folic acid, vitamin D prevented preeclampsia alone or combined with calcium.     

The Role of Serum Iron Levels in Diagnosing Hypertensive Disorders in Pregnancy

Objective: The clinical use of serum iron in the assessment of 46 patients of mixed parity with hypertensive pregnancies was compared to other laboratory parameters and the possible relationship between maximum serum iron levels and pregnancy outcome was assessed.

Methods: Serum iron concentrations measured in 46 women admitted because of pregnancy-induced hypertensive disorders were related to pregnancy outcome and compared to a control group consisting of 128 normotensive women with uncomplicated pregnancies.

Results: Serum iron levels were significantly higher and birth weights were significantly lower in patients with established preeclampsia (PE) as compared to patients with gestational hypertension (GH) or normotensive control women.

Conclusions: Both serum uric acid as well as serum iron correlate positively with the presence of hypertensive disorders in pregnancy, however, unlike serum uric acid, serum iron was shown (a) to be significantly different between the GH and the PE groups, and (b) to correlate negatively with birth weight.