Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy.

Background and Objective: The occurrence of diabetic ketoacidosis (DKA) during pregnancy is considered a medical emergency. The aims of the present study were to evaluate the incidence of DKA in pregnant and non-pregnant women with diabetes; to compare the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women; and to show a case of euglycemic DKA in pregnancy. Methods: The subjects consisted of 90 cases of DKA in pregnant women with diabetes and 286 cases of non-pregnant female inpatients receiving treatment for diabetes during 2001 to 2005 in our hospital. The incidence of DKA in pregnant and non-pregnant women with diabetes and the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women were compared. Results: DKA had a higher incidence in pregnant women with diabetes (8/90, 8.9%) than in non-pregnant women with diabetes (9/286, 3.1%) (P < 0.05). The blood glucose levels (mmol/L) in pregnant women with DKA were significantly lower than those in non-pregnant women with DKA (16.3 +/- 4.6 vs 27.5 +/- 4.8, P < 0.001). A case of euglycemic DKA in pregnancy was described whose serum glucose level was only 6.9 mmol/L. Conclusions: DKA in pregnant women with diabetes may occur more frequently, and at lower blood glucose levels than DKA in non-pregnant women with diabetes.     

Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy

Background and Objective:  The occurrence of diabetic ketoacidosis (DKA) during pregnancy is considered a medical emergency. The aims of the present study were to evaluate the incidence of DKA in pregnant and non-pregnant women with diabetes; to compare the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women; and to show a case of euglycemic DKA in pregnancy.
Methods:  The subjects consisted of 90 cases of DKA in pregnant women with diabetes and 286 cases of non-pregnant female inpatients receiving treatment for diabetes during 2001 to 2005 in our hospital. The incidence of DKA in pregnant and non-pregnant women with diabetes and the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women were compared.
Results:  DKA had a higher incidence in pregnant women with diabetes (8/90, 8.9%) than in non-pregnant women with diabetes (9/286, 3.1%) ( P  < 0.05). The blood glucose levels (mmol/L) in pregnant women with DKA were significantly lower than those in non-pregnant women with DKA (16.3 ± 4.6 vs 27.5 ± 4.8, P  < 0.001). A case of euglycemic DKA in pregnancy was described whose serum glucose level was only 6.9 mmol/L.
Conclusions:  DKA in pregnant women with diabetes may occur more frequently, and at lower blood glucose levels than DKA in non-pregnant women with diabetes.     

Maternal and fetal serum nitric oxide (NO) concentrations in normal pregnancy, pre-eclampsia and eclampsia.

OBJECTIVES: To measure the maternal and fetal serum concentrations of total nitrites and nitrates (as an index of nitric oxide production) in normal pregnancy, pre-eclampsia and eclampsia. DESIGN: Three groups of women were studied cross-sectionally: late pregnant women with pre-eclampsia and eclampsia (n=31); normal late pregnant women (n=32); and age-matched healthy non-pregnant women (n=21). Venous blood samples were collected from all women and both maternal and umbilical venous samples were collected from pregnant women. METHODS: Blood samples were assayed for nitric oxide (NO) production by Greiss reaction which measures the combined oxidation products of NO (total nitrites and nitrates). RESULTS: There was a significant increase in serum total nitrites and nitrates concentrations in normal pregnant women than in the serum of age-matched normal non-pregnant women (P<0.0001). Significantly higher total nitrites and nitrates levels were found in the maternal sera of the pre-eclamptic and eclamptic women compared with those of normal pregnant women (P<0.0001). Also, fetal blood levels of total nitrites and nitrates were significantly increased in pre-eclampsia and eclampsia compared with those of normal pregnancy (P<0.0001). CONCLUSIONS: (1) Serum nitric oxide (NO) production is increased in normal pregnancy than in the normal non-pregnancy. (2) Maternal and fetal serum NO levels are increased significantly in pre-eclampsia and eclampsia, which possibly represents a compensatory/protective mechanism to maintain blood flow and limit platelets aggregation in the fetal-maternal circulations. (3) The increase in NO production is directly related to the severity of pre-eclampsia; this would be of diagnostic significance for the prediction of the severity of this syndrome.     

妊娠期妇女糖耐量胰岛素 胰岛素抵抗变化规律的观察

目的：观察不同孕期孕妇的糖耐量、胰岛素释放、胰岛素抵抗，以了解妊娠期糖代谢变化的规律。方法：对早、中、晚孕期三组共１２４例正常孕妇及２３例健康非孕妇女作为对照组进行７５ｇ口服糖耐量试验（ＯＧＴＴ）。其中１３例自早孕期开始纵向跟踪。以胰岛素曲线下面积与血糖曲线下面积的比值反映胰岛素抵抗（ＩＳＲ）。结果：各个孕期的空腹血糖无明显差异，但均显著低于非孕期（Ｐ＜００５），服糖后血糖、胰岛素释放、胰岛素抵抗均随孕期延长逐渐上升。于中孕期开始出现显著性改变，至晚孕期进一步加重均显著高于孕早期（Ｐ＜００５）。结论：中孕期是妊娠期糖代谢开始出现根本性变化的时期，于此期对孕妇进行血糖监测，有助于妊娠期糖尿病（ＧＤＭ）的早期诊断。晚孕期是ＧＤＭ最容易发生的时期     

Peripheral blood neutrophils reactive oxygen intermediates (ROI) production in early pregnancy complicated by diabetes mellitus type I

The components of maternal innate immune system are activated in pregnancy. Increased number of circulating neutrophils and monocytes, reactive oxygen intermediate production (ROI), increased expression of the adhesion molecules can be observed. The activation status and neutrophils response to stimulators in pregnant diabetic women's comprise, to some extend, both situations pregnancy and diabetes, combined effect of both seems to be very intriguing. AIM OF STUDY: Evaluation production of ROI on peripheral blood neutrophils in early pregnancy of diabetic mothers. MATERIAL: 12 pregnant diabetic women demonstrating good glycemic control and without major complications before pregnancy were studied at 8-12 weeks of first gestation, 11 healthy pregnant women match for weeks of gestation, age and parity; 11 healthy non-diabetic women; 13 diabetic, non-pregnant women, were also studied. METHODS: ROI production was evaluated with chemiluminescence method using standard stimuli fMLP, PMA, OZ and also after 15 min. priming with TNF-alpha. We used MLX Microtiter Plate Luminometr DYNEX, USA. with computer program Revelation 97. For statistic analysis Fisher, Kolmogorow-Smirnow and Wilcoxon tests were used (p < 0.05). RESULTS: 1. Peripheral blood neutrophils of healthy pregnant, diabetic and pregnant diabetic women independently from the stimuli used showed an increase in ROI production 2. Peripheral blood neutrophils change their activity, evaluate by ROI production during pregnancy, diabetes and pregnancy complicated by diabetes. 3. Peripheral blood neutrophils of pregnant diabetes women do not show expected impairment of their function. CONCLUSIONS: Diabetes type 1 with good glycemic control and pregnancy, change the production of ROI by peripheral blood neutrophils but these events do not sum up in diabetic pregnancies.     

Increased lipolysis in non-obese pregnant women studied in the third trimester

BACKGROUND: During pregnancy, metabolic adaptation takes place in the mother to provide for the supply of substrates to the growing fetus. OBJECTIVE: To determine rates and endocrine regulation of lipolysis and glucose production (GPR) in late pregnancy. DESIGN: Energy substrate production was measured in healthy pregnant women by use of stable isotope-labelled compounds. SETTING: University Hospital, Uppsala, Sweden. SAMPLE: Eight healthy non-obese, non-smoking women with normal pregnancies were studied at 33-36 weeks of gestation after an overnight (12-14 hours) fast. METHODS: Rates of glycerol and glucose production were analysed by gas chromatography/mass spectrometry following constant rate infusion of [1,1,2,3,3-(2)H(5)]-glycerol and [6,6-(2)H(2)]-glucose. MAIN OUTCOME MEASURE: Glycerol and glucose production in the third trimester. RESULTS: The mean rate of glycerol production, reflecting lipolysis, was 3.06 (0.66) and the mean GPR was 13.2 (1.5) micromol kg(-1) minute(-1) [2.38 (0.27) mg kg(-1) minute(-1)]. There was a correlation between rate of glycerol production and GPR (r = 0.75, P = 0.033). Fasting insulin levels correlated inversely with both the rate of glycerol production (r = -0.85, P = 0.008) and GPR (r = -0.78, P= 0.021). CONCLUSIONS: Our results show that lipolysis is markedly increased during late pregnancy compared with reported data for non-pregnant women. The data also confirm the occurrence of an increased GPR in pregnant women. The finding of a correlation between rate of glycerol production and GPR corroborates the view that lipolysis promotes gluconeogenesis. Although late gestation is associated with insulin resistance, the results show that insulin plays a regulatory role both in lipolysis and glucose production.     

Oxidative stress in diabetic pregnancy: SOD, CAT and GSH-Px activity and lipid peroxidation products.

Diabetic pregnancy is often complicated by a number of pathological conditions among which is increased oxidative stress. This study was conducted to investigate the parameters of oxidative stress in 90 patients divided into the three groups: pregnant women with Type 1 diabetes mellitus, healthy pregnant women and non-pregnant women. In pregnancy groups all parameters were followed in 1st, 2nd and 3rd trimester. Diabetic control was monitored by fasting blood glucose and glycosylated hemoglobin (HbA(1c)) and these values, as well as measured biochemical parameters (urea, creatinine, total cholesterol and uric acid), were appropriate throughout the study. The concentration of TBARS, as a measure of lipid peroxidation, and activity of antioxidant enzymes superoxide dismutase (Cu, Zn-SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) were investigated in hemolysate of erythrocytes. TBARS concentration increased significantly in pregnant women when compared with control group (non-pregnant women), as well as in pregnant diabetics compared with healthy pregnant women. The SOD activity was gradually increased in the group of normal pregnant women vs. non-pregnant group, but decreased significantly in the group of diabetic pregnant women. Catalase activity was significantly increased only in 3rd trimester diabetic pregnant women. Increased lipid peroxidation and reduced antioxidant status, despite good diabetic control, show that pregnant women are exposed to oxidative stress to a greater degree than controls.     

Serum levels of 1,5-anhydro-D-glucitol during the normal and diabetic pregnancy and puerperium

In 25 normally non-pregnant women, 543 normally pregnant women and 75 pregnant women with diabetes mellitus or gestational diabetes mellitus, the relationship between the serum concentration of 1,5-anhydro-D-glucitol (1-deoxy-glucose) and carbohydrate metabolism was studied. The concentration of 1,5-anhydro-D-glucitol was estimated by means of gas-liquid chromatography. In normally non-pregnant women the concentration was found to be 18.6 +/- 5.2 mg/l (mean +/- SD). During the normal pregnancy, from 9 weeks of gestation, a steadily decreasing concentration was observed as the pregnancy progressed and the lowest value (10.2 +/- 4.6 mg/l) was found in the third trimester. After 5 days of puerperium the concentrations were found to be 10.8 +/- 3.7 mg/l. On the 30th day postpartum, the level was within the range for non-pregnant subjects. The values in pregnant women with diabetes mellitus and gestational diabetes mellitus were mostly below 10 mg/l throughout the entire pregnant period. The 1,5-anhydro-D-glucitol concentration was not affected by meals or oral glucose loading. A concentration below 10 mg/l was found in 36% of the normally pregnant women, where oral glucose tolerance tests and measurement of glycohemoglobin were shown to be within the normal range. The present study suggests that a change of 1,5-anhydro-D-glucitol level during pregnancy may reflect a mild alteration of carbohydrate metabolism that goes undetected by all the other diabetic indicators.     

A study of alpha-human atrial natriuretic peptide in normal pregnancy and in pre-eclampsia.

The object of this study was to compare plasma levels of alpha-human atrial natriuretic peptide (ANP) in patients with pre-eclampsia, normal pregnant women, and healthy non-pregnant women. This was an observational study carried out at Llandough Hospital, Cardiff, Wales on 85 age-matched women divided into three groups (30 patients with pre-eclampsia, 30 healthy pregnant women in the third trimester and 25 healthy non-pregnant women). Plasma ANP concentration was measured between 14.00 and 16.00 hours, in the recumbent position using pre-extraction radioimmunoassay. The following measurements were also performed: blood urea, serum creatinine, serum uric acid and serum sodium in all study subjects and 24-hour urinary protein in pregnant women. All women were eating a normal diet. It was shown that plasma ANP levels were significantly higher in healthy pregnant women in the third trimester of pregnancy than in non-pregnant women (18.12 +/- 7.36 vs. 13.68 +/- 6.41 pmol/l, P < 0.05). This difference was also observed in pre-eclamptic women (17.6 +/- 12.06 pmol/l vs. 13.68 +/- 6.41 pmol/l, P < 0.05) but the plasma hormone levels were not significantly different from healthy pregnant women. In all pregnant women, plasma ANP level was related to the gestational age and birth weight as shown by the regression coefficient (+ 0.39,-0.26 respectively, P < 0.05). In pre-eclamptic patients, there was no relationship between the severity of hypertension, assessed by the level of systolic and diastolic blood pressure, serum uric acid level and amount of proteinuria, and log (plasma) ANP levels. There was a significant negative correlation between serum sodium level and log (plasma) ANP level in all pregnant subjects (r=- 0.51, P < 0.05). Compared with non-pregnant women, plasma ANP levels are increased during the third trimester of normal pregnancy and in pregnancies complicated by pre-eclampsia. A relationship between ANP and pre-eclampsia seems unlikely but ANP is probably involved in the regulation of sodium and water balance in normal pregnancy and in pre-eclampsia.     

Platelet angiotensin II binding sites in normotensive and hypertensive women

Specific binding of angiotensin II (AII) to platelets was measured in 89 women, 25 nulliparous non-pregnant women and 64 primigravida in the third trimester of pregnancy. There was significantly lower binding in the 25 pregnant women who were normotensive (2.3 fmol/10(9) cells) when compared with the non-pregnant women (9.0 fmol/10(9) cells P less than 0.001). Significantly higher platelet AII binding levels were found in the 39 women who had pregnancy induced hypertension (PIH) (5.5 fmol/10(9) cells) when compared with the 25 normotensive pregnant women (P less than 0.001). Of the 39 women with PIH, platelet AII binding was higher in the 23 women who had pre-eclampsia (7.0 fmol/10(9) cells), when compared with the 16 who had non-proteinuric PIH, (4.6 fmol/10(9) cells) although the difference was not statistically significant (P less than 0.04). The pressor response to AII is also diminished in pregnancy, yet less so if pregnancy induced hypertension develops. Platelets may provide a readily accessible tissue with which to study AII responsiveness in pregnancy.     

妊娠合并系统性红斑狼疮患者血清白细胞介素6、8检测的临床意义

目的探讨妊娠合并系统性红斑狼疮(SLE)稳定期的患者血清中白细胞介素6(IL-6)、白细胞介素8(IL-8)水平变化的临床意义.方法采用固相酶联免疫反应法,对14例SLE稳定期(仅服用小剂量强的松)患者(SLE组),12例正常孕妇(正常孕妇组)和12例正常未孕妇女(正常未孕组)的血清IL-6、IL-8水平进行检测.结果 SLE组患者的血清IL-6、IL-8水平分别为(20.31±5.70) ng/L和(48.80±9.17) ng/L;显著高于正常孕妇组[IL-6、IL-8水平分别为(8.40±2.49) ng/L和(21.15±5.21) ng/L,P＜0.01]和正常未孕组[IL-6、IL-8水平分别为(6.14±0.86) ng/L和(17.71±4.43) ng/L,P＜0.01].而正常孕妇组与正常未孕组之间比较,差异无显著性(P＞0.05).结论妊娠合并SLE患者的血清IL-6、IL-8水平变化,可能对判断病情进展及预后有重要作用.     

Glycosylated Haemoglobin in Pregnancy

Summary: A study of the use of glycosylated haemoglobin (glyco Hb) levels to identify the pregnant woman with abnormal glucose tolerance and as an adjunct in the control of the diabetic pregnant patient was undertaken.
There was no difference in glyco Hb levels in pregnant women with normal or abnormal glucose tolerance. Mean glyco Hb levels were found to increase with the progress of pregnancy.
Serial estimations of glyco Hb level in diabetic pregnant women reflected the degree of overall control, but were inadequate, when compared with serial glucose estimations, to assess the often rapidly-changing requirements of pregnancy.     

Insulin pump therapy for pregnancy: a primer

Current knowledge and advances in insulin formulations, insulin pump technology, and blood glucose monitoring techniques have improved practitioners’ ability to achieve diabetic people’s blood glucose targets. Practitioners and pregnant women should bear in mind that important differences exist in glucose metabolism during pregnancy and require a different approach from non-pregnant people to avoid pregnant women’s experience being adversely affected. Insulin pump therapy, if used skillfully by practitioners and their pregnant patients, can be especially beneficial for some diabetic women during their pregnancies. Women’s healthcare practitioners should endeavor to be familiar with this therapy, even if they are not experts in its full complexity.     

Decreased maternal lipolysis in intrauterine growth restriction in the third trimester

OBJECTIVE: Intrauterine growth restriction (IUGR) is a common complication of pregnancy. There are many possible aetiologic factors of maternal, placental and/or fetal origin. Often there is no known explanation. The aim of this study was to investigate whether a reduction in maternal energy substrate production could be one of the factors involved in IUGR. DESIGN: Measurement of maternal energy substrate production and glucoregulatory hormones in women with growth-restricted fetuses. SETTINGS: University Hospital, Uppsala, Sweden. POPULATION: Ten healthy pregnant women with IUGR were compared with eight recently reported healthy women with normal pregnancies. The women were studied at 35.4+/-1.6 weeks of gestation after an overnight fast. METHODS: Rates of glycerol and glucose production were analysed by gas chromatography/mass spectrometry following constant-rate infusion of [1,1,2,3,3-(2)H5]glycerol and [6,6-(2)H2]glucose. MAIN OUTCOME MEASURE: Third trimester glycerol and glucose production. RESULTS: Glycerol production, reflecting lipolysis, was lower in the women with IUGR than in those with normal pregnancies, 2.36+/-0.58 versus 3.06+/-0.66 micromol kg-1 minute-1 (P=0.033), whereas there was no difference in rate of glucose production (glucose production rate [GPR]), 12.1+/-1.5 versus 13.2+/-1.5 micromol kg-1 minute-1 (P=0.23). Plasma glycerol levels were increased in the women with IUGR (P=0.008). CONCLUSIONS: Lipolysis is lower in pregnancies complicated by IUGR as compared with normal pregnancies. Increased lipolysis during pregnancy provides substrate for maternal energy metabolism, which spares glucose for the fetus. A reduced maternal production of energy substrate could be one of several factors underlying IUGR. A lack of relationship between insulin levels and either lipolysis or GPR suggests defective regulation of energy substrate production in this group of pregnant women.     

Abnormal cytokine levels in non-pregnant women with a history of recurrent miscarriage

OBJECTIVE: To compare cytokine levels in serum from non-pregnant women with a history of recurrent miscarriage with those found in non-pregnant women with no such history. STUDY DESIGN: Two patient groups were enrolled into the study. Group 1 comprised 25 non-pregnant women with no history of recurrent miscarriage. Group 2 comprised 50 non-pregnant women who had a history of at least three previous miscarriages. Fifteen of these women have since become pregnant again--10 had a successful pregnancy and five miscarried. Serum levels of IL-4, IFN gamma, IL-12 and IL-18 were measured. RESULTS: Results showed IFN gamma ( 0.68 +/- 0.72 versus 0.45 +/- 0.29 P < 0.05) and IL-12 levels (66 +/- 25 versus 51 +/- 24 P < 0.05) were significantly higher in Group 2 compared to Group 1. Levels of IL-18 were significantly lower in Group 2 patients (318 +/- 140 versus 246 +/- 219 P < 0.05). Of the 15 women who became pregnant, those who miscarried again had significantly higher IL-18 levels when not pregnant than those women whose next pregnancies went successfully to term (547 +/- 20 versus 274 +/- 129 P < 0.05). CONCLUSION: These results suggest that women with a history of recurrent miscarriage can have abnormal cytokine expression even when not pregnant. This may influence the potential for future successful immune modulatory therapy.     

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。     

Plasma concentrations of motilin and somatostatin are increased in late pregnancy and postpartum.

OBJECTIVE: To examine plasma levels of motilin and somatostatin throughout pregnancy. DESIGN: Prospective observational study. SETTING: University Hospital, Norway. SUBJECTS: Eight healthy pregnant women (aged 24-38 years) six of them primigravidae and eight healthy non-pregnant women of similar age with ovulatory menstrual cycles. INTERVENTIONS: In the pregnant women blood samples were obtained at 4-week intervals from 8 weeks gestation throughout pregnancy and again at 5 days and 28 days postpartum. In the non-pregnant controls blood samples were obtained on cycle days 4, 7, 10, 13, 14, 15, 18, 21 and 24. MAIN OUTCOME MEASURES: Plasma levels of motilin and somatostatin. RESULTS: Plasma concentrations of both motilin and somatostatin rose continuously during pregnancy, and motilin levels increased still further to a peak of 165.1 (SE 35.8) pmol/l at 5 days postpartum. Plasma motilin levels were significantly higher during the third trimester and at 5 days postpartum compared with non-pregnant controls (P less than 0.0001). The highest plasma somatostatin levels were found at 40 weeks gestation and at 5 days postpartum (mean 32.1 SE 1.1 pmol/l). Somatostatin levels were significantly higher during the second and third trimester and the postpartum period compared with levels in the follicular phase of the non-pregnant controls (P less than 0.0001). CONCLUSIONS: Circulating levels of motilin cannot play a major role in the relaxation of the gut in pregnancy, but somatostatin may play a part in regulating motility.     

Criteria for the oral glucose tolerance test in pregnant and non-pregnant Nigerian women

In order to establish diagnostic criteria for detection of abnormal oral glucose tolerance test (OGTT) in pregnant and non-pregnant Nigerian women, the test was performed in 25 non-pregnant and 60 pregnant non-diabetic women at various trimesters of pregnancy. The upper limit of normal plasma glucose was the same as that from caucasian populations with respect to the fasting values but much less at 60 and 120 min. When compared to the non-pregnant controls, fasting plasma glucose was significantly lower during pregnancy, however, there was no change in glucose tolerance during pregnancy. The possible reasons for these observations are discussed and it would appear that our criteria would be the ideal ones to use for clinical purposes in Nigerian women.     

妊娠高血压综合征患者血浆P-选择素和一氧化氮含量变化及意义

目的　探讨妊娠高血压综合征（妊高征）患者血浆P-选择素和一氧化氮(nitricoxide,NO)含量的变化及其在妊高征发病中的意义。方法　采用酶联免疫吸附法测定36例妊高征患者（妊高征组,其中轻度妊高征患者11例,中重度妊高征患者25例）、18例正常晚孕妇女（正常晚孕组）和19例正常非孕妇女（正常非孕组）血浆P-选择素含量。用镀铜镉还原法测定血浆中代表NO水平的亚硝酸盐及硝酸盐（nitrite and nitrate,NO     

Plasma from preeclamptic women activates endothelial cells via monocyte activation in vitro

In this study we tested whether plasma from preeclamptic women contains factors that can activate endothelial cells in the presence of monocytes in vitro. Plasma from preeclamptic women (n=6), healthy pregnant women (n=6) and nonpregnant women (n=6) was incubated with mono-cultures and co-cultures of human umbilical vein endothelial cells (HUVEC) and monomac-6 monocytes. Reactive oxygen species (ROS) production and ICAM-1 expression were measured using flow cytometry. Whether scavenging of ROS by superoxide dismutase and catalase inhibited HUVEC ICAM-1 expression was also investigated. We found that in HUVEC co-cultured with monomac-6 cells but not in HUVEC cultured alone, ICAM-1 was upregulated after incubation with plasma from preeclamptic women but not plasma from non-pregnant women. Also in co-cultures, monomac-6 ICAM-1 was upregulated by plasma from preeclamptic women, while in both mono- and co-cultures monomac-6 ROS production was upregulated by plasma from pregnant and preeclamptic women, compared with plasma from non-pregnant women. Scavenging of ROS by superoxide dismutase and catalase resulted in a further upregulation of HUVEC ICAM-1 after incubation with plasma from preeclamptic women, compared with incubation without superoxide dismutase and catalase. These results show that endothelial cells in vitro are activated by plasma of preeclamptic women only if they are co-cultured with monocytes. This upregulation appeared not to be due to extracellular ROS production by monocytes or HUVEC, pointing to involvement of other mechanisms. Our data suggest that plasma of preeclamptic women activates monocytes, and that these monocytes subsequently activate endothelial cells.