Lipid peroxidation and antioxidants in preeclampsia

OBJECTIVE: To determine the changes in plasma levels of lipid peroxide, vitamin E and vitamin C in women with preeclampsia and to investigate their relationship with diastolic blood pressure. STUDY DESIGN: Cross sectional study consisting of 22 preeclamptic and 21 healthy pregnant women. Fasting venous blood samples were collected during the antepartum period and plasma levels of malondialdehyde, alpha-tocopherol and ascorbic acid were measured. RESULTS: In the preeclamptic group malondialdehyde, a lipid peroxidation product, was significantly increased, while vitamins E and C were significantly decreased compared to healthy pregnant women. A strong correlation was detected between malondialdehyde and antioxidant factors (vitamins E and C) with blood pressure. CONCLUSION: Our findings are consistent with previous studies suggesting that lipid peroxidation is an important factor in the pathogenesis of preeclampsia. In preeclampsia, antioxidant nutrients are excessively utilised to counteract the cellular changes mediated by free radicals.     

Effects of intranasal estradiol treatment on serum paraoxonase and lipids in healthy, postmenopausal women

BACKGROUND/AIMS: Serum lipid concentrations worsen after the menopause because of estrogen deficiency, leading to an increased atherogenic pattern. It is known that serum paraoxonase (PON1) activity prevents the development of atherosclerosis. The aim of this cross-sectional study was to observe the effects of intranasal 17beta-estradiol (300 microg/day) on serum PON1 and lipid levels in healthy postmenopausal women. METHODS: 48 healthy, postmenopausal women were enrolled into this cross-sectional study. 28 subjects without an intact uterus and ovaries were using single-dose (300 microg/day) intranasal 17beta-estradiol and 20 subjects with spontaneous natural menopause were not on any hormone therapy. Body mass index (BMI), blood pressure, serum follicle-stimulating hormone, estradiol, fasting glucose, insulin, lipid fractions and PON1 levels were measured. Homeostasis model assessment (HOMA-R) was used to estimate insulin resistance. RESULTS: The higher estradiol, high-density lipoprotein and salt-stimulated paraoxonase (SSP) levels were observed in intranasal 17beta-estradiol users in comparison with non-users. There were no statistically significant differences in BMI, blood pressures, other lipid fractions, basal paraoxonase, arylesterase, fasting glucose and insulin levels, HOMA-R between the groups. SSP was inversely associated with fasting insulin levels and HOMA-R. CONCLUSION: These observations may suggest that intranasal 17beta-estradiol does not have harmful effects on the PON1 activity and lipid metabolism.     

Relationship between hemostatic factors and known cardiovascular disease correlates in two suburban populations in Taiwan.

The Cardiovascular Disease (CVD) Risk Factor Two-Township Study is a longitudinal cardiovascular epidemiologic study of two suburban towns in Taiwan. Analyzing baseline data from 1,080 men and 1,510 women aged 18 and above, this paper focuses on the relationship of several hemostatic factors to CVD correlates: blood lipids, apolipoproteins, glucose, and uric acid, and blood pressure. Information on these relationships can shed light on whether hemostatic factors contribute to the pathogenesis of CVD independently or through known mechanisms. Pearson correlation and multiple regression analysis were used to analyze the data. In the population studied, cholesterol, and apolipoprotein B had the strongest correlations with all hemostatic factors tested. Triglyceride was also strongly associated with factor VIIc. Factor VIIIc, factor VIIc, and fibrinogen, ordered by the strength of the correlation, were positively and significantly correlated with glucose, uric acid, and blood pressure levels. The associations of apolipoprotein B and cholesterol with fibrinogen (p = 0.14-0.20) were not as strong as those with factors VIIc (p = 0.28-0.37) and VIIIc (p = 0.15-0.30). Factors VIIc and VIIIc were independently associated with most clinical variables studied, including the levels of cholesterol components, triglyceride, glucose, uric acid, and diastolic blood pressure. These finding indicate that states of coagulating factors correlated, to varied degrees, with levels of blood lipid parameters, uric acid, and blood pressure in the population studied.     

Significance of changes in lipid peroxides and antioxidant enzyme activities in pregnant women with preeclampsia and eclampsia

This review addresses the general hypothesis that the pathogenesis of preeclampsia and eclampsia are related to an imbalance of increased oxidative stress and lipid peroxidation coupled with a deficiency of antioxidant protection. Accordingly, this study was initiated to assess total antioxidant status and free-radical activity in preeclampsia and eclampsia. The patients studied were 44 healthy pregnant women and 45 women with hypertension classified as having preeclampsia (n=27), and eclampsia (n=18). The serum levels of lipid peroxide were significantly increased (p<0.0001) and antioxidant enzyme activities (superoxide dismutase and glutathione levels) in erythrocytes were significantly decreased (p<0.0001) in women with preeclampsia and eclampsia compared with the controls. The groups of preeclampsia and eclampsia had similar values of catalase activities as the controls (p>0.05). There were no correlations between serum levels of lipid peroxide and antioxidant enzyme activities or systolic-diastolic blood pressure of pregnant women with preeclampsia and eclampsia. The mean systolic and diastolic blood pressure, the serum lactate dehydrogenase (LDH) and aspartate transaminase (AST) levels of preeclamptic and eclamptic women were high, whereas haemoglobin (Hb), Hematocrit (Htc) and platelet levels were lower than those of the control subjects (p<0.0001). There were no differences in mean gestational week, whereas the mean age of eclamptic women was lower than that of the other two groups (p<0.001). The serum levels of Alanine-transaminase (ALT) and urea in eclamptic women were significantly higher compared with the other two groups (p<0.0001), whereas creatinine levels were lower than those of the other two groups (p<0.05). Our findings give support to those few studies considering lipid peroxidation as an important factor in the pathogenesis of preeclampsia and eclampsia. Further studies are needed to clarify the relations between lipid peroxidation and antioxidative function and their pathophysiological significance in preeclampsia and eclampsia.     

Pre-eclampsia associated with increased lipid peroxidation and decreased serum vitamin E levels.

OBJECTIVE: To evaluate lipid peroxidation and the serum levels of the antioxidant vitamin E in pre-eclampsia according to the disease severity. METHOD: Serum malondialdehyde (MDA) and vitamin E levels were measured in 18 pre-eclamptic, 15 eclamptic and 25 normotensive pregnant women in Ondokuz Mayis University Hospital. The correlation of these levels with the factors indicating disease severity was tested. Mann-Whitney U-test and correlation coefficients were used for the statistical analysis. RESULT: Both the pre-eclamptic and the eclamptic patients had higher MDA and lower vitamin E levels compared with control (P < 0.05); but these values were not significantly different from each other (P > 0.05). MDA levels were significantly correlated with the systolic and diastolic blood pressure (BP) and with serum uric acid levels. There was significant but negative correlation with the vitamin E levels. CONCLUSION: There is an imbalance between lipid peroxidation and serum vitamin E levels in pre-eclampsia and eclampsia. Increased lipid peroxidation is well correlated with the increase in systolic and diastolic BP measurements and serum uric acid levels.     

Elevated diastolic blood pressure in insulin-resistant polycystic ovarian syndrome patients

Objective

The purpose of this study was to further understand interrelationships between insulin resistance in PCOS and elevated diastolic blood pressure.

Design

A prospective case control study.

Participants

Fifty normal women and 43 PCOS patients, 16 of them with insulin resistance.

Setting

Academic Institution.

Interventions

Clinical, anthropometric and ultrasonographic features of PCOS were assessed, as were blood levels for luteinizing hormone, follicle-stimulating hormone, androstenedione, DHEAS, and basal insulin. A lipid profile and an oral glucose tolerance test (OGTT) were also performed.

Main outcome measures

To demonstrate the effect of insulin resistance on blood pressure in patients with PCOS.

Results

Patients with PCOS and those with PCOS plus insulin resistance (IR) had significantly elevated levels of plasma androgen but only those with IR showed greater body mass index and waist: hip ratios than PCOS or control. PCOS plus IR differed significantly in their response to OGTT when compared to PCOS or control. Alterations in lipid profile were shown to be atherogenic. Patients with PCOS plus IR demonstrated a significant elevation of diastolic blood pressure when compared to PCOS alone or controls.

Conclusions

We hypothesize that hyperlipidemia and IR may be involved in the pathophysiologic features of the elevated diastolic blood pressure in PCOS patients.     

Cardiovascular risks of oral contraceptives: dose-response relationship

This article examines the effect of dose level of both estrogens and progestins as factors in the cardiovascular risk of oral contraceptives (OCs), and also examines the roles of blood pressure, coagulation factors, and lipid metabolism. A large number of epidemiologic studies have demonstrated the connection between OC use and thromboembolic disease since the 1st such study appeared 2 decades ago, but the early studies concerned formulations with much higher estrogen doses than those currently used, taken by women who were older and more likely to smoke than at present. Very few epidemiologic studies dealing with the newer formulations are yet available. It is easier to analyze the dose-response relations for the progestins than for the estrogens given that the 2 estrogens primarily used, ethinyl estradiol (EE) and mestranol, were used for a series of progestins at different doses to examine their effects with a constant dose of estrogen. Nevertheless, the epidemiologic studies show increased risks of thrombotic accidents and a dose-response relation for both the estrogen and progestin components. It is likely that different mechanisms are responsible. The effects of OCs on blood pressure have been monitored carefully since the 1st observations of hypertension in OC users. Blood pressure elevations are usually attributed to the estrogen, but there is evidence of a progestin role as well. Some studies have found differences in blood pressure at the same estrogen dose but with different progestin content. It is very likely that blood pressure undergoes physiologic variations depending on hormonal fluctuations. The mechanism by which some OC users develop hypertension is poorly understood, but it may be related to changes in the renin-angiotensin-aldosterone system. Androgenic progestins accentuate sodium retention, which may play a role. Researchers have shown that the lipid profiles of women at different stages of life are different, whether or not they use OCs. Among young women HDL cholesterol levels decline and LDL levels increase among users relative to nonusers of OCs. On the other hand, old women receiving estrogen substitution therapy tend to have more favorable lipid profiles than do women of the same age not receiving estrogen. Coagulation factors, especially factors VII and fibrinogen, have been established as important cardiovascular risk factors in men. Some studies have shown the levels of factors VII and fibrinogen to be elevated in OC users. These procoagulant alterations are also observed in women receiving estrogen substitution, but unlike OC users such women appear to be protected by age-related increases in the level of antithrombin III. Smoking is an important influence on the fibrinogen level, which probably explains part of the increased risk of myocardial infarct among OC users.     

Blood pressure patterns through consecutive pregnancies are influenced by body mass index

OBJECTIVE: The purpose of this study was to analyze the impact of parity and baseline body mass index on blood pressure levels in pregnancy. STUDY DESIGN: We studied a longitudinal historic cohort of 166 healthy pregnant women who gave birth in 2000 to a third child at the University Hospital of Lund; blood pressure measurements were obtained at each antenatal visit during the three consecutive pregnancies. RESULTS: The mean systolic and diastolic blood pressure levels were consistently higher during the first pregnancy at comparable weeks of gestation, significantly so during the third trimester. The body mass index correlated with diastolic blood pressure levels only in the first pregnancy, and the impact of parity on third trimester blood pressure levels was greatest in the women with a high body mass index. Age, smoking, change of paternity, or a short time interval between pregnancies did not influence blood pressure levels. CONCLUSION: The interrelationship among blood pressure levels, parity, and body mass index in normal pregnancy resembles the situation in hypertensive pregnancies, which implies common adaptive mechanisms.     

Combined contraceptive ring versus combined oral contraceptive (30-μg ethinylestradiol and 3-mg drospirenone)

Objectives

To compare the adverse effects, cycle control, and metabolic effects of NuvaRing and a combined oral contraceptive (COC).

Methods

Women seeking contraception received NuvaRing (n = 300) or a COC (n = 300) for 12 cycles in a randomized, open-label trial.

Results

The total number of women with adverse effects did not differ significantly between the 2 groups. Leucorrhea, vaginitis, decreased libido, and ring-related problems were more common with NuvaRing, whereas weight increase, acne, and emotional lability were more common with the COC. Breakthrough bleeding occurred in 11.3% of women receiving NuvaRing and in 14.7% of women receiving the COC; 2.1% and 2.9% of women, respectively, had no withdrawal bleeding. Differences in blood pressure, blood sugar levels, lipid profile, liver enzyme activity, and anticoagulant activity were not statistically significant, with the exception of low-density lipoprotein levels measured at 6 and 12 months, which were significantly lower in the NuvaRing group than in the COC group.

Conclusions

NuvaRing is a good alternative to a COC. It is associated with a slightly reduced incidence of breakthrough bleeding and there were no clinically relevant adverse effects or changes in blood pressure, blood sugar levels, lipid profile, or anticoagulant activity when compared with the COC.     

Influence of triphasic oral contraceptives on blood rheology and hemostatic and metabolic patterns in young women. Results of a three-year study.

Long-term (three-year) variations in clinical, hemorheologic, hemostatic and blood lipid parameters were evaluated in 20 young healthy women taking a triphasic oral contraceptive. Body weight, arterial blood pressure, whole blood, plasma and serum viscosity, erythrocyte deformability, fibrinogen, fibronectin, alpha-2 macroglobulin, Von Willebrand factor antigen, triglycerides, nonesterified fatty acids, total and low density lipoprotein cholesterol, very low density lipoprotein, low density lipoprotein and apolipoprotein B levels remained unchanged throughout the study. However, high density lipoprotein cholesterol, high density lipoprotein and apolipoprotein A1 serum concentrations increased significantly during treatment. Long-term use of the triphasic oral contraceptive does not seem to adversely affect the blood rheology pattern or vascular endothelium function, which are the main factors responsible for the development of thromboembolic complications.     

Serum lipids, blood pressure, body weight, and serum chemistry in women using subcutaneous contraceptive implants releasing the progestin ST 1435.

OBJECTIVE: To study the changes in serum lipids, serum chemistry, blood pressure, and body weight in long-term users of subcutaneous contraceptive implants releasing the progestin ST 1435. METHODS: The study was done in the outpatient clinic of the City Maternity Hospital, Helsinki, Finland. Subdermal implants releasing the progestin ST 1435 were inserted in 30 women for 2 years of use. Healthy women aged 19-35 used the implants for contraception. Measurements of body weight and blood pressure were made and blood samples for lipid analysis (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides) and serum chemistry were taken before insertion of the implants and every 6 months thereafter until removal. Results are reported for 30 subjects after 6 months of use, 25 subjects after 12 months, 13 after 18 months, and 12 after 24 months. RESULTS: Blood pressure and serum chemistry, ie, liver enzymes and electrolytes, remained unchanged. Slight weight gain occurred, but was not statistically significant. No statistically significant changes were found in lipids or lipid ratios when comparing the values during use of the implant with the pre-treatment values. CONCLUSIONS: The progestin ST 1435, used parenterally for contraception or progestin therapy, had no adverse effects on serum lipids, blood pressure, or body weight, which are known to be risk factors for coronary artery disease. The steroid had no effects on serum chemistry determinations in long-term use.     

Relationship between blood pressure level in early pregnancy and subsequent changes in blood pressure during pregnancy

BACKGROUND: It is not known whether women with high blood pressure in the first trimester are likely to exhibit a large increase in blood pressure during pregnancy. METHODS: We conducted a retrospective, longitudinal study of 1599 pregnant women, among whom 29 women (1.8%) received antihypertensive medication during pregnancy. The blood pressure levels measured during the first (7.9 +/- 2.4 weeks), second (20.7 +/- 1.2 weeks) and third trimesters (38.4 +/- 1.7 weeks) were analyzed. The obstetric outcomes were examined in five subgroups divided according to the quintile of the first-trimester mean arterial pressure level. RESULTS: The net change in blood pressure levels (third-trimester value minus first-trimester value) was significantly inversely correlated with the first-trimester blood pressure levels irrespective of the use or lack of use of antihypertensive drugs. Women with the highest quintile first-trimester mean arterial pressure had the largest body weight, exhibited a fall in blood pressure and had the smallest increase in body weight during pregnancy, and were significantly more likely to have a growth-restricted infant. CONCLUSIONS: Women with high initial blood pressure tended to exhibit a fall in blood pressure, whereas women with low initial blood pressure tended to exhibit a large increase in blood pressure during pregnancy. Women with high initial blood pressure and a small increase in body weight during pregnancy tended to have growth-restricted infants.     

Is carbohydrate metabolism altered among women who have undergone a preeclamptic pregnancy?

OBJECTIVE: To compare women after a preeclamptic pregnancy with women after a normal pregnancy with respect to androgenic-anabolic status and carbohydrate and lipid profiles. METHOD: Twenty-one patients and 22 controls were followed up to 26-119 weeks after delivery. Blood was sampled for analyses of insulin, glucose, insulin growth factor-1, lipids, androgens, sex hormone-binding globulin (SHBG) and uric acid. Anthropometric data and blood pressure were recorded. Data are presented as median and ranges (within parentheses) or mean +/- SEM where appropriate. Comparisons were made by unpaired t test or Mann-Whitney U test, respectively. RESULTS: Significantly higher values were found in the preeclampsia than in the control group for fasting insulin, fasting glucose, fasting insulin resistance index (FIRI, fasting glucose x fasting insulin/25), serum triglycerides, uric acid and blood pressure. There were no differences in androgen status and IGF-1 levels. CONCLUSION: Patients with a recent history of preeclampsia demonstrate signs of relative insulin resistance, hypertriglyceridemia and hyperuricemia as well as increased blood pressure as compared with women who had a normal pregnancy. However, in contrast to other women with insulin resistance, they have a normal androgen status. Copyright Copyright 1999 S. Karger AG, Basel     

绝经后妇女血脂血糖测定及与血压关系的探讨

对绝经后妇女１５例和正常对照组８例进行了血脂、血糖与血压关系的研究。结果发现绝经后妇女收缩压和舒张压均明显高于正常对照组；甘油三酯、胆固醇和低密度脂蛋白－胆固醇在绝经后妇女明显增高，而高密度脂蛋白－胆固醇却明显低；绝经后妇女有较高的空腹血糖、胰岛素和２小时血糖、胰岛素水平，且胰岛素／血糖比值也明显高于正常对照组。提示：绝经后妇女由于卵巢功能的丧失而失去了雌激素对心血管系统的保护作用，因而出现中心型肥胖、高血脂、高血糖、高胰岛素血症及胰岛素抵抗。     

Lead and other metals in gestational hypertension.

OBJECTIVES: To identify any effects that lead, calcium, magnesium, and zinc may have on the development of gestational hypertension. METHODS: Third-trimester 110 normotensive and 33 gestational hypertension cases were assayed for various metal levels, using standard techniques, including atomic absorption spectrometry. RESULTS: Gestational hypertension cases showed significantly higher blood lead levels than normotensives. No differences were noticed regarding calcium (ionized and total), magnesium, and zinc levels. Blood lead was significantly related with blood pressure, even after correcting for the body mass indices and age. Blood pressure levels showed no relation to the other analyzed metals. However, the lead:ionized calcium ratio showed a stronger association with blood pressure, than lead alone. Blood lead showed a significant negative relationship with ionized calcium, but none with the other metals. CONCLUSIONS: Blood lead evidently influenced blood pressure increments and gestational hypertension development. This implies that all efforts should be made to reduce the population's exposure.     

Effects of E2 and E2/norgestimate hormone therapy on elevated baseline lipids

OBJECTIVE: To evaluate lipid effects of estradiol/ norgestimate hormone therapy in postmenopausal women with elevated lipid levels. STUDY DESIGN: Postmenopausal women were randomized to E2, 1 mg/intermittent norgestimate (NGM) 90 microg (n = 31), or opposed E2, 1 mg (n = 36), in a 12-month trial. A subset analysis was conducted on participants with unfavorable baseline lipid levels, either total cholesterol (TC) levels > 200 mg/dL, high-density lipoprotein cholesterol (HDL-C) levels < 40 mg/dL, low-density lipoprotein cholesterol (LDL-C) levels > or = 160 mg/dL or triglyceride levels > or = 150 mg/dL. Mean changes and categorical shifts were assessed on fasting blood samples collected at baseline and at 7 and 12 months. RESULTS: Twelve-month mean changes from baseline in women treated with E2/NGM included a 19.8% increase in HDL-C and decreases of 13.4% in LDL-C, 17.5% in triglycerides and 3.3% in TC. Women with poorer lipid profiles at baseline showed the greatest benefit. Results were similar in women randomized to unopposed E2. CONCLUSION: E2/NGM and unopposed E2 were similarly beneficial in modifying lipid fractions in women with unfavorable baseline levels.     

Benefits of soy isoflavone therapeutic regimen on menopausal symptoms

OBJECTIVE:To examine the change in menopausal symptoms and cardiovascular risk factors in response to 4 months of daily 100-mg soy isoflavone in postmenopausal women. METHODS: In this double-blind, placebo-controlled study, 80 women were randomly assigned to isoflavone (n = 40) and placebo (n = 40) treatment. The menopausal Kupperman index was used to assess change in menopausal symptoms at baseline and after 4 months of treatment. Cardiovascular risk factors were assessed by evaluating plasma lipid levels, body mass index, blood pressure, and glucose levels in the participants. To examine the effects of this regime on endogenous hormone levels, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and 17 beta-estradiol were measured. Transvaginal sonography was performed to quantify endometrial thickness. RESULTS: The data showed a decrease in menopausal symptoms (P <.01, paired t test, two-tailed, between baseline and isoflavone groups, and P <.01, unpaired t test, between placebo and isoflavone groups). Total cholesterol and low-density lipoprotein decreased significantly in the isoflavone group compared with the baseline or placebo group (P <.001, paired t test, two-tailed, between baseline and isoflavone groups, and P <.01, unpaired t test, between placebo and isoflavone groups). The isoflavone treatment appeared to have no effect on blood pressure, plasma glucose, and high-density lipoprotein and triglyceride levels. CONCLUSION: This study suggests that isoflavone 100-mg regime treatment may be a safe and effective alternative therapy for menopausal symptoms and may offer a benefit to the cardiovascular system.     

Lipid peroxidation in cord blood: the effects of umbilical nuchal cord

Objective To examine the relation between cord entanglement around the fetal neck and umbilical arterial measures of free oxygen radical activity at birth.
Design Prospective observational stuy of the lipid peroxide levels in umbilical cord arterial blood.
Setting Delivery suite of Prince of Wales Hospital, Hong Kong.
Population Women with a singleton pregnancy, at term (37 to 42 weeks of gestation), cephalic presentation, spontaneous or induced labour and an initially normal fetal heart rate tracing.
Methods A series of 230 singleton deliveries had determination of two lipoperoxides in umbilical arterial cord blood: malondialdehyde and organic hydroperoxide. Umbilical pH, PO₂, PCO₂ and base excess were also measured in both umbilical cord arterial and venous blood.
Main outcome measures Umbilical cord blood gases and arterial malondialdehyde and organic hydroperoxide levels.
Results Forty-nine cases of nuchal cord were observed: 14 tight and 35 loose. Tight nuchal cord was associated with a low 1-min Apgar score and increased lipid peroxide levels. Loose nuchal cord was associated with larger amniotic fluid volume and significantly decreased lipid peroxide levels.
Conclusions This study suggests that tight nuchal cord is associated with increased free oxygen radical activity in the fetus, but that loose nuchal cord carries no adverse effects.     

Effect of epidural analgesia on maximum and minimum blood pressures during the first stage of labour in primigravidae with mild/moderate gestational hypertension

One of the arguments used in favour of epidural analgesia for hypertensive patients in labour is its effect on mean arterial blood pressure, although the fetal and maternal risk from hypertension is more closely linked to maximum recorded levels. We have therefore assessed the effect of epidural analgesia on maximum blood pressure. There was no change in the maximum systolic or diastolic blood pressure after epidural analgesia when compared to baseline values or levels in untreated hypertensive controls. We conclude that this form of analgesia should be offered to hypertensive patients purely for its analgesic effect and not as a method for blood pressure control.     

Automated blood pressure measurement as a predictor of proteinuric pre-eclampsia

Objectives To investigate the relation between antenatal clinic, obstetric day unit and 24-hour ambulatory blood pressure measurements and 24-hour proteinuria levels in hypertensive pregnancies.
Design An observational study.
Participants Forty-eight women presenting with new hypertension after 20 weeks of gestation.
Results The closest relation was found between ambulatory blood pressure measurements and 24-hour proteinuria levels. No significant relation was found between the conventional diastolic blood pressure threshold of 90 mmHg and 24-hour proteinuria levels.
Conclusions Ambulatory blood pressure measurement gives better information about disease status in pre-eclampsia as assessed by proteinuria than does conventional sphygmomanometry.