Plasma total homocysteine in uncomplicated pregnancy and in preeclampsia

OBJECTIVES: (a) To establish the reference values for plasma total homocysteine in our pregnant population. (b) To determine the possible association between hyperhomocysteinemia and preeclampsia in our geographical area. STUDY DESIGN: Control-case study with 32 preeclamptic patients and 64 controls without pregnancy complications. Plasma total homocysteine, determined by HPLC (fluorescence detection), was correlated with serum folate and Vitamin B(12) (analyzed by competitive protein binding chemiluminescent assay). Statistical analyses: Mann-Whitney, Wilcoxon and Spearman test (SPSS, 10.0). RESULTS: Homocysteine concentrations in the controls were significantly higher while folate was significantly lower in the third trimester of pregnancy when compared with the second (P<0.0001). Homocysteine and folate values were significantly higher in patients compared with controls in the third trimester (P=0.005 and 0.005, respectively). The OR for preeclampsia in hyperhomocysteinemia was 7.7 (95% CI: 1.7-34.8). CONCLUSION: Pregnant women with hyperhomocysteinemia have a 7.7-fold risk for preeclampsia (CI 95%: 1.7-34.8) compared with normal controls.     

Plasma fibronectin in pregnancy complicated by diabetes mellitus and preeclampsia

OBJECTIVES: The aim of this study was to evaluate concentration of plasma fibronectin (FN) in course of pregnancy complicated by preeclampsia accompanied by diabetes mellitus and to assess whether the concentration of FN depends on the state of carbohydrate metabolism. MATERIAL AND METHODS: The study was carried out in 2 groups: group K--consisting of 35 healthy pregnant women without complications, and group G --consisting of 12 pregnant women, 4 with gestational diabetes mellitus and 8 with pregestational diabetes mellitus, who developed preeclampsia, in course of research, after 37th week of pregnancy. Concentration of FN and Fm--in order to the state of carbohydrate metabolism--was marked in the following: before 33rd week of pregnancy, between 33rd and 37th week of pregnancy and after 37th week of pregnancy. RESULTS: No correlation between concentration of FN and duration of pregnancy in group K was found. Average concentration of FN in the subsequent periods of the pregnancy in group K were similar and have not shown vital, statistical differences. In group G crucial statistical increase in FN concentration along with increase of pregnancy duration was found (r = 0.3860, p < 0.07). No correlation between concentration of FN nor Fm was found in both groups. CONCLUSIONS: The results obtained demonstrate that vascular endothelial damage, as expressed by increase in plasma fibronectin levels, is a condition specific for preeclampsia, preceding its clinical manifestation. Maternal blood concentrations of FN do not depend on the state of carbohydrate metabolism estimated by concentration of Fm.     

子痫前期再妊娠问题

患有子痫前期再次妊娠女性为子痫前期的高危人群,再次妊娠时面临诸多问题,应给予高度重视。提高产前保健水平和产科诊治能力是临床重要课题,努力做到早预防、早发现以及早治疗。     

Plasma fibronectin receptor levels during pregnancy complicated by preeclampsia and abruptio placentae.

The level of human fibronectin receptor (FNR) in plasma was measured by enzyme-linked immunosorbent assay in samples from normal pregnant women in the 1st trimester (n = 5), 2nd trimester (n = 7), 3rd trimester (n = 23), normal postpartum women day 1 (n = 4), day 2 (n = 5), day 3 (n = 8), nonpregnant women (n = 18), 20 preeclamptic patients in the 3rd trimester, and 8 patients with abruptio placentae in the 3rd trimester. In normal pregnancy, the mean value of FNR was 1.4 +/- 0.4 micrograms/ml in the 1st, 1.4 +/- 0.2 micrograms/ml in the 2nd, and 1.9 +/- 0.3 micrograms/ml (p less than 0.05) in the 3rd trimester. FNR values increased with pregnancy. During the puerperium, its level decreased with time, being 1.4 +/- 0.5 micrograms/ml (p less than 0.01) on day 1, 1.0 +/- 0.3 micrograms/ml on day 2, and 0.8 +/- 0.2 micrograms/ml on day 3. The level in preeclamptic patients was 2.0 +/- 0.4 micrograms/ml, and that in abruptio placentae was 2.7 +/- 0.4 micrograms/ml. There were significant differences between the levels in abruptio placentae versus preeclampsia (p less than 0.05) and 3rd-trimester normal pregnant women (p less than 0.01). In the immunohistochemical study, the surface of normal decidual cells stained weakly for FNR, and the decidual cell membranes of the cases of preeclampsia stained moderately or strongly. Decidual cells and their extracellular matrix close to hematomas of abruptio placentae stained very strongly for FNR.(ABSTRACT TRUNCATED AT 250 WORDS)     

Second pregnancy outcomes following preeclampsia in a first pregnancy.

OBJECTIVES: We compared second pregnancy outcomes among women with and without preeclampsia in their first pregnancies who all had second pregnancies without preeclampsia. METHODS: One hundred thirty women with and 6148 without preeclampsia in their first pregnancies, who all had nonpreeclamptic second pregnancies, were included. Outcomes, including delivery gestational age, birthweight, small-for-gestational-age (SGA), and preterm delivery were compared. RESULTS: Overall, second pregnancy outcomes were not different between women with and without preeclampsia in their first pregnancy. However, when women were stratified by gestational timing of preeclampsia, women with preeclampsia at < 34 weeks (N = 22) had smaller infants and delivered earlier in their second nonpreeclamptic pregnancy compared to women with later preeclampsia (N = 108) or no preeclampsia in the first pregnancy. Women with early preeclampsia also had an increased risk of prematurity (< 37 weeks) in second pregnancies that persisted after controlling for confounding factors [Odds ratio (OR = 3.2)]. DISCUSSION: Second, nonpreeclamptic pregnancy outcomes are different between women with previous early preeclampsia and controls but not between late preeclampsia and controls. These findings support other epidemiological data indicating differences between early and late onset preeclampsia as well as a potential relationship of preeclampsia and spontaneous preterm birth.     

Twin pregnancy and preeclampsia

INTRODUCTION: Preeclampsia is a pregnancy-specific disorder of humans which rates among one of the major cases of maternal and fetal morbidity and mortality. Etiology of preeclampsia is still largely unraveled and treatment is syndrome specific. OBJECTIVE: Evaluation of the incidence of preeclampsia in twin pregnancies and comparison of selected clinical characteristics among preeclamptic and non-preeclamptic twin pregnancy patients. METHODS: Retrospective analysis of 194 normotensive and 25 preeclamptic patients with twin pregnancies admitted to the Lublin State Hospital Nr 4 between January 1st 1992 and December 31st 1997. Patients were matched for gravidity, parity, maternal age and selected biochemical parameters. RESULTS: Preeclampsia occurred two times more frequently in nulliparous women (68% vs 32%). Gravidas with preeclampsia had significantly higher serum uric acid levels than their non-preeclamptic counterparts (6.7 +/- 0.3 vs 4.3 +/- 0.1; p < 0.001). Hypertension, proteinuria and edema coexisted concomitantly in 52% of preeclamptic patients. CONCLUSIONS: 1. Preeclampsia complicates one tenth of twin pregnancies. 2. In preeclamptic women nulliparas were two times more frequent. 3. In preeclamptic women is significantly higher level of uric acid.     

多胎妊娠如何预防子痫前期

子痫前期是妊娠期的严重并发症,可引起多器官功能损害。随着辅助生殖技术的应用、二孩政策的放开,多胎妊娠发生率呈上升趋势。由于多胎妊娠的特殊生理变化,其子痫前期发生率高于单胎妊娠。目前,关于单胎妊娠中子痫前期的发生、预测与预防的研究较多,但关于多胎妊娠的研究较少。文章将对多胎妊娠中子痫前期的风险预测、预防及治疗进行阐述。     

Hypertensive drugs in pregnancy. Antihypertension therapy in pregnancy, preeclampsia, and eclampsia.

The value of antihypertensive drugs in pregnancy is unproved. This article summarizes the available literature on the subject and gives guidance to the obstetrician who is considering the use of these agents in pregnancy. The possible benefits and side-effects are discussed.     

Plasma and tissue expression of the long pentraxin 3 during normal pregnancy and preeclampsia

OBJECTIVE: Cell death normally occurs during pregnancy and is critical during its common complication, preeclampsia. The long pentraxin 3 (PTX3) gene is generated in tissues that cope with excessive or deregulated cell death and inhibits the cross-presentation of cell-associated antigens. We examined whether PTX3 is expressed during pregnancy and possibly involved in the development of preeclampsia. METHODS: Women with preeclampsia (n = 30), women with uncomplicated pregnancies (n = 66), age-matched healthy women (n = 50), women who developed acute bacterial infections (n = 20), and women with rheumatoid arthritis (n = 20) were studied. The concentrations of PTX3 were measured in the blood by a sandwich enzyme-linked immunosorbent assay (ELISA) and in placentas by immunohistochemistry. The concentrations of PTX3 and C-reactive protein in the various groups were compared by nonparametric tests (the Mann-Whitney U and the Kruskal-Wallis tests). The odds of developing preeclampsia were assessed using logistic regression. RESULTS: PTX3 was expressed in amniotic epithelium and chorionic mesoderm, trophoblast terminal villi, and perivascular stroma in placentas from pregnancies of uncomplicated subjects. Circulating levels steadily rose during normal gestation and peaked during labor. Serum levels of PTX3 were strikingly higher in preeclampsia compared with normal control pregnancies (5.08 +/- 1.34 and 0.59 +/- 0.07 ng/mL, respectively, P < .001). Sites of higher expression in the placentas from preeclamptic patients include infarcts and fibrinoid zones. CONCLUSION: Defects in the homeostatic response to cell death/remodeling events, revealed by enhanced levels of PTX3, could be implicated in preeclampsia. LEVEL OF EVIDENCE: II-2.     

Plasma thiol status in preeclampsia

OBJECTIVE: To measure plasma thiol levels in women with normal pregnancies, women with preeclampsia, and nonpregnant controls to define plasma thiol's effect on glutathione homeostasis and pathophysiology of preeclampsia. METHODS: Total plasma cysteine, gamma-glutamylcysteine, homocysteine, cysteinylglycine, and glutathione levels were measured in ten nonpregnant women, ten women with normotensive pregnancies, and 20 women with preeclampsia at delivery. RESULTS: Median total plasma levels of all thiols in normotensive pregnant women were significantly lower than in nonpregnant women. Median total plasma cysteine and homocysteine levels in women with preeclampsia were significantly higher compared with pregnant controls (254 versus 190 micromol/L, P < .001; and 13.3 versus 8.4 micromol/L, P < .02, respectively), whereas glutathione levels were significantly lower in women with preeclampsia compared with those in pregnant controls (5.1 versus 6.3 micromol/L, P < .05). CONCLUSION: In women with preeclampsia, homocysteine and cysteine levels, which are lowered in normotensive pregnancy, were comparable to levels in nonpregnant women, whereas glutathione levels were lower. Those results suggest that in women with preeclampsia, glutathione use is higher or its synthesis is disturbed. Therefore, glutathione might affect pathophysiology of preeclampsia.     

Endogenous anti-oxidants in pregnancy and preeclampsia

Oxidative stress has been implicated in a wide variety of diseases and degenerative states including cancer, rheumatoid arthritis, cardiovascular disease and ageing. There is now considerable evidence to suggest that pregnancy leads to the generation of an increased oxidative burden, but whether this overwhelms the anti-oxidant capacity within the placenta and/or the peripheral circulation remains a point of conjecture. There is little doubt that oxidative stress is a significant contributor in the pathogenesis of preeclampsia. The use of exogenous anti-oxidants such as vitamins C and E in the prevention of preeclampsia is the subject of several large clinical trials currently being conducted in many countries around the world. The results of these studies are eagerly awaited, but what of the endogenous anti-oxidant systems that have evolved to combat the oxidative burden associated with living in an aerobic environment? This review will focus on several important anti-oxidant enzyme systems, their role in pregnancy and the evidence to suggest that endogenous anti-oxidants are important in the development of complications of pregnancy such as preeclampsia.     

Resistance artery smooth muscle function in pregnancy and preeclampsia.

OBJECTIVE: The purpose of this study was to investigate whether the altered vascular resistance in pregnancy and preeclampsia results from alterations in intrinsic vascular smooth muscle properties or from external influences on vascular smooth muscle function. STUDY DESIGN: We studied subcutaneous resistance arteries from women with preeclampsia, from normal pregnant women, and from nonpregnant women, that were obtained during cesarean delivery or gynecologic surgical procedures, in a pressure myograph. Arteries were denervated, and smooth muscle cells were loaded with calcium indicator fura-2. Contractile properties were tested in physiologic saline solution and during potassium- and norepinephrine-induced constriction at various pressures. In addition, endothelial function was assessed. Intracellular calcium and tone were measured continuously. RESULTS: No significant differences in basal tone, constrictor, and myogenic responses were found between groups. Contractile element calcium sensitivity was significantly increased in women with preeclampsia. Norepinephrine caused an increase in calcium sensitivity in all groups. CONCLUSION: Vascular smooth muscle calcium sensitivity is increased in preeclampsia.     

Plasma and urine beta-thromboglobulin in severe preeclampsia

Summary Beta-thromboglobulin (BTG) has been shown to be a specific platelet protein and can be used as a marker of platelet activation in preeclampsia. Concomitant studies of BTG levels in plasma and urine were performed with eight primiparous severe preeclamptic patients and eight normal primiparous women matched for age. The mean plasma BTG in the severe preeclamptic patients was 186.62±29.93 ng/ml, and in the control group 45.38±31.84 ng/ml. TheP-value for the difference was highly significant (P=0.000). In contrast, the mean urine BTG in the study group was 8.42±4.61 ng/ml, while the mean value for the control group was similar, 5.00±3.20 ng/ml. TheP-value for the difference was not significant (0.05<P<0.10). These results show that urinary BTG cannot be considered an indicator of platelet activation in severe preeclampsia. A low rather express renal impairment. Failure of BTG renal clearance would contribute to further raising the level of plasma BTG.     

Plasma aminopeptidase activity (oxytocinase) in pregnancy and labor

The primary oxytocinase activity of pregnancy plasma is apparently due to a cystine aminopeptidase. The latter activity may be measured by a chemical procedure which utilizes the synthetic substrate cystine-di-β-naphthylamide.The results of 110 determinations during pregnancy indicate a progressive rise of this aminopeptidase activity in plasma, paralleling the oxytocinase curves obtained by biologic assay methods. Contrary to some reports, there is no decline of activity during early or late labor, parturition, or the early puerperium. The onset of spontaneous labor in women can hardly be attributed to a diminished ability of the plasma to inactivate endogenous oxytocin.