Evaluation of maternal serum progranulin levels in normotensive pregnancies,and pregnancies with early- and late-onset preeclampsia

Aims: To investigate the possible pathophysiological associations between progranulin (PGRN) and preeclampsia (PE), early-onset PE (EOPE) and late-onset PE (LOPE).

Study design: A cross-sectional study was designed to include consecutive patients with uncomplicated pregnancy (n?=?28), EOPE (n?=?30) and LOPE (n?=?22). Maternal levels of serum PGRN were measured with the use of an enzyme-linked immunosorbent assay kit.

Results: The mean serum PGRN level was significantly higher in women with PE compared to the control group (54.17?±?4.20?pg/ml versus 42.37?±?5.64?pg/ml, p?<?0.001), in the LOPE group compared to the control group (51.63?±?4.61?pg/ml versus 42.37?±?5.64?pg/ml, p?<?0.001) and also in women with EOPE compared to women with LOPE (56.03?±?2.68?pg/ml versus 51.63?±?4.61?pg/ml, p?<?0.001). Serum PGRN was negatively correlated with gestational age at birth (r?= ?0.669, p?=?0.001) and birth weight (r?= ?0.653, p?=?0.001); and positively correlated with systolic (r?=?0.653, p?=?0.001) and diastolic blood pressure (r?=?0.601, p?=?0.001), C-reactive protein (r?=?0.519, p?=?0.001), uterine artery pulsatility (r?=?0.441, p?=?0.001) and resistance indices (r?=?0.441, p?=?0.001).

Conclusions: Serum PGRN levels increase significantly in women with PE as an indirect sign of placental dysfunction. This increase is even more prominent in women with EOPE. The serum PGRN in the third trimester is positively correlated with gestational age at birth and birth weight.     

Maternal serum glycodelin levels in preeclampsia and its relationship with the severity of the disease

Purpose: Preeclampsia, in which insufficient trophoblastic invasion is thought to be one of the underlying mechanisms, is a common pregnancy disorder. Glycodelin is a regulator of immunosuppression, fertilization, implantation, and placentation. Because of its inhibitory effects on trophoblastic activity, trophoblast invasion is disturbed when its levels alter. We aimed to analyze serum glycodelin levels in preeclampsia and evaluate whether it correlates with the severity of disease.

Methods: This is a prospective case–control study conducted in a research and training hospital between March and September 2016. In this study, a total of 55 preeclamptic and 65 healthy pregnants were included. Preeclamptic patients were divided into two subgroups: 25 severe and 30 mild. Maternal serum glycodelin levels were measured using enzyme-linked immunosorbent assay.

Results: Glycodelin levels were higher in preeclamptic group as compared with controls (71.38?±?22.78 versus 42.32?±?12.28?ng/ml, p?p?r?=?0.637 and r?=?0.714, respectively, p?r?=?0.369, p?=?.006 and r?=?0.377, p?=?.005) and proteinuria (r?=?0.342, p?=?.011). Moreover, it was correlated with birth weights and gestational age at delivery (r?=??0.386, p?=?.004 and r?=??0.394, p?=?.003, respectively). The role of glycodelin to diagnose preeclampsia was evaluated by receiver operating curve (ROC) curve. Area under the curve for glycodelin is 0.897 with p?53.64?ng/ml. Moreover, area under the curve for glycodelin to diagnose severe preeclampsia is 0.788 with p?83.97?ng/ml.

Conclusion: Glycodelin may be a promising marker in predicting the presence and severity of preeclampsia.     

Maternal levels of growth differentiation factor-15 in patients with preeclampsia

ABSTRACT

Objective: Growth differentiation factor-15 (GDF-15) is a stress-induced cytokine and related to the prognosis of cardiovascular diseases. Our purpose is to measure the maternal levels of GDF-15 in patients with early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE).

Methods: This cross-sectional study was conducted including 72 pregnant women, 23 with normal pregnancies and 49 with preeclampsia (26 with EOPE and 23 with LOPE). Maternal serum levels of GDF-15 were measured by using enzyme-linked immunosorbent assay kits.

Results: The median serum GDF-15 level was found to be the highest in the EOPE group (EOPE: 441.7 pg/ml). The median serum GDF-15 levels were higher in women with preeclampsia than in the control group (309.7 pg/ml vs. 436.6 pg/ml, p: 0.009).

Conclusion: Our findings suggest GDF-15 increased as a response to endothelial injury caused by cytokines triggered by preeclampsia.     

Maternal cytoglobin (CYGB) serum levels in normal and preeclamptic pregnancies

Objective: To investigate cytoglobin levels in women with preeclampsia and women with uncomplicated pregnancies.

Materials and methods: A cross-sectional study including 26 pregnant women complicated with early-onset preeclampsia (EO-PE) and 26 pregnant women complicated with late-onset preeclampsia (LO-PE) were recruited for the study group. Twenty-seven healthy pregnant women selected randomly were included in the control group. The serum CYGB concentrations were measured using an enzyme-linked immunosorbent assay.

Results: Gestational age at delivery and mean birth weight were significantly lower in the preeclampsia groups than in the control group and were found to be the lowest in the EO-PE group (p?p?p?=?1.000).

Conclusions: Serum CYGB levels were significantly higher in patients with EO-PE and LO-PE as compared to healthy pregnant women.     

Serum-free placental growth factor isoform 1 at 11–13-week gestation: effects of maternal factors,mean arterial pressure,placental volume,and uterine artery pulsatility index

Introduction: To define the effects of maternal factors, mean arterial pressure (MAP), placental volume (PV), and uterine artery Doppler pulsatility index (UtAPI) to serum level of free form of placental growth factor isoform 1 (free PlGF-1) measured with a novel automated assay.

Methods: We enrolled 200 Thai women singleton pregnancy from 11⁺⁰ to 13⁺⁶ weeks gestation with low prior risk maternal factors (age, parity, tobacco use, assisted reproductive technology, and body mass index). MAP was measured. Serum-free PlGF-1, PV, and UtAPI were measured with a new assay, transabdominal three-dimensional, and color Doppler ultrasounds, respectively. Effects of these variables to serum-free PlGF-1 level were assessed.

Results: Data from 195 eligible subjects showed an elevation of serum-free PlGF-1 from 11, 12, and 13 weeks (mean?±?SD; 36.89?±?24.92, 38.71?±?17.44, and 49.68?±?22.30?pg/mL, respectively (p?r?=?0.290, p?r?=??0.717, p?=?.05 and r?=??0.221, p?r?=??0.243, p?r?=??0.372, p?p?>?.05). There was no preeclampsia at <34 weeks in 161 subjects (82.6%) with known pregnancy outcomes.

Conclusions: There was modest correlation of serum-free PlGF-1, PV, and UtAPI, but not with maternal factors or MAP. Adjustment of serum-free PlGF-1 in early preeclampsia screening algorithm should be considered.     

Comparison of sVCAM-1 and sICAM-1 levels in maternal serum and vaginal secretion between pregnant women with preterm prelabour ruptures of membranes and healthy pregnant women

Objective: The study aims to evaluate the maternal serum and the vaginal fluid levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecular (sICAM-1) in pregnant women complicated by preterm prelabour ruptures of membranes (PPROM).

Materials and methods: The prospective case control study included 34 pregnant women with PPROM and 34 healthy pregnant women. Patients with additional diseases, a smoking habit and vaginal bleeding, as well as those using antibiotics, during the study period were not included in the study. Cervicovaginal fluid and serum samples were taken during the patients’ admission. The demographic data, maternal serum and vaginal fluid sVCAM-1 and sICAM-1, C reactive protein (CRP) and leukocyte counts were noted for all pregnant women included in the study. The sVCAM-1 and sICAM-1 levels were measured by enzyme-linked immunosorbent assay kits.

Results: In pregnant women with PPROM, the serum leukocyte (mean?±?SD =11.41?±?1.067 versus 9.18?±?1.56, p?p?p?=?.06), vaginal sVCAM-1 (median 208.00 versus 140.20?ng/ml, p?=?.014) and sICAM-1 (mean?±?SD 32.32?±?6.49?ng/ml versus 24.87?±?6.79?ng/ml, p?r?=?0.850; p?Conclusion: To the best of our knowledge, this is the first study evaluating the levels of sICAM-1 in maternal serum in pregnant women with PPROM. The maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels can be used as biochemical markers supporting the PPROM diagnosis because of the increase in both maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels in pregnant women with PPROM.     

Evaluation the relationship between serum progesterone level and pain perception after cesarean delivery

Introduction: Cesarean delivery is the most common surgery in obstetrics, and pain relief after cesarean section is an important concern for obstetricians and their patients.

Objective: The aim of this study was to evaluate the relationship between serum progesterone level and pain perception after cesarean delivery.

Method: The study was performed as a prospective cohort study on 166 pregnant women who were candidates for elective cesarean delivery due to previous cesarean section. Before surgery, serum progesterone level was measured. Pain score of women was evaluated 4, 8, 12, and 24?h after surgery using visual analog scale (VAS) score, and correlation between progesterone level and pain was evaluated.

Results: The median value of serum progesterone was 119.45?ng/ml. Mean pain score in hours 4, 8, 12, and 24 were 6.80?±?2.11, 5.31?±?1.48, 3.89?±?1.68, and 2.30?±?1.26, respectively. The women were divided according to mean progesterone level of 119.45?ng/ml into two groups of high progesterone level (≥119.45) and low progesterone level (<119.45), and the pain score was evaluated in different times (hour 4, 8, 12, and 24) for both levels of progesterone. The mean pain score in the 4, 8, 12, and 24?h were significantly lower in high progesterone group (progesterone level ≥119.45). The number of women with low pain score (less than five) in hours 12 and 24 was significantly higher in high progesterone level group. With increasing BMI, progesterone level was lower and women with higher BMI, had a higher pain score in hours 4, 8, 12, and 24, while women with lower BMI had a lower pain score during the same hours. (p?=?.004, r?=?0.223; p?=?.004, r?=?0.223; p?=?.039, r?=?0.160; and p?=?.007, r?=?0.207). Progesterone level and BMI (p?=?.025, r?=???0.174), and progesterone level and pain score in hours 4, 8, 12, and 24 (p?=?.000, r?=???0.324; p?=?.000, r?=???0.474; p?=?.000, r?=???0.329; and p?=?.000, r?=???0.417, respectively) showed a negative significant correlation. Putting three variables of age, gestational age, and BMI in a multiple regression model, progesterone level showed significant negative correlation with the pain score in hour 4 (p?=?.000, r?=???0.305), hour 8 (p?=?.000, r?=???0.461), hour 12 (p?=?.000, r?=???0.328), and hour 24 (p?=?.000, r?=???0.409).

Conclusions: Serum progesterone level showed a negative correlation with the pain score after cesarean section.     

Maternal/fetal eNOS-Glu298Asp genotypes and their influence on the severity,prognosis, and lipid profile of preeclampsia

Objectives: To analyze the contribution of maternal eNOS-Glu298Asp genotypes and also the association with fetal genotypes to the development of preeclampsia, prognosis, and maternal dyslipidemia.

Methods: Sixty-nine pairs of preeclamptic mothers/newborns and 94 pairs of normotensive mothers/newborns were genotyped for eNOS-Glu298Asp using PCR-RFLP methods.

Results: Women carriers of at least one Asp298 allele had a 1.53-fold (p?=?NS), 1.88-fold (p?=?NS), and 2.08-fold (p?=?.05), respectively, increased risk to develop PIH, mild, or severe preeclampsia. If both the mother and the newborn were carriers of the Asp298 allele, the risk for preeclampsia was 5.09-fold higher (p?p?=?.02) and LDL (mg/dl, 194.9?±?42.8 versus 144.98?±?54.84, p?=?.04) levels and lower HDL levels (mg/dl, 32.12?±?5.48 versus 57.84?±?20.59, p?=?.02) compared to noncarriers. Also, higher LDL levels (mg/dl, 188.76?±?46.61 versus 136.75?±?41.85, p?=?.03) and lower HDL levels (mg/dl, 32.8?±?5.64 versus 61.06?±?22.45, p?=?.02) were found in preeclamptic women with severe preeclampsia whose newborns were carriers of the Asp298 allele.

Conclusions: The eNOS-Glu298Asp variant (in mothers and newborns) in association with dyslipidemia could affect bioavailability of NO and could represent an increased risk for preeclampsia.     

Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants?

Objective: Examine the association between placental inflammation and neonatal infections, and 25OH vitamin D (25OH D) levels at birth among very low birth weight infants (VLBWI).

Study design: Serum 25OH D levels were measured in 89 VLBWI (≤1250?g) and 47 mothers on day one, and in 78 infants on day 21. Placentas were examined for maternal and fetal inflammation. Infants were divided into deficient (≤10?ng/ml) and adequate (>10?ng/ml) groups based on 25OH D levels on day 1.

Results: Mean?±?SD maternal levels of 25OH D (21?±?9?ng/ml) correlated with infants’ levels (15?±?8?ng/ml), (p?p?=?.011). Infants’ 25OH D levels rose significantly by day 21 (p?p?>?.05). Logistic regression analyses revealed no association between deficient 25OH D levels and the odds of maternal or fetal inflammation or other infections. Levels of 25OH D did not correlate with severity of placental inflammation.

Conclusions: Deficient levels of 25OH D at birth are not associated with the occurrence of placental inflammation or neonatal infections among VLBWI.     

Correlation between maternal serum-amniotic fluid anti-angiogenic factors and uterine artery Doppler indices

Purpose: Elevated sFlt-1 and sEng is usually a clue for impending preeclampsia and intrauterine growth restriction. Likewise, uterine artery Doppler ultrasound is being investigated for prediction of similar conditions. In this study, we aimed to explore the possible relations of these two proteins in different body compartments with uterine artery Doppler indices (UtAD) in a healthy second trimester obstetric population.

Methods: Levels of sFlt-1 and sEng were measured in serum and amniotic fluid samples of 43 patients. UtAD were measured on the days of sample collections. Findings were then analyzed for possible correlation.

Results: There was a positive correlation between the levels of maternal serum sFlt-1 (MSsFlt-1) and sEng levels (MSsEng) (r=?0.516, pr=??0.371, p=?0.016). No correlation was found between UtAD and studied protein levels in amniotic fluid. Mean MSsFlt-1 level was 305.2?±?220.1?pg/ml and mean AFsFlt-1 was 48.9?±?11.8?ng/ml. Mean MSsEng level was 4.5?±?1.3?ng/ml, mean AFsEng level was found 0.7?±?0.3?ng/ml. Mean values for UtAD were 1.3?±?0.4, 0.6?±?0.1 and 3.5?±?1.3 for PI, RI, and S/D, respectively.

Conclusion: In normal second trimester pregnancies, there is a positive correlation between serum levels of sFlt-1 and sEng levels. Amniotic fluid levels of sEng and sFlt-1 are not correlated with UtAD in uncomplicated pregnancies.     

Colostrum and mature breast milk analysis of serum irisin and sterol regulatory element-binding proteins-1c in gestational diabetes mellitus

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.

Methods: GDM positive women (n?=?33) and normal glucose tolerant women (NGT) (n?=?33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72?hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed by commercially available ELISA kits for all maternal samples.

Results: Lower levels of irisin were seen in serum, colostrum and mature breast milk of GDM females (p?r?=?0.439; p?r?=?0.403; p?=?.01), HbA1c (r?=??0.312; p?=?.011), Fasting blood glucose (r?=?0.992; p?=?.008), and baby weight at birth (r?=?0.486; p?r?=?0.325; p?=?.017; r?=?0.296; p?=?.022, respectively). Serum SREBP-1c at 6 weeks correlated with random blood glucose (r?=?0.318; p?=?.009), and HbA1c (r=??0.292; p?=?.011). All correlations were lost once we adjusted for maternal BMI.

Conclusions: Low irisin and SREBP1-c levels may favor development of GDM in pregnant subjects. Further, low mature breast milk levels may act as a continued stressor from fetal to infant life as long as breast-feeding is continued. Further studies are required to identify the mechanistic relationship between these biomarkers and GDM.     

Possible effects of lipoprotein-associated phospholipase A2 single-nucleotide polymorphisms on cardiovascular risk in patients with preeclampsia

Purpose: Lipoprotein lipase-associated phospholipase A2 (Lp-PLA2) is a vascular inflammatory marker associated with cardiovascular diseases (CVD). Women with preeclampsia (PE) have elevated vascular inflammation and at higher CVD risk in the later life. We hypothesize that vascular inflammation related genetic variations increase the risk for developing future cardiovascular disease in women with PE. To test this hypothesis, we studied PLA2G7 gene polymorphisms, Lp-PLA₂ mass, activity, index, and other cardiovascular risk factors in women with preeclampsia.

Methods: A total of 200 pregnant women were included into the study. We stratified the PE group: early (28.7?±?3.0 weeks) and late onset (36.0?±?1.4 weeks). Serum Lp-PLA2 mass in the early PE and the late PE group were significantly higher than the control group (p?=?.000). Lp-PLA2 index, Hs-C-reactive protein (CRP), serum amyloid A (SAA), calprotectin, and PTX3 levels were higher in early and late PE (p?=?.000). Single-nucleotide mutations of PLA2G7 rs1805017 (r?=??0.228, p?r?=?0.216, p?Conclusions: Lp-PLA2 genetic variability with vascular inflammatory markers might contribute the incidence of future cardiovascular events.     

Placental ghrelin and leptin expression and cord blood ghrelin,adiponectin, leptin,and C-peptide levels in severe maternal obesity

Purpose: The purpose of this study is to investigate placental ghrelin and leptin expression as well as cord blood ghrelin and adiponectin levels in maternal obesity and associations between placental ghrelin expression, cord blood ghrelin levels and maternal and infant variables.

Materials and methods: Placental ghrelin and leptin expression were analyzed by RT-PCR in 32 severely obese and 32 matched normal-weight women. Cord blood ghrelin, adiponectin, leptin, and C-peptide concentrations were analyzed by ELISA.

Results: Neither ghrelin nor leptin expression and neither cord blood ghrelin nor adiponectin levels differed between the groups. Placental ghrelin expression was associated with BMI at delivery in the obese women (r?=?0.424, p?=?.016) and in the infants born to normal-weight women with their weight z-scores at six (r?=??0.642, p?=?.010), nine (r?=??0.441, p?=?.015), and 12 months of age (r?=??0.402, p?=?.028).

Conclusions: Placental ghrelin and leptin expression as well as cord blood ghrelin and adiponectin levels do not seem to be altered in severe maternal obesity. Placenta-derived ghrelin may influence the infants’ postnatal weight gain, but possibly only when the mother has normal weight.     

Vitamin D deficiency in Egyptian mothers and their neonates and possible related factors

Abstract

Objective: To correlate vitamin D level in Egyptian mothers with that of their newborns, and examine risk factors related to maternal vitamin D deficiency.

Methods: A cross-sectional study was carried out at the university teaching hospital in Cairo, Egypt. Serum 25(OH) D levels were measured by enzyme-linked immunosorbent assay in 135 pregnant women at ≥37 weeks’ gestation immediately before delivery and in cord blood of their newborns.

Results: The levels of serum 25(OH) D were 32.6?±?21.4?ng/ml in mothers and 16.7?±?10?ng/ml in their newborns. Maternal vitamin D level was strongly correlated with that of the newborns (r?=?0.7, p?<?0.0001). Maternal vitamin D deficiency/insufficiency and neonatal vitamin D deficiency/insufficiency were encountered in (40%, 28.9% and 60%, 32.6% respectively). Maternal vitamin D levels showed significant correlations with maternal body mass index (BMI; r?=??0.201, p?=?0.021), gestational age at delivery (r?=?0.315, p?≤?0.0001), fish consumption (r?=?0.185, p?=?0.032), educational level (r?=?0.29, p?=?0.001), and skin exposure (r?=?0.247, p?=?0.004).

Conclusion: Maternal vitamin D levels strongly correlate with neonatal levels. Maternal vitamin D deficiency is a real problem in Egypt; this is generally related to high BMI, low fish consumption, low educational level, and limited skin exposure.     

The effect of maternal anemia and iron deficiency on fetal erythropoiesis: comparison between serum erythropoietin,hemoglobin and ferritin levels in mothers and newborns

Objective: Maternal and fetal serum erythropoietin levels were correlated with hemoglobin, mean corpuscular volume and serum ferritin in a group of anemic pregnant women to evaluate the effect of maternal anemia on fetal erythropoiesis. Methods: Serum erythropoietin, ferritin, hemoglobin and mean corpuscular volume were investigated in 33 pregnant women with anemia, 11 women with normal hematological parameters and in their newborns. Results: Maternal serum erythropoietin concentration (mean ± SEM) was significantly higher in the anemic group (145.2 ± 42.9 mU/ml) as compared to the control group (37.3 ± 7.6 mU/ml) (p < 0.05). In newborns, all parameters were comparable in both groups except cord serum erythropoietin concentration (mean ± SEM) which was significantly higher in newborns born to anemic women (43.9 ± 5.3 mU/ml) than controls (29.4 ± 3.7 mU/ml) (p < 0.05). In the anemic group, maternal serum erythropoietin was inversely correlated to maternal hemoglobin (r = -0.375, p = 0.03), maternal hemoglobin was inversely correlated to cord serum erythropoietin (r = -0.552, p = 0.001) and maternal ferritin was correlated to fetal ferritin (r = 0.521, p = 0.002). Conclusion: Although cord hemoglobin and mean corpuscular volume were not affected by maternal anemia, increased cord serum erythropoietin levels related to low maternal hemoglobin levels suggest an induced fetal erythropoiesis in maternal anemia.     

The agonistic autoantibodies to the angiotensin II type 1 receptor in pregnancies complicated by hypertensive disorders

Introduction: The etiology and pathogenesis of pregnancy-related hypertensive disorders is complex and multifactorial. The aim of our study is the investigation of the differences in the autoantibodies against angiotensin II type 1 receptor (AT1-AA) titers among pregnant patients with chronic hypertension, gestational hypertension, and preeclampsia compared to the healthy pregnant women.

Patients and methods: We created three study groups (preeclampsia [n?=?16], chronic hypertension [n?=?13], gestational hypertension [n?=?17]) and the control group consisting of 17 healthy pregnant women. Every compared group was matched for mother’s age, parity, prepregnancy BMI, and gestational age at time of recruitment into study. The autoantibodies titer were assessed using commercially available ELISA kit.

Results: We found a statistically higher AT1-AA titer in the group of patients with gestational hypertension (GH) and preeclampsia (PE) compared to healthy normotensive pregnant women (median 9.6 versus 7.8?ng/ml, p?=?.01 and 10.9?ng/ml versus 7.8?ng/ml, p?=?.02, respectively). There was no correlation between blood pressure values and AT1-AA titer in any group. We found no correlation in group with preeclampsia between urinary protein excretion and AT1-AA titer (p?=?.23, R?=?0.32).

Conclusions: We assume that pregnancy-related hypertensive disorders might be autoimmune diseases and AT1-AA contribute to the pathophysiology of the disease. Our study may have some therapeutic implications and shows the necessity of new research into the mechanisms involved in the production of AT1-AA. Such investigations might enable to inhibit the formation of these autoantibodies or elaborate another method for AT1-AA removal.     

Serum Makorin ring finger protein 3 values for predicting Central precocious puberty in girls

This study evaluated the serum level of MKRN3 and investigated its diagnostic usefulness in girls with central precocious puberty (CPP). In total, 41 girls with CPP and 35 age-matched normal control girls were enrolled. Serum values of MKRN3 were measured in both groups. Gonadotropin and estradiol concentrations were evaluated after 6 and 12?months of GnRH agonist (GnRHa) treatment in CPP patients. The MKRN3 concentrations were much lower in the patient group than in the control group (p?=?.005). Over 1 year of GnRHa treatment in patients, the gonadotropin concentrations were significantly decreased (p?<?.05), while the MKRN3 concentrations were unchanged (p?>?.05). MKRN3 levels were inversely correlated to standard deviation (SD) in height (r?=??0.46, p?=?.000), SD in weight (r?=??0.32, p?=?.005), Tanner stage (r?=??0.41, p?=?.000), and bone age (r?=??0.46, p?=?.000). Based on ROC analysis, the area under curve was 0.758 for MKRN3, with 82.9% sensitivity and 68.5% specificity. The measurement of serum MKRN3 level may provide some help for CPP prediction, but relatively various values need further validation     

Endoglin in pregnancy complicated by fetal intrauterine growth restriction in normotensive and preeclamptic pregnant women: a comparison between preeclamptic patients with appropriate-for-gestational-age weight infants and healthy pregnant women

Objective: The aim of this study was to determine the maternal serum endoglin concentration in pregnancies with intrauterine growth restriction (IUGR) in the presence or absence of preeclampsia and to compare the results with preeclamptic pregnant women with appropriate-for-gestational-age weight infants and with healthy pregnant controls. Patients and methods: The study was performed on 52 normotensive pregnant patients with pregnancy complicated by isolated IUGR, 33 patients with preeclampsia complicated by IUGR and 33 preeclamptic patients with appropriate-for-gestational-age weight infants. The control group consisted of 54 healthy normotensive pregnant patients with singleton uncomplicated pregnancies. The maternal serum endoglin concentrations were determined using a sandwich enzyme-linked immunosorbent assay assay. Results: Our study revealed increased levels of endoglin in the serum of women with normotensive pregnancy complicated by isolated IUGR, and in both groups of preeclamptic patients with and without IUGR. The levels of endoglin were the highest in pregnancy complicated by fetal intrauterine growth restriction (IUGR) in the course of preeclampsia. The mean values were 12.2?±?4.3 ng/ml in the IUGR group, 14.1?±?3.6 ng/ml in preeclamptic patients with normal intrauterine fetal growth, 15.1?±?3.2 ng/ml in preeclamptic pregnant women with IUGR and 10.6?±?3.7 ng/ml in the healthy controls. We also found positive correlations between serum endoglin levels and systolic and diastolic blood pressure and inverse correlations between maternal endoglin and infant birth weight. Conclusions: Our results suggest that increased endoglin concentration may be at least responsible for the pathogenesis of preeclampsia and/or intrauterine fetal growth restriction. It seems that the pathomechanism underlying the development of preeclampsia and isolated IUGR is similar, but that their beginning or intensity may be different in these two pregnancy complications. The positive correlation between endoglin and blood pressure and inverse correlation between endoglin and infant birth weight and additionally higher levels of ENG in patients with pregnancy complicated by HELLP syndrome (hemolysis, increased liver enzymes, low platelet count) or eclampsia suggest that endoglin may be a marker of severity of these pregnancy disorders.     

Circulating levels of Elabela and Apelin in the second and third trimesters of pregnancies with gestational diabetes mellitus

Abstract

We design this study to detect levels of Elabela (ELA) and Apelin (APLN) in women with and without gestational diabetes mellitus (GDM) in the second and third trimesters, and to identify whether there is any association between ELA, APLN, and metabolic parameters. Seventy-nine GDM and 80 control subjects in the second trimester and 87 GDM and 88 healthy subjects in the third trimester were included. In the second trimester, lower ELA levels [(14.1 versus 16.9) ng/ml, p?=?.025] and higher APLN levels [(1021.8 versus 923.5) pg/ml, p?=?.046] were observed in GDM patients compared to controls. ELA levels were positively correlated with fasting plasma glucose (FPG) (r?=?0.423, p?<?.001) in the control group, and APLN levels were negatively correlated with triglycerides (TG) (r?=??0.251, p?=?.025) in the control group and total cholesterol (TC) (r?=??0.227, p?=?.044) in the GDM group. ELA appeared to be related to glucose metabolism and APLN is involved in lipid metabolism during pregnancy. The expression of ELA is significantly downregulated from the second trimester to the third trimester.     

Assessment of left ventricular function using the Myocardial Performance Index in term fetuses that develop intrapartum compromise

Objective: To investigate the relationship between the prelabour left ventricular Myocardial Performance Index (LVMPI) and intrapartum fetal compromise (IFC) in low-risk term pregnancies.

Methods: A blinded, prospective observational cohort study at the Mater Mother’s Hospital, Brisbane, Australia. A cohort of 284 women with uncomplicated singleton pregnancies underwent fortnightly ultrasound from 36 weeks until delivery. The LVMPI was assessed by conventional Doppler ultrasound and correlated with intrapartum outcomes. The LVMPI was also correlated with other Doppler indices of fetal wellbeing.

Results: Two hundred and seventy-three women were included in the final analysis, the median LVMPI was higher in fetuses that required any emergency operative delivery for IFC (0.56, 0.52–0.60 versus 0.54, 0.50–0.58, p?=?.007). The left ventricular cardiac output (LVCO) and cerebroplacental ratio (CPR) were lower in fetuses that required any emergency operative delivery for IFC compared to those that did not (164?±?19?ml/min/kg versus 181?±?30?ml/min/kg, p?p?r?=??0.20, p?r?=??0.29, p?r?=??0.22, p?Conclusions: Higher global LVMPI is associated with a higher risk for IFC and poorer condition of the newborn.