Serum leptin concentrations during pregnancy and their relationship to fetal growth

Objective: To test the hypothesis that maternal and cord serum leptin concentrations correlate with birth weight of infants.Methods: Pregnant women (n = 135) of low socioeconomic status who delivered full-term infants were selected from more than 1500 women who participated in a study to identify factors related to fetal growth restriction (FGR). They were divided into two groups based on their infants being classified as having FGR (n = 66) or not (n = 69), and each group was divided further into three subgroups based on prepregnancy body mass index (BMI): less than 19.8, 19.8–28.9, and 29 or more. Sample estimations indicated that 20 subjects per subgroup would be adequate to detect 50% difference in leptin concentrations.Results: Mean maternal serum leptin concentrations adjusted for BMI were highest at approximately 22–27 weeks' gestation (29.8 ng/mL) and declined thereafter until term (25.2 ng/mL). Leptin concentration and prepregnancy BMI correlated significantly. We found neither significant difference in leptin concentrations between the subjects with and without FGR infants nor significant correlation between maternal leptin concentrations and birth weight of infants. Mean cord serum leptin concentration (10.8 ng/mL) was lower than maternal concentrations and correlated significantly with birth weight (r = .61, P < .001).Conclusion: Our findings suggest that maternal leptin concentration during pregnancy is not an accurate indicator of fetal growth. Cord serum leptin concentrations were lower than maternal serum concentrations and correlated significantly with birth weight.     

The hypertensive disorders of pregnancy: their contribution to maternal mortality

The hypertensive disorders of pregnancy and their complications are the major cause of maternal mortality in the developed world and the third most common cause of maternal mortality in the world. In this paper the extent of the problem is described and factors affecting pre-eclampsia and eclampsia are described. Ways of reducing deaths from these causes are suggested.     

Fetal and maternal leptin in pre-gestational diabetic pregnancy

ObjectiveTo compare maternal and fetal leptin among women without diabetes, women with type 1 diabetes, and women with type 2 diabetes.MethodsIn a prospective study at the National Maternity Hospital, Dublin, 40 women with type 1 diabetes, 10 with type 2 diabetes, and 30 without diabetes were enrolled between July 2006 and July 2008. Maternal (36-week) and cord blood leptin was measured by enzyme-linked immunoassay.ResultsNo difference was found in maternal leptin among the groups: without diabetes (mean, range): 325 pg/mL, 36–1492 pg/mL; type 1 diabetes: 343.2 pg/mL, 55.5–1108.2 pg/mL; type 2 diabetes: 202.2 pg/mL, 35.1–1553.3 pg/mL (P > 0.05). Leptin levels were higher among fetuses of women with type 1 (223 pg/mL, 25.7–810 pg/mL) and type 2 (447.2 pg/mL, 136.3–679 pg/mL) diabetes than among women without diabetes (80.3 pg/mL, 27.3–623.1 pg/mL; P < 0.05). The single significant predictor of fetal leptin for the whole cohort was maternal body mass index (BMI; r = 0.39, P = 0.01). Only third-trimester glycosylated hemoglobin (HbA1c) was significantly related to fetal leptin after controlling for maternal BMI among women with diabetes (r = 0.28, P = 0.04).ConclusionFetuses of women with diabetes might have some degree of leptin resistance. This might be important in appetite regulation in extrauterine life.     

Serum leptin levels in hypertensive disorder of pregnancy

OBJECTIVE: To determine serum leptin levels in hypertensive disorder of pregnancy. MATERIALS AND METHODS: In this prospective, cross-sectional, case control study, we measured serum leptin levels of 58 hypertensive pregnant women and 54 normal pregnant women. We also did blood and urine analysis for the evaluation of the severity of hypertensive disorder of pregnancy. The patients were followed until after delivery and information about labour was recorded. We analysed the difference and correlation between anthropometric measures, hormonal and biochemical parameters, and serum leptin levels in two groups. RESULTS: In the study group, serum leptin levels were determined to be higher than the control group. Neonatal birth weight was significantly lower in the hypertensive group. While the serum uric acid, urea, aspartate aminotransferase, fibronectin, and fasting blood glucose levels were found to be higher, serum total protein and albumin levels were significantly lower among the hypertensive pregnant women. Hypertensive pregnant women were more insulin resistant. Serum leptin levels were highly and positively correlated with serum fibronectin, and C peptide levels. A negative significant correlation was observed between maternal serum leptin levels and neonatal birth weight among the pregnant women having the hypertensive disorders. CONCLUSION: Serum leptin levels in hypertensive pregnant women appear to be higher. The determination of serum leptin levels may be as important as serum fibronectin and C peptide levels in the management of hypertensive disorder of pregnancy. C peptide and insulin may be due to hyperinsulinemia which leads to increased stimulation of leptin production by fatty tissue. Insulin resistance which appears in late pregnancy is more significant especially in pregnancies complicated by preeclampsia.     

母亲妊娠期高血压疾病对新生儿脑发育的影响

目的　探讨母亲妊娠期高血压疾病对新生儿脑发育的影响. 方法　采用颅脑超声测量56例妊娠期高血压疾病母亲的新生儿脑岛面积、周长及新生儿脑回宽度,并与53例同胎龄对照组新生儿相比较. 结果 对照组足月儿脑回宽度低于早产儿,脑岛面积与周长大于早产儿,差异有统计学意义(P<0.01).妊娠期高血压疾病组胎龄34周以上新生儿脑岛周长[胎龄≥37周:(87.43±10.21)mm;胎龄34～37周:(72.59±7.50)mm]与面积[胎龄≥37周:(413.60±90.05)mm2;胎龄34～37周:(285.71±48.62)mm2]明显小于对照组同胎龄新生儿脑岛周长[胎龄≥37周:(102.14±9.97)mm;胎龄34～37周:(78.42±10.14)mm]和面积[胎龄≥37周:(557.08±98.89)mm2;胎龄34～37周:(356.01±93.07)mm2],差异有统计学意义(P<0.05或0.01).妊娠期高血压疾病组小于胎龄儿发生率为30.36%(17/56),其脑回宽度宽于适于胎龄儿,脑岛面积与周长明显减小,差异均有统计学意义.妊娠期高血压疾病组新生儿均有肌张力增高,在新生儿行为神经测定评分时,主动、被动肌张力共8项都未扣分,但行为能力扣分较多,分值明显低于对照组(P<0.01). 结论 母亲妊娠期高血压疾病可造成新生儿脑发育欠佳,可通过颅脑超声测量新生儿脑岛面积、周长及脑回宽度予以评价.     

Hemostasis in hypertensive disorders of pregnancy

We studied parameters of hemostasis reported to be altered with "pure" preeclampsia in hypertensive disorders of pregnancy. Plasma fibronectin, antithrombin, and alpha-2 antiplasmin were measured in normal pregnancies (N = 26) and in pregnancies complicated by preeclampsia (N = 19), hypertension (N = 11), and chronic hypertension with superimposed preeclampsia (N = 11). Preeclampsia, both pure and superimposed, was associated with high fibronectin (P less than .001), low antithrombin III (P less than .001), and low alpha-2 antiplasmin (P less than .05) levels, suggesting endothelial injury, clotting, and fibrinolysis, respectively. Alpha-2 antiplasmin was increased with chronic hypertension (P less than .001), regardless of whether there was superimposed preeclampsia. Fibronectin appeared to be more closely linked with preeclampsia than antithrombin III or alpha-2 antiplasmin and may prove valuable in detecting preeclampsia when evaluating hypertension in pregnancy.     

妊娠期高血压疾病的热点问题讨论

主要讨论内容:1．妊娠高血压疾病的分类;2．早发型子痫前期的处理;3．子痫前期一子痫的解痉治疗;4．小剂量阿司匹林能否预防子痫前期;5．子痫前期患者心衰的处理。     

Maternal serum leptin concentrations do not correlate with cord blood leptin concentrations in normal pregnancy

OBJECTIVE: To determine whether there is a difference in maternal leptin concentration and cord blood concentration, consistent with the hypothesis of a noncommunicating, two-compartement model of fetoplacental leptin regulation. METHODS: Blood samples were collected from 139 women, identified as having an uncomplicated pregnancy, from an antecubital vein at delivery. Cord blood samples were taken from the umbilical vein. Leptin was measured by radioimmunoassay, and its relationship to fetal and maternal anthropometrics was assessed by Spearman correlation. Differences in maternal and cord blood leptin levels between male and female infants were tested with the Mann-Whitney Utest. Maternal and cord blood leptin were compared by the Wilcoxon signed rank test. The outcome measures were maternal and cord blood leptin at delivery, fetal birth weight, length, weight/length ratio, and ponderal index, maternal prepregnancy body mass index, pregnancy weight gain, relative weight gain, and body mass index at delivery. RESULTS: No correlations were found between maternal and cord blood leptin concentrations. Fetal leptin level correlated with birth weight (rho = 0.665; P <.0001), length (rho = 0.490; P <.0001), ponderal index (rho = 0.260; P =.002), and weight/length ratio (rho = 0.625; P <.0001). Median leptin concentrations were higher in female (9.3 ng/mL, range 1.5-34.4 ng/mL) than in male (8.2 ng/mL, range 1.6-38.3 ng/mL) neonates, but this difference was statistically not significant. Logistic regression analysis showed a significant influence on umbilical venous leptin concentration for birth weight (P <.0001) but not for gender. Maternal leptin concentrations were significantly higher than cord leptin concentrations (P <.0005 for the male and female neonates and the entire group). CONCLUSION: There was no correlation between maternal and cord leptin, which supports the hypothesis of a noncommunicating, two-compartment model of fetoplacental leptin regulation.     

Hemolysis in hypertensive disorders of pregnancy.

The hemolysis markers LDH, haptoglobin, bilirubin (serum, urine), urobilinogen (urine), fragmentocytes and free hemoglobin were compared in 166 patients with various degrees of hypertensive disorders of pregnancy and 179 nonhypertensive pregnant controls in a weekly screening program. Early recognition of hemolysis was limited to a period of 1 week before the actual delivery date. In the diagnostic sensitivity, haptoglobin and to a lesser degree unspecific LDH were clearly superior to the other hemolysis parameters. A decreasing platelet count also has to be taken as an indicator of impending hemolysis. Subclinical hemolysis was associated with poorer fetomaternal outcome. With the aid of haptoglobin, LDH and thrombocytes, an incipient HELLP syndrome could be recognized 1-2 days before the complete clinical picture became apparent.     

Lipid peroxidation in hypertensive disorders of pregnancy

The present article discusses potential mechanisms by which lipid peroxidation might contribute to the pathogenesis of hypertensive disorders of pregnancy.     

转化医学与妊娠期高血压疾病

转化医学的核心是从"实验台到临床"的研究模式,对于疾病的预防、诊治和预后评估具有重要意义。文章介绍了转化医学的定义和模式,并从转化医学角度分析妊娠期高血压疾病的研究策略和前景。     

Human maternal and fetal plasma glyceryl trinitrate concentrations

OBJECTIVE: This study was undertaken to determine the maternal and fetal steady-state concentrations of glyceryl trinitrate (GTN) and its dinitrate metabolites during transdermal administration, at the time of fetal blood sampling for obstetric indications. STUDY DESIGN: Transdermal GTN (0.4 mg/h) was applied approximately 2 hours before investigative fetal blood sampling to maintain uterine quiescence. Serial maternal venous (MV) and a single fetal venous (FV) plasma samples were collected and assayed for GTN and its metabolites, 1,2- and 1,3-glyceryl dinitrate. RESULTS: The steady-state MV plasma concentration was 4.3+/-0.84 nmol/L (mean+/-SEM, n=7), and the dinitrate metabolites were detectable in the MV but not quantifiable. GTN was detectable in the FV (n=7) but was not quantifiable as the levels were less than the lower limit of sensitivity of the assay (<1 nmol/L). CONCLUSION: During transdermal GTN administration, the steady-state FV/MV concentration ratio is less than 0.23 at the time of fetal blood sampling.     

Benchmarking and patient safety in hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy are a major cause of morbidity and mortality worldwide. Reliable, published individual patient data from units and countries are lacking. Without these data, clinicians are unable to benchmark their incidence, treatments and outcomes, and patient safety is unable to be routinely assessed. Available data suggest that a notable proportion of the adverse events that occur with hypertensive disease of pregnancy may be preventable. Theory and practice indicate several methods that can offer the possibility of averting these preventable adverse events. These methods include benchmarking outcomes, standardisation of care processes, simulation, and enhancement of patient knowledge. However, data on optimal methods to enhance patient safety and quality of care of pregnant women with hypertensive disease remain limited, and further research is required.