Higher plasma AOPP is associated with increased proteinuria excretion and decreased glomerular filtration rate in pre-eclamptic women

BackgroundAdvanced oxidation protein products (AOPP) as a novel biomarker of oxidative stress has been demonstrated in chronic kidney disease (CKD) patients. The research was to investigate the plasma AOPP level in pre-eclamptic pregnant women and its correlation with 24-h proteinuria collection, cystatin C(CC), uric acid(UA) and creatinine(Cr).MethodsFifty pre-eclamptic women, including 22 mild and 28 severe preeclampsia were enrolled. Twentyfive healthy singleton pregnant women were selected as control. Blood samples were obtained from all groups to measure the levels of AOPP, CC, UA, Cr and other biochemical parameters at admission. Total protein in the 24 h urine collection was measured. Pearson correlation was performed to evaluate the associations between plasma AOPP level and 24-h proteinuria collection, plasma cystatin C, uric acid and creatinine.ResultsThe means of AOPP levels were significantly different among severe, mild pre-eclampsia and normotensive pregnant women (88.6 ± 10.0 μmmol/L, 72.1 ± 11.1 μmmol/L and 48.7 ± 11.3 μmmol/L). The means of cystatin C levels were significantly different among severe, mild pre-eclampsia and normotensive pregnant women (1.8 ± 0.6 μmmol/L, 1.2 ± 0.3 μmmol/L and 1.0 ± 0.2 μmmol/L). Mild, severe pre-eclampsia and control groups did not differ significantly from each other with respect to uric acid and creatinine. Significant positive correlation between AOPP and 24-h proteinuria excretion in preeclamptic pregnant women was found in mild and severe preeclamptic pregnant women (r = 0.792). Significant positive correlation between AOPP and cystatin C was found in normal and preeclamptic pregnant women (r = 0.521).ConclusionPlasma AOPP level had a significant positive correlation with 24-h proteinuria excretion and cystatin C. Further research about the relevance between the level of AOPP and the onset of preeclampsia was needed in order to have a profound prospective in oxidative stress and preeclampsia.     

Maternal soluble human leukocyte antigen-G levels in pregnancies complicated by foetal intrauterine growth restriction with and without preeclampsia

ObjectiveThe aim of this study was to investigate the maternal serum of soluble human leukocyte antigen-G (sHLA-G) levels in pregnant women with an isolated intrauterine growth restricted foetus (IUGR) and in preeclamptic pregnancies with and without IUGR.Patients and methodsThe study was conducted on 31 normotensive patients with pregnancy complicated by IUGR, 17 preeclamptic patients with appropriate-for-gestational-age foetal intrauterine growth, 21 with preeclampsia complicated by IUGR, and 32 healthy pregnant controls. Maternal serum sHLA-G levels were calculated using the enzyme-linked immunosorbent assay.ResultsMaternal serum sHLA-G levels tended to be higher in both groups of preeclamptic patients, and were highest in patients with IUGR in the course of severe preeclampsia. Lower serum levels of sHLA-G were observed in the group of normotensive pregnant women with an intrauterine growth restricted foetus, but these differences were not statistically significant. The mean values were 22.759 ± 14.151 units/mL in the IUGR group, 25.948 ± 18.888 units/mL in preeclamptic patients with normal intrauterine foetal growth, 31.646 ± 27.576 units/mL in preeclamptic pregnant women with IUGR, and 24.178 ± 24.828 units/mL in the healthy controls.ConclusionsOur findings suggest that the increased levels of sHLA-G in the maternal serum may play a significant role in the pathogenesis of preeclampsia, especially in preeclampsia complicated by intrauterine foetal growth restriction. These associations may offer a better insight into the etiology and pathogenesis of preeclampsia with and without IUGR. It seems that sHLA-G does not play a clinically significant role in the pathogenesis of isolated intrauterine foetal growth restriction in normotensive pregnancies.     

Is there any relationship between ABO/Rh blood group and patients with pre-eclampsia?

ObjectivesThe purpose of the present study was to evaluate the association between pre-eclampsia and blood groups in a group of pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil – Hospital São Lucas (HSL)/PUCRS.Study designOur sample consisted of 10,040 pregnant women admitted to the maternity department of HSL between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Medical records of 414 women were diagnosed as preeclampsia/eclampsia and 9611 women were identified to the control group. The patients were divided into two groups: the group with preeclampsia/eclampsia and the control group, and their blood groups were considered. Data were analyzed using SPSS for Windows version 17.0. Categorical data were summarized by counts and percentages, with the statistical significance evaluated by the Chi-square test. The null hypothesis was rejected when p < 0.05.Main outcome measuresMaternal parameters were compared between control group and pre-eclampsia, respectively, Systolic Blood Pressure (117 ± 19.98 vs. 165 ± 19.99); Diastolic Blood Pressure (73 ± 14.23 vs. 106 ± 14.24) and maternal weight at booking (73 ± 33 vs. 83 ± 33). For all data: mean + SD; p < 0.05. In relation to blood groups, firstly they were stratified by Rh and ABO phenotypes, separately. After that the groups were put together.ResultsNo differences in blood group distribution were observed between controls and pre-eclampsia for any analysis. (p > 0.05).ConclusionsWhen we adopted stricter criteria for pre-eclampsia and a large sample from the same region we noted that the results did not show any association between blood groups and the development of pre-eclampsia.     

Interleukin-18 concentrations in pregnancies complicated by preeclampsia with and without IUGR: A comparison with normotensive pregnant women with isolated IUGR and healthy pregnant women

ObjectiveThe aim of present study was to assess the maternal serum levels and clinical significance of interleukin-18 (IL-18) in pregnancies complicated by preeclampsia and/or intrauterine growth restriction (IUGR).Patients and methodsThe study was carried out on 30 patients with pregnancy complicated by severe preeclampsia (15 patients with IUGR and 15 with appropriate-for-gestational-age weight fetuses), 11 normotensive pregnant patients with pregnancy complicated by isolated IUGR and 32 healthy normotensive women with uncomplicated pregnancies. The interleukin-18 levels were determined using an ELISA assay.ResultsDecreased levels of maternal serum IL-18 in preeclamptic patients with and without IUGR were observed. Contrary to the preeclamptic women, no difference was found in the maternal serum levels of IL-18 in normotensive patients with pregnancies complicated by isolated fetal growth restriction. These levels were the same as observed in the healthy controls. The mean values of maternal serum IL-18 were 219.118 ± 180.079 pg/mL in the PRE group, 438.170 ± 229.657 pg/mL in the group of women with isolated IUGR, and 457.053 ± 528.142 pg/mL in the control group. The levels of maternal serum IL-18 were similar in both study preeclamptic subgroups. The mean values of IL-18 were 204.823 ± 188.171 pg/mL in the group PI and 233.414 ± 176.995 pg/mL in the P group.ConclusionsOur findings suggest that decreased levels of IL-18 in maternal serum play a significant role in etiology and pathogenesis of preeclampsia. But normotensive pregnancies complicated by isolated IUGR are not associated with the altered interleukin 18 levels in maternal serum.     

OS001. Pregnancy outcome in subsequent pregnancies after eclampsia

IntroductionEclampsia in the previous pregnancy may have impact on future reproductive performance of the women. Few studies have been conducted in recent years to review the subsequent pregnancy outcome. In this study women with previous eclampsia were followed up in subsequent pregnancy and outcome was compared with normotensive control group.ObjectivesTo study the risk of recurrence of hypertension and associated complications in subsequent pregnancies following eclampsia.MethodsFifty-three pregnant women with previous history of eclampsia were supervised and delivered in PGIMER, Chandigarh, India (2001 April–2011 March) were studied prospectively. The pregnancy outcome was compared with 106 age and gravida matched controls who had remained normotensive in previous pregnancies. The data analysis was done by Chi-square test and Student ‘t’ test.ResultsAmongst women with previous eclampsia eight women (15%) were found to have underlying chronic hypertension. The incidence of gestational hypertension and pre-eclampsia was 37.7% amongst these women, compared to 7.5% in control group (p = 0.0001). Preterm deliveries mainly due to preterm inductions were higher (32%) amongst women with previous eclampsia compared to 12% amongst controls (p = 0.0004). Incidence of intra uterine growth restriction was significantly higher amongst cases (15% vs 1.5%, p = 0.0003).ConclusionWomen with previous eclampsia have higher incidence of chronic hypertension. These women are at significant risk to develop hypertensive disorders of pregnancy and its related complications. The recurrence of eclampsia is low with aggressive and vigilant antenatal care.     

Preeclampsia,gestational hypertension and subsequent hypothyroidism

ObjectivesTo evaluate the effect of preeclampsia (PE) and gestational hypertension (GH) on subsequent hypothyroidism. Recent studies suggest that women with PE have increased risk for reduced thyroid function, but the association between PE and GH with overt hypothyroidism has not been examined.Study designTwo prospective population-based cohort studies, the Northern Finland Birth Cohorts 1966 and 1986, followed women who had PE (N = 955), GH (N = 1449) or were normotensive (N = 13531) during pregnancy. Finnish national registers were used to confirm subsequent hypothyroidism. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) estimated hypothyroidism risk when comparing women with PE or GH with normotensive women.Main outcome measuresPrimary hypothyroidism during follow-up of 20–40 years.ResultsThe subsequent prevalence of hypothyroidism was higher among women with PE (4.0%) and GH (4.5%) compared with normotensive women (3.5%), but the risk increase was not significant (aHR for PE 1.13, 95% CI 0.80–1.59 and aHR for GH 1.11, 95% CI 0.85–1.45).Subgroup analysis among nulliparous women revealed a significant association between late PE and subsequent hypothyroidism (aHR 1.82, 95% CI 1.04–3.19).Early or recurrent PE was not associated with hypothyroidism (aHR 0.93, 95% CI 0.46–1.81 and aHR 1.35, 95% CI 0.63–2.88, respectively).ConclusionsOverall, PE or GH during pregnancy was not significantly associated with subsequent hypothyroidism in Finnish women after 20–40 years of follow-up. However, late PE in nulliparous women was associated with a 1.8-fold increased risk of subsequent hypothyroidism, a finding that merits further study in other populations.     

Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors

AimThe aim of this study was to demonstrate that women with severe early-onset preeclampsia and concomitant risk factors benefit from expectant management.MethodsThis retrospective study was conducted between January 2009 and December 2010. Stable women with severe preeclampsia between 23 + 6 and 33 + 6 weeks of gestation were admitted to the IOCU for conservative management. They were classified into two groups: those with concomitant risk factors, i.e. associated medical conditions, HELLP syndrome, severe oligohydramnios, fetal growth restriction and multiple pregnancies (group A) and those without (group B). P values lesser than 0.05 were considered statistically significant.ResultsNo significant differences were found in maternal and perinatal outcomes between groups. Neither were differences observed in pregnancy prolongation (mean: 8.42 days (SD ± 7.462) in group A and 10.5 days (SD ± 8.235) in group B (p = 0.391)). At the start of expectant management, 31.8% of fetuses had an abnormal middle cerebral artery Doppler; prior to delivery, this percentage was 77.4%.ConclusionPregnant women with severe early-onset preeclampsia and associated risk factors benefited from expectant management. During expectant management using a continuous magnesium sulfate regimen, the majority of fetuses showed cerebral vasodilatation. The exact clinical value of this finding should be clarified in further studies     

Cardiovascular risk markers in pregnancies complicated by diabetes mellitus or preeclampsia

ObjectiveTo explore biomarkers indicating cardiovascular disease in pregnant women with diabetes or preeclampsia, since these women are at increased risk for future cardiovascular disease.Study designEDTA-plasma from 262 women in gestational week 24–42 (healthy pregnancies n = 71, preeclampsia n = 105, type 2 diabetes n = 17, gestational diabetes n = 61, diabetes with preeclampsia n = 8) was analyzed by immunoassay for neopterin, midregional pro-adrenomedullin (MR-proADM) and C-terminal pro-arginine vasopressin (CT-proAVP). The diabetes groups were also analyzed for midregional pro-atrial natriuretic peptide (MR-proANP), and compared to previously reported MR-proANP concentrations for healthy, normotensive and preeclamptic patients.ResultsIn contrast to preeclampsia, median plasma MR-proANP was not increased in pregnancies complicated by diabetes, but in fact lower, compared to healthy pregnancies. Neopterin was increased in diabetic pregnancies and in late onset preeclampsia, compared to healthy pregnancies. Median plasma MR-proADM was increased in pregnancies complicated by gestational diabetes or preeclampsia, compared to healthy pregnancies. Median plasma MR-proANP was increased in diabetic pregnancies complicated by preeclampsia compared to pregnant women with diabetes only.ConclusionWomen with pregnancies complicated by diabetes mellitus or preeclampsia are at risk for future cardiovascular disease, but differ in circulating cardiovascular biomarker profile. A cardiovascular biomarker profiling during pregnancy might prove helpful in identifying women at risk for future cardiovascular disease, thus enabling targeted prophylactic interventions and follow-up.     

Adverse maternal and fetal outcomes and deaths related to preeclampsia and eclampsia in Haiti

ObjectiveThe purpose of this study was to define the prevalence and clinical characteristics of preeclampsia and eclampsia at a hospital in rural Haiti.MethodsThis is a retrospective review of women presenting to Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti with singleton pregnancy and diagnosis of preeclampsia or eclampsia from January 1, 2011 through December 31, 2012. Hospital charts were reviewed to obtain medical and prenatal history, hospital course, delivery information, and fetal/neonatal outcomes. The outcomes included placental abruption, antepartum eclampsia, postpartum eclampsia, maternal death, birthweight <2500 g and stillbirth. Data are presented as median (quartile 1, quartile 3) or n (%) and risk ratios.ResultsDuring the study period, 1743 women were admitted to the maternity service at HAS and 290 (16.6%) were diagnosed with preeclampsia or eclampsia. Only singleton pregnancies were analyzed (N = 270). Nearly all (95.0%) patients admitted with preeclampsia had severe preeclampsia. There were 83 patients with eclampsia (30.7%) of which 61 (73.4%) had antepartum eclampsia. There were 48 stillbirths (17.8%) and 5 maternal deaths (1.9%). Patients with antepartum eclampsia were younger, more likely to be nulliparous and had less prenatal care compared to women with antepartum preeclampsia. Antepartum eclampsia was associated with placental abruption and maternal death.ConclusionsThe rates of preeclampsia and its associated complications, such as eclampsia, placental abruption, maternal death and stillbirth, are high at this facility in Haiti. Such data are essential to developing region-specific systems to prevent preeclampsia-related complications.     

Evaluation of the value of the first and third trimester maternal mean platelet volume (MPV) for prediction of pre-eclampsia

IntroductionPre-eclampsia is one of the most serious complications of pregnancy and one of the major causes of maternal mortality. Thus its prediction is a matter for serious concern.ObjectiveThe purpose of the present study is to determine the value of mean platelet volume (MPV) measurement in the first and third trimesters of pregnancy for the prediction of pre-eclampsia.MethodA prospective nested case–control study was performed on pregnant women who were at 9–12 weeks of pregnancy. In the first trimester and again in 26–28 weeks, MPV was calculated. All eligible women were then monitored to delivery and the MPV of women who were pre-eclamptic was compared with the MPV of normotensive women.ResultsPre-eclamptic women were compared with 269 normotensive women. MPV at the first trimester of pre-eclamptic women was significantly higher than normotensive women (10.2 ± 1.06 fl VS 9.68 ± 1.09 fl, P = 0.008). Also, MPV at the third trimester of pregnancy of pre-eclamptic women was more than normotensives (10.16 ± 1.23 fl VS 9.62 ± 1.12 fl, P = 0.009).Area under the curve in receiver operating characteristics (ROC) curve was calculated as 0.64 for the predictive value of MPV at the first and third trimesters of pregnancy, which showed a low value of this test for predicting of pre-eclampsia.ConclusionMPV at the first and third trimesters of pregnancy are higher in women who eventually would be pre-eclamptic, but has low predictive value and is not a good predictor of pre-eclampsia.     

Circulating endothelial progenitor cells and placental abruption in women with preeclampsia

ObjectiveAbnormalities in circulating angiogenic factors and endothelial progenitor cells (EPCs) have been reported in patients with preeclampsia and placental abruption. The objective of this study was to determine whether the number of EPCs is altered in patients with placental abruption.DesignA case control study.SettingHiroshima University Hospital in Japan.SamplePregnant Japanese women with preeclampsia (n = 27) and those without any complications (n = 15).MethodThe EPC (CD45^lowCD34⁺CD133⁺ cells) counts were examined using flow cytometry in peripheral blood collected from 27 women with preeclampsia and 15 normal pregnant women. Among the 27 women with preeclampsia, five subsequently developed placental abruption. All subjects were divided into three groups: normal pregnancy (NP, n = 15), preeclampsia without placenta abruption (PE, n = 22) and preeclampsia with placental abruption (PA, n = 5).Main outcome measuresThe EPC counts were measured in pregnant women with preeclampsia who subsequently developed placental abruption.ResultsThe EPC count in the PE group significantly decreased in comparison to that observed in the NP group (620 cells/ml versus 1918 cells/ml, P < 0.01). In the PA group, the EPC count was found to markedly decrease in comparison to that observed in the PE group (221 cells/ml, P < 0.05).ConclusionsThe number of EPCs was found to significantly decrease in preeclamptic women who subsequently developed placental abruption.     

Plasma levels of S100B during pregnancy in women developing pre-eclampsia

ObjectiveS100B is suggested to be a peripheral biomarker of central nervous system injury with increased blood–brain barrier permeability. The aim of this study was to investigate if there is a difference in plasma levels of S100B throughout pregnancy between women developing pre-eclampsia and those who did not.Study designA nested case-control study within a longitudinal study cohort was performed. Healthy pregnant women were enrolled and plasma samples were collected at gestational weeks 10, 25, 28, 33 and 37. Levels of S100B throughout pregnancy were analyzed with an ELISA assay.ResultsThe levels of S100B did not change between gestational weeks 10 and 37 (0.047 vs. 0.052; p = 0.71) in the healthy controls, but the S100B levels increased between corresponding weeks in women who developed pre-eclampsia (0.052 vs. 0.075; p < 0.05). In gestational weeks 33 and 37 women who developed pre-eclampsia had higher levels of S100B than the controls (p = 0.047 and p = 0.010, respectively).ConclusionS100B levels increase during pregnancy in women who develop pre-eclampsia and there is an increased S100B level in women who develop pre-eclampsia compared with healthy pregnancies several weeks before clinical symptoms of the disease. The increased amount of plasma S100B in women developing pre-eclampsia might be secondary to cerebral vascular damage and S100B is a potential peripheral biomarker reflecting cerebral involvement in pre-eclampsia.     

Comparison of maternal serum levels of interleukin-10, interleukin-12, and interleukin-2 in normal and preeclamptic pregnancies

ObjectiveThe aim of this study was 2 fold: (1) to compare the maternal serum levels of IL-10, IL-12, and IL-2 in preeclamptic and normal pregnant women, and (2) to study the serum levels of these cytokines in preeclamptic pregnancies with and without intrauterine growth retardation.Study designForty women with singleton pregnancies complicated by preeclampsia (32 severe and 8 mild) and 29 normotensive healthy pregnant women were included in the study. Preeclamptic patients were further divided into 2 groups according to the presence or absence of intrauterine growth retardation. Maternal serum levels of IL-10, IL 12, and IL-2 were compared between these groups using enzyme-linked immunosorbent assays.ResultsMaternal serum levels of IL-10 were significantly higher in the preeclampsia group than in controls (p < 0.001). There were no statistically significant differences in maternal serum concentrations of IL-2 and IL-10 between the study and control groups (p > 0.05). Serum levels of IL-2 and IL-10 in the patients with preeclampsia complicated by IUGR were elevated in comparison with the uncomplicated preeclampsia group. These differences were statistically significant (p < 0.05 for both).ConclusionsIL-10 may be involved in the pathologic process of preeclampsia. Increased serum levels of IL-10 and IL-2 in preeclampsia complicated with IUGR suggests a possible role of these cytokines in IUGR.     

Ejercicio físico durante el embarazo y su relación con los tiempos de las etapas del parto

ObjectiveTo determine the influence of aerobic exercise during the second and third trimesters of pregnancy on the duration of stages of labor.Subjects and methodsAn experimental (casecontrol) study was performed. Four hundred eighty women were interviewed at their first prenatal visit. One hundred forty-two pregnant women without complications or multiple pregnancies were randomly selected and were divided into two groups: cases (n = 72) and controls (n = 70).ResultsCases: stage 1 (n = 65): 7.0 ± 3.4 hours. Stage 2 (n = 61): 32.5 ± 24.7 min. Stage 3 (n = 61): 8.0 ± 2.2 min. Controls: stage 1 (n = 62): 6.5 ± 2.5 hours. Stage 2 (n = 59): 35.9 ± 31.5 min. Stage 3 (n = 59): 7.7 ± 1.7 min. The SPSS statistical program was used to analyze the results.ConclusionPhysical exercise seems not to influence the duration of stages of labor. Future studies with more homogeneous groups and different intensities of exercise are required.     

Vitamin D Insufficiency Is Prevalent among Pregnant African American Adolescents

Study ObjectiveRecent attention has focused on vitamin D insufficiency but few data exist on vitamin D status among pregnant minority youth.DesignA screening study was undertaken in adolescents having prenatal blood samples drawn for other routine tests obtained during the second trimester (18 ± 1.8 week gestation, n = 44) or third trimester of pregnancy (28.4 ± 2.1 week gestation, n = 36). Serum 25- hydroxyvitamin D (25(OH)D) was measured and significant determinants of vitamin D insufficiency in this cohort were identified.SettingUrban prenatal clinic.ParticipantsEighty pregnant African American adolescents (≤ 18 y of age).Main Outcome Measure(s)Vitamin D status, STDs, hemoglobin, season, birth weightResultsSerum 25(OH)D in this group averaged 21.6 ± 8 ng/mL (age 16.5 ± 1.1 y, n = 80), and did not significantly differ between the second (20.95 ± 8.2 ng/mL, n = 44) and third trimester cohorts (22.5 ± 7.9 ng/mL, n = 36). Vitamin D insufficiency (< 20 ng/mL) was evident in 46.25% and vitamin D deficiency (<15 ng/mL) was evident in 21.25% of those studied. Significant predictors of suboptimal vitamin D status included sampling during the winter months (P = 0.004), lower hemoglobin concentration (P = 0.019), and higher second trimester leptin levels (P = 0.018). Inverse associations between 25(OH)D and bacterial vaginosis were evident when controlled for season of sampling (P = 0.02, n = 80).ConclusionsVitamin D insufficiency was prevalent among urban pregnant minority adolescents. Further studies are needed to address the impact of this finding on maternal and neonatal calcium homeostasis and bone health.     

The effects of adipocytokines on the endocrino-metabolic features and obstetric outcome in pregnant obese women with polycystic ovary syndrome

ObjectiveTo estimate the effects of adipocytokines on the metabolic and endocrine features, and the obstetric outcome in pregnant women with polycystic ovary syndrome (PCOS).DesignProspective cross sectional study.Main outcome measures: plasma concentration of adipocytokines, insulin resistance/hyperinsulinism (IR/HI), lipid profile, androgens and obstetric outcome.Materials and methodsThe study included hundred pregnant PCOS (PPCOS) women with android obesity (group 1), 100 pregnant non-PCOS women with android obesity (group 2), 100 PPCOS women with gynoid obesity (group 3), and 100 pregnant non-PCOS women with gynoid obesity (group 4). All patients in the four groups were primigravidae and women with PCOS (groups 1 and 3) became pregnant after treatment with clomiphene citrate and/or gonadotropins.Plasma concentrations of fasting glucose, fasting serum insulin, insulin sensitivity by quantitative insulin sensitivity check index (QUICKI), serum concentrations of triglycerides (TGs), total cholesterol (TC), high density lipoprotein cholesterol, (HDL-c), low density lipoprotein cholesterol (LDL-c); plasma adipocytokines: interleukin (IL)-10, adiponectin (both are insulin sensitizers and anti-inflammatory), pro-inflammatory cytokines: IL-6, prothrombin activator inhibitor-1(PAI-1), high sensitivity C-reactive protein (hsCRP); serum total testosterone (TT), sex-hormone binding globulin (SHBG), free androgen index (FAI) were estimated for the four groups between 22 and 24 weeks’ gestation Glucose loading test was done at 22–24 weeks’ gestation to check for gestational diabetes mellitus and if normal it was repeated at 30–34 weeks. Gestational hypertension (GH), preeclampsia (PE) and preterm labor (PTL) (delivery <37 weeks’ gestation) were recorded.ResultsGroups 1 and 2 with android obesity had IR/HI, (QUICKI < 0.331 ± 0.010). Groups 3 and 4 with gynoid obesity had normal insulin sensitivity (NIS), (QUICKI > 0.331 ± 0.010). Serum concentration of TGs, LDL-c, and plasma concentration of IL-6, PAI-1, hsCRP were significantly higher in groups 1 and 2 than groups 3 and 4. Serum HDL-c, plasma IL-10 and adiponectin were significantly higher in groups 3 and 4 than groups 1 and 2. Serum TT and FAI were significantly higher in groups 1 and 3 (cases of PPCOS) than their controls. There was no significant difference in the serum concentration of TC between the four groups.Incidence of spontaneous early miscarriage (SM) in groups 1, 2, 3, and 4 was 36%, 12%, 33%, and 11% respectively. Incidence of SM was significantly higher in PPCOS than non-PCOS pregnancy irrespective of the type of obesity.Rate of late pregnancy complications, GDM, GH, PE and PTL was significantly higher in groups 1 and 2 with android obesity than groups 3 and 4 with gynoid obesity. There was no significant difference in the rates of cesarean section (CS) between the 4 groups. The rates of neonatal complications and perinatal mortality were significantly higher in groups 1 and 2 (android obesity) than groups 3 and 4 (gynoid obesity).Conclusion

• 1.TT and FAI were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity.
• 2.Incidence of early SM (9–12 weeks) was significantly higher in PPCOS than in non-PCOS pregnancy irrespective of the type of obesity.
• 3.Incidence of late-onset pregnancy complications, GDM, GH, PE and PTL was significantly higher in patients with android obesity than patients with gynoid obesity. PCOS per se seemed to be not related to the incidence of late-onset pregnancy complications.Pregnant patients with android obesity, (both PCOS and non-PCOS) with diminished serum concentration of anti-inflammatory cytokines, and increased serum concentration of pro-inflammatory cytokines had IR/HI and dyslipidemia. Pregnant patients with gynoid obesity, (both PCOS and non-PCOS) with normal serum concentration of anti- and pro-inflammatory cytokines had NIS and normal lipid profile.
• 4.In pregnancy with android obesity patients had reduced plasma concentration of IL-10 and increased concentration of IL-6 which may impair the development of the placenta with increased risk of PTL.
• 5.Neonatal complications and perinatal mortality were significantly higher in PPCOS with android obesity than PPCOS with gynoid obesity.

     

Left ventricular remodeling and diastolic function in chronic hypertensive pregnant women

Hypertension during pregnancy is a problem that impacts maternal morbidity and mortality. Dyspnea and edema are common symptoms, often secondary to physiological changes, but may raise doubts as to ventricular dysfunction.ObjectiveTo evaluate the ventricular geometry pattern and diastolic function in chronic hypertensive pregnant women (HPW).MethodsProspective, cross-sectional study on 62 pregnant women over a 29-month period, from March 2009 to July 2011, in Brazil was done. Thirty-one HPWs and 31 normotensive pregnant women (NPW) underwent clinical and cardiovascular evaluations, and were subjected to transthoracic echocardiogram.ResultsLV mass (HPW: 220.9 ± 43.3 vs. NPW: 192.9 ± 39.8 g, p = 0.01), posterior wall thickness (HPW: 9.9 ± 1.1 vs. NPW: 9.2 ± 0.9 mm, p = 0.005), mitral flow A wave velocity (HPW: 0.60 ± 0.16 vs. NPW: 0.52 ± 0.10 m/s, p = 0.02), tissue Doppler A′ wave velocity (HPW: 10 ± 2 vs. NPW: 8.9 ± 1 cm/s, p = 0.02), and E/E′ ratio (HPW: 6.8 ± 2.2 vs. NPW: 5.5 ± 1.6, p = 0.01) were higher in HPWs. Septal and lateral walls E′ wave velocities (HPW: 13 ± 2 vs. NPW: 15 ± 3 cm/s, p = 0.001), and E′/A′ ratio (HPW: 1.26 ± 0.38 vs. NPW: 1.77 ± 0.49, p = 0.00003) were lower in HPWs. There was a positive linear correlation between body mass index (BMI) and ventricular mass, A wave, systolic, diastolic blood pressures, and a negative correlation between BMI, E′ wave and E′/A′ ratio.ConclusionVentricular remodeling showed a direct relationship with body weight, and both groups showed a predominant pattern of eccentric ventricular hypertrophy. The LV diastolic function was abnormal in HPWs.     

2-Methoxyestradiol deficiency is strongly related to hypertension in early onset severe pre-eclampsia

Objective2-Methoxyestradiol (2ME) deficiency leading to placental insufficiency has been related to pre-eclampsia (PE). Here we investigate whether 2ME is related to clinical profiles and vasoactive factors in early onset severe PE patients.Methods28 severe PE patients and 20 uncomplicated normal pregnant women, with gestational weeks between 24 and 32 weeks, were recruited. All cases and controls had singleton pregnancies and were matched for maternal age, parity, body mass index, and gestational weeks. Plasma levels of 2ME, estradiol (E2), soluble Fms-like tyrosine kinase-1 (sFLT-1), endothelin-1 (ET-1), nitric oxide (NO) were determined.ResultsPE patients had significant lower 2ME [906(422–1768) vs. 2032(1400–2910) pg/mL, P = 0.002], higher sFLT-1 [5.55(3.24–11.22) vs. 3.13(2.17–5.36) ng/mL, P = 0.015] and higher NO [122.40(72.92–168.23) vs. 45.83(25.52–61.46) μmol/L, P = 0.0008] levels in their plasma than the controls. In the PE group, plasma 2ME level correlated negatively with systolic pressure (r = −0.48, P = 0.012), diastolic pressure (r = −0.52, P = 0.007) and mean arterial pressure (r = −0.54, P = 0.005) even after controlling for maternal age; 2ME level did not correlate with proteinuria, plasma levels of E2, sFLT-1, ET-1 or NO. In the control group, plasma 2ME level did not correlate with any of the above clinical profiles or laboratory measurements.Conclusions2ME levels were markedly lower in early onset severe PE and they correlated inversely with blood pressure only in women with PE. Although we cannot tell whether lower 2ME level is the causation or the result of PE, our study provides clinical evidences that 2ME deficiency is strongly related to hypertension in early onset severe PE patients.     

Association between placental growth factor levels in early onset preeclampsia with the occurrence of postpartum hemorrhage: A prospective cohort study

ObjectivesTo determine the association between PlGF (placental growth factor) estimation in early second trimester (22–24 weeks of gestation), with the occurrence of postpartum hemorrhage in pregnant women with early onset preeclampsia and whether the mode of delivery (cesarean or vaginal) has any association with increased risk of developing postpartum hemorrhage.Study designA prospective cohort study was conducted on 788 pregnant women with singleton pregnancies diagnosed with early onset preeclampsia between March 2009 and June 2011. Maternal serum PlGF level estimation was done between 22 and 24 weeks of gestation and a cut-off value of <122 pg/ml was determined by receiver operating characteristic (ROC) curve analysis for identifying those at risk of developing postpartum hemorrhage. Association between serum PlGF level <122 pg/ml and cesarean deliveries with the risk of developing postpartum hemorrhage was analyzed by logistic regression analysis and Odds ratio, which were computed. The results were considered statistically significant when P-value <0.05.Main outcome measuresProportion of study population developing postpartum hemorrhage.ResultsLogistic regression analysis showed the association of serum PlGF <122 pg/ml at 22–24 weeks (Odds ratio 8.9516; 95% CI, 5.0728–15.7963) and that of cesarean delivery (Odds ratio 2.4252; 95% CI, 1.4573–4.0360) with the risk of developing postpartum hemorrhage. Both the associations were found to be statistically significant.ConclusionMaternal serum PlGF level <122 pg/ml at 22–24 weeks of gestation and cesarean delivery are both strongly associated with the risk of developing postpartum hemorrhage in pregnant women with early onset preeclampsia.     

Expression imbalance of IL-17/IL-35 in peripheral blood and placental tissue of pregnant women in preeclampsia

ObjectivesThe possible mechanism of preeclampsia is investigated in this study to facilitate the exploration of the future remediation of this disease by analysing the changes of IL-17 and IL-35 in peripheral blood and placental tissue of pregnant women with preeclampsia (PE).Materials and methodsThe study was conducted using 45 healthy pregnant women as the control group and 90 pregnant women in the preeclampsia group, including 45 cases with severe preeclampsia and 45 cases with mild preeclampsia. All of 135 pregnant women underwent caesarean delivery. IL-17 and IL-35 concentrations in the serum were measured by ELISA, and IL-17 and IL-35 expression in placental specimens was detected by immunohistochemistry.ResultsThere were no statistically significant differences in age among the three study groups. Serum IL-17 levels were significantly higher in PE patients than in healthy pregnant women (P < 0.01). The ratio of positive staining for IL-17 was markedly higher in mild PE tissues (84.44%; 38/45) and severe PE tissues (86.67%; 39/45) than in healthy pregnant tissues (35.56%; 16/45) (P < 0.01). The strong positive rates for IL-17 were markedly higher in mild PE tissues (48.89%; 22/45) and severe PE tissues (68.89%; 31/45) than in healthy pregnant tissues (13.33%; 6/45) (P < 0.01). No differences between mild PE tissues and severe PE tissues were noted in both positive case rates and strong positive rates. Consistent with this finding, the ratio of strong positive staining for IL-35 was higher in healthy pregnant tissues (66.67%; 30/45) than in mild PE tissues (33.11%; 14/45) and severe PE tissues (26.67%; 12/45) (P < 0.01).ConclusionsThe abnormal increase in serum and placental of IL-17 has an association with the formation and development of PE. IL-35 expression is significantly lower in severe PE placenta tissue and serum compared with normal pregnant women. These results suggested that IL-17/IL-35 imbalance may play a role in the pathophysiology of PE.