Lipid concentration in small for gestational age (SGA)pregnancies and hypertensive disorders

ObjectiveLow maternal serum lipid and high maternal serum lipid have both been associated with some complications in pregnancy. The lipid profiles in pregnancies complicated by small for gestational age (SGA) or hypertension disorders have been compared with those of normal pregnancies.MethodIn a prospective study, 900 pregnant women between 13 and 23 weeks of pregnancy were studied. Primarily, serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, were measured. Ultimately, the serum lipid levels at 13–23 weeks of pregnancies were compared between the women who later suffered from hypertension disorders or SGA and the matched women with normal pregnancies.ResultsAt 13–23 weeks of pregnancy, the mean triglyceride levels were significantly higher in the women who later experienced preeclampsia when compared with normal, matched pregnancies with an appropriate weight for gestational age and women who had gestational hypertension (p = 0.001 and p = 0.014, respectively). Also, triglyceride levels were significantly higher in women with neonates with large for gestational age (LGA) in comparison with those who gave birth to neonates with SGA (p = 0.012) and with uncomplicated matched pregnant women who gave birth to neonates with weight >10th and <90th percentile for their gestational age (p = 0.007).ConclusionOnly the levels of TG and not any other lipids evaluated were found to be different in pregnancies complicated by preeclampsia when compared to pregnancies complicated by SGA.     

Plasma antithrombin levels correlate with albumin and total protein in gestational hypertension and preeclampsia

ObjectiveTo analyze the antithrombin-III (AT-III) activity in the plasma in relation to the serum albumin and total protein in preeclampsia and gestational hypertension.Study designThe medical records of 139 patients who were diagnosed with gestational hypertension (n = 33) and preeclampsia (n = 106) were reviewed, and the relationships between the activity of AT-III and serum albumin or total protein were evaluated.Main outcome measuresThe plasma AT-III activity in gestational hypertension and preeclampsia was correlated with the serum albumin and TP levels.ResultsThere were significant correlations between AT-III activity and albumin in gestational hypertension (r = 0.504, p = 0.003) and preeclampsia (r = 0.343, p = 0.003). There were also significant correlations between AT-III activity and TP in gestational hypertension (r = 0.619, p = 0.001) and preeclampsia (r = 0.366, p = 0.001). Regression coefficients between AT-III and albumin and between AT-III and TP in gestational hypertension (23.7 and 14.0, respectively) were significantly steeper than those in preeclampsia (14.6 and 9.6, respectively).ConclusionsThe plasma AT-III activity in gestational hypertension and preeclampsia was correlated with the serum albumin and TP levels. This suggests that AT-III activity is more likely to decrease in gestational hypertension than in preeclampsia.     

Baseline placental growth factor levels for the prediction of benefit from early aspirin prophylaxis for preeclampsia prevention

ObjectivePlacental growth factor (PlGF) levels early in pregnancy are lower in women who ultimately develop preeclampsia. Early initiation of low-dose aspirin reduces preeclampsia risk in some high risk women. We hypothesized that low PlGF levels may identify women at increased risk for preeclampsia who would benefit from aspirin.Study designSecondary analysis of the MFMU High-Risk Aspirin study including singleton pregnancies randomized to aspirin 60 mg/d (n = 102) or placebo (n = 72), with PlGF collected at 13 w 0 d–16 w 6 d. Within the placebo group, we estimated the probability of preeclampsia by PlGF level using logistic regression analysis, then determined a potential PlGF threshold for preeclampsia prediction using ROC analysis. We performed logistic regression modeling for potential confounders.ResultsROC analysis indicated 87.71 pg/ml as the threshold between high and low PlGF for preeclampsia-prediction. Within the placebo group high PlGF weakly predicted preeclampsia (AUC 0.653, sensitivity/specificity 63%/66%). We noted a 2.6-fold reduction in preeclampsia with aspirin in the high-PlGF group (12.15% aspirin vs 32.14% placebo, p = 0.057), but no significant differences in preeclampsia in the low PlGF group (21.74% vs 15.91%, p = 0.445).ConclusionsUnlike other studies, we found that high rather than low PlGF levels were associated with an increased preeclampsia risk. Low PlGF neither identified women at increased risk of preeclampsia nor women who benefitted from aspirin. Further research is needed to determine whether aspirin is beneficial in women with high PlGF, and whether the paradigm linking low PlGF and preeclampsia needs to be reevaluated.CondensationHigh-risk women with low baseline PlGF, a risk factor for preeclampsia, did not benefit from early initiation of low-dose aspirin.     

Maternal hypertensive diseases negatively affect offspring motor development

ObjectiveHypertension in pregnancy and preeclampsia have been linked to poor outcomes in cognitive, mental and psychomotor development; however, few longitudinal studies have researched their effect on offspring motor development, particularly in late childhood and adolescence. The purpose of this study was to determine if maternal hypertensive diseases during pregnancy are a risk factor for compromised motor development at 10, 14, and 17 years.Study designLongitudinal cohort study using data from the Western Australian Pregnancy Cohort Study (Raine).Main outcome measureOffspring (n = 2868) were classified by their maternal blood pressure profiles during pregnancy: normotension (n = 2133), hypertension (n = 626) and preeclampsia (n = 109). Offspring motor development, at 10, 14, and 17 years was measured by the Neuromuscular Developmental Index (NDI) of the McCarron Assessment of Motor Development (MAND).MethodsLinear mixed models were used to compare outcomes between pregnancy groups.ResultsOffspring from pregnancies complicated by preeclampsia had poorer motor outcomes at all ages than offspring from either normotensive mothers (p ⩽ 0.001) or those with hypertension (p = 0.002).ConclusionHypertensive diseases during pregnancy, in particular preeclampsia, have long term and possibly permanent consequences for motor development of offspring.     

Transient gestational hypertension: Not always a benign event

ObjectivePregnancy outcome in women with transient gestational hypertension (TGH);defined as de novo blood pressure elevation after 20 weeks gestation that normalizes by subsequent evaluation in a Day Assessment Unit.Study designRetrospective cohort analysis of hypertensive pregnancies between 2003 and 2008.Main outcome measuresFinal hypertensive delivery diagnosis and composites of adverse maternal and fetal outcome.ResultsOverall 1417 women were referred; 890 met criteria; 41% (65% of study population) had TGH. Twenty percent with TGH developed gestational hypertension and 19% preeclampsia. Women with TGH who developed preeclampsia had similar composite adverse maternal outcomes to other preeclamptic women (51% vs. 63%; p = 0.24) but fewer adverse fetal outcomes (50% vs. 71%; p < 0.01) due to less prematurity (30% vs. 45%; p = 0.02) and small for gestational age babies (33% vs. 51%; p = 0.02). Within the TGH population;developing gestational hypertension or preeclampsia was associated with referral at gestation <33 weeks (RRR 2.8; p < 0.01);initial average systolic blood pressure 130–139 mmHg (RRR 2.1; p < 0.01) and initial average diastolic blood pressure 80–89 mmHg (RRR 3.2; p < 0.01).ConclusionTGH after 20 weeks is common in pregnancy. Although initial assessment implies low risk;the risk of progression to gestational hypertension or preeclampsia is substantial and warrants appropriate clinical surveillance.     

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.     

Postpartum alterations in circulating endothelial progenitor cells in women with a history of pre-eclampsia

ObjectiveTo characterize persistent postpartum maternal endothelial dysfunction following pre-eclampsia (PE) through the assessment of endothelial progenitor cells as markers of endothelial reparative capacity.Study designMaternal circulating endothelial progenitor cells were measured at 2 months and 6 months postpartum in women who had recently experienced PE pregnancies (n = 17). Normotensive controls (n = 13) with uncomplicated pregnancies served for comparison at the same time points. Progenitor cells were measured by flow cytometry and by colony forming units. Maternal cardiovascular risk was measured at 6 months postpartum.Main outcome measuresLevels of maternal circulating endothelial progenitor cells and cardiovascular risk in the early postpartum period of uncomplicated and PE pregnancies.ResultsCD34 + VEGFR-2+ and CD133 + VEGFR-2+ cells were elevated in PE subjects at 2 months postpartum compared to healthy control subjects, although reduced by 6 months postpartum. PE was associated with reduced colony forming units at 2 and 6 months postpartum. Cardiovascular risk scores were increased in PE compared to normotensive controls.ConclusionsWe have demonstrated that there is a physiological alteration in the number and function of circulating progenitor cells following PE pregnancies. Furthermore, this population of women exhibited elevated cardiovascular risk profiles compared to those with uncomplicated pregnancies. Pregnancy and the development of PE identify an early window for cardiovascular risk screening in women. Cellular markers of vascular health offer an approach to the investigation of postpartum endothelial dysfunction.     

Pregnancy outcomes in women with heart disease: Experience of a tertiary center in the Netherlands

ObjectivesClinical data of pregnant women with heart disease were obtained with the intention to provide input for local counseling and management guidelines.Study designRetrospective data from all pregnant women with congenital or acquired heart disease between 2000 and 2011 in the VU University Medical Centre Amsterdam.Main outcome measuresMaternal and neonatal outcomes were evaluated.ResultsData of 122 women with 160 pregnancies were obtained. The most common heart diseases were congenital heart disease (n = 65, 53.3%) and arrhythmia (n = 20, 16.4%). Based on the functional criteria of the New York Heart Association (NYHA), 114/122 patients (93.4%) were classified NYHA class I–II. Patients in NYHA class III–IV (n = 8/122, 6.6%), mainly had a history of myocardial infarction or pulmonary hypertension. There were 156 singleton and 4 twin pregnancies. 22 (13.5%) pregnancies were complicated by hypertensive disorders. Heart failure developed in 11 women (9.0%), 37.5% in NYHA class III–IV and 6.5% in NYHA class I–II. Mean gestational age and birth weight were 270 days and 3196 g in NYHA class I–II compared to 237 days and 1972 g for NHYA class III–IV. There were two maternal deaths (1.6%) and 5 fetal deaths (3.1%). There were 29 (12.8%) preterm births, 20 (12.8%) neonates small for gestational age and 34 (21.8%) admittances on the Neonatal Intensive Care Unit (NICU).ConclusionsPregnancy in women with pre-existing heart disease in all NYHA classes is associated with increased maternal morbidity and perinatal morbidity. Risk of structural fetal anomalies is especially high in women with congenital heart disease.     

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.     

How accurate are placental growth factor,urate, lactate dehydrogenase and proteinuria in diagnosing preeclampsia and its severity?

ObjectiveThe objective was to assess the diagnostic accuracy of serum and urinary placental growth factor (sPlGF and uPlGF, respectively), urate, lactate dehydrogenase (LDH), and proteinuria for diagnosing and differentiating between women with preeclampsia and women with a normal healthy pregnancy, gestational hypertension, and gestational proteinuria.Study designUrine and blood samples were taken from pregnant women diagnosed with late-onset severe preeclampsia (30 patients), mild preeclampsia (30 patients), gestational hypertension without meeting the criteria for preeclampsia (30 patients), gestational proteinuria without meeting the criteria for preeclampsia (30 patients), and healthy pregnant control women (30 patients). A receiver operating characteristic (ROC) curves analysis was performed to evaluate the diagnostic accuracy and to select the optimal cutoff points for different markers.ResultssPlGF is the best test for differentiating women with severe preeclampsia from women in all of the other groups (p = 0.001). However, there was no significant difference between sPlGF and proteinuria in the 24-h urine collection (p = 0.329) in this differentiation. uPlGF can be used to differentiate women with severe preeclampsia from women in all of the other groups. However, proteinuria in the 24-h urine collection is better than uPlGF for this differentiation (p = 0.013).ConclusionsPlGF and uPlGF can be used to diagnose women with severe preeclampsia and should be considered at least as important as proteinuria in the diagnosis of preeclampsia. A large study that considers the cost-effectiveness of adding these markers to the diagnosis of preeclampsia should be conducted before our recommendation is applied.     

Characteristics of hypertensive disorders in twin versus singleton pregnancies

ObjectiveTo determine the characteristics of hypertensive disorders of pregnancy in twin compared with singleton pregnancies.Study designAnalysis of a prospectively recorded database of 4976 hypertensive pregnancies.Main outcome measuresComparison of progression to pre-eclampsia and maternal and neonatal outcomes.ResultsThere were 3942 singleton and 214 twin pregnancies. De novo hypertension in twin pregnancy was diagnosed earlier (p < 0.001). In singleton pregnancies with de novo hypertension (n = 3161), 60% had an initial diagnosis of gestational hypertension (GH) and 40% had pre-eclampsia (PE). In twin pregnancies with de novo hypertension (n = 199), 35% of women were initially diagnosed with GH and 65% with PE (p < 0.001). At delivery, 46% of the singletons had GH and 54% had PE, compared with twin pregnancies where 23% had GH and 77 % had PE (p < 0.001). The progression from GH to PE for twins was twice that of singleton pregnancies (p < 0.001).There were 781 singleton and 15 twin pregnancies with chronic hypertension (CH). Twin pregnancies complicated by CH were more likely to progress to PE than singletons (p < 0.01). The gestation at delivery was earlier for twin pregnancies (p < 0.001) and there were more twins that were smaller for gestational age (p < 0.001). There were no differences in maternal outcomes.ConclusionWomen carrying twins with de novo hypertension are more likely to present earlier, have initial PE and to subsequently progress from GH to PE. Neonatal outcomes are worse in such pregnancies.     

Clinical risk factors for gestational hypertensive disorders in pregnant women at high risk for developing preeclampsia

ObjectivesTo evaluate clinical risk factors for the development of gestational hypertensive disorders in a group of pregnant women at high risk for developing preeclampsia. Secondly we evaluated the incidence and recurrence rate of preeclampsia and pregnancy-induced hypertension.Study designA prospective analysis of data obtained from a cohort study was performed. Pregnant women were included who had at least one of the following risk factors for preeclampsia: previous history of preeclampsia, previous history of HELLP syndrome, chronic hypertension, diabetes mellitus, multiple pregnancy, obesity, or autoimmune disease. Univariate and multivariate logistic regression analyses were used to evaluate the role of clinical characteristics and risk factors in the development of hypertensive disorders.Main outcome measuresDevelopment of gestational hypertensive disorders.ResultsThirty-five percent (36/103) developed a hypertensive disorder. The univariate analysis identified preeclampsia in a previous pregnancy (OR 2.94, 95% CI: 1.25–6.91, p = 0.013) as a significant risk factor. Multivariate logistic regression revealed that a previous history of preeclampsia was the only significant independent risk factor for gestational hypertensive disorders (OR 2.89, 95% CI: 1.17–7.08, p = 0.021). Women with a previous history of PE had the highest incidence rate of 51.4% for hypertensive disorders compared to the incidence rates of other risk factors (20.8%–38.5%).ConclusionA previous history of preeclampsia proves to be a strong independent clinical risk factor for gestational hypertensive disorders in high-risk pregnant women, even in our relatively small cohort study.     

Intérêt du dosage des d-dimères comme marqueurs de sévérité en cas de prééclampsie

ObjectivesAlterations in blood coagulation and fibrinolysis play a major role in the pathogenesis of preeclampsia. HELLP syndrome is associated with hypercoagulability and leads to maternal and perinatal complications. Our purpose was to evaluate d-dimer as a marker for severity in pregnancies with preeclampsia.Patients and methodsPlasma d-dimer levels were measured using an enzyme-linked immunosorbent assay (ELISA) technique. We studied the association between d-dimer levels and clinical and biological characteristics of pregnancies complicated by preeclampsia.Resultsd-dimer values increased with increasing gestational age. Patients with HELLP syndrome had mean d-dimer values significantly greater than patients with preeclampsia alone (3848 ± 2551 versus 1578 ± 1077, P < 0.001). However, the level of d-dimer at the time of admission was poorly predictive of occurrence of HELLP syndrome. Area under of the ROC curve was 0.69 (CI 95%: 0,59–0,79). The best threshold was 2170 ng/mL with a sensitivity of 0.91 and a specificity of 0.40. Other severity criteria of preeclampsia were not associated with higher levels of d-dimer.Discussion and conclusionIn preeclamptic patients, d-dimer levels were related with gestational age and HELLP syndrome. However, accuracy of this test to predict occurrence of HELLP syndrome or severe preeclampsia was too low to recommend its use routinely.     

Maternal serum ratio of ghrelin to obestatin decreased in preeclampsia

ObjectiveGhrelin, an endogenous for the growth hormone secretagogue receptor, has been shown to participate in blood pressure regulation. Obestatin, encoded by the same gene as ghrelin, is described as a physiological opponent of ghrelin. We hypothesized that ghrelin/obestatin imbalance played a role in the pathogenesis. This study was designed to determine the alterations of ghrelin and obestatin concentrations and ghrelin/obestatin ratio in maternal serum in preeclampsia.MethodThis retrospective case–control study included 31 preeclampsia and 31 gestational week-matched normal pregnancies. Ghrelin and obestatin concentrations in maternal serum were determined by radioimmunoassay, and the ghrelin/obestatin ratio was calculated.ResultsThe ghrelin concentration and ghrelin/obestatin ratio in maternal serum were significantly lower in preeclampsia than in normal pregnancies (214.34 ± 14.27 pg/mL vs 251.49 ± 16.15 pg/mL, P = 0.041, 1.07 ± 0.09 vs 0.82 ± 0.08, P = 0.023). The obestatin concentration in maternal serum was significantly higher in preeclampsia than in normal pregnancies (276.35 ± 15.38 pg/mL vs 223.53 ± 18.61 pg/mL, P = 0.019). The systolic blood pressure in preeclampsia was negatively correlated with ghrelin concentration and ghrelin/obestatin ratio (r = −0.549, P = 0.003; r = −0.491, P = 0.004) and was positively correlated with obestatin concentrations in preeclampsia (r = 0.388, P = 0.013).ConclusionsThe findings of this study suggested disturbance of ghrelin and obestatin in maternal serum in preeclampsia, and ghrelin/obestatin imbalance might play a role in the pathogenesis of preeclampsia.     

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.     

Evidence of inflammation and predisposition toward metabolic syndrome after pre-eclampsia

BackgroundPre-eclampsia (PE) is a hypertensive disorder of pregnancy characterized by exaggerated inflammatory and metabolic responses. Women with a history of PE are at increased risk of the metabolic syndrome (MetS) and cardiovascular disease although the pathophysiological underpinnings of this association remain unclear. This study aimed to compare levels of plasma immunoregulatory factors with the presence of cardiovascular and MetS risk factors in women with and without a history of PE.Study designMaternal plasma and general health survey data were collected from women 5 to 7 months postpartum of uncomplicated pregnancies (n = 28) and pregnancies complicated by PE (n = 35). Maternal plasma samples were analyzed for 14 immunoregulatory factors using a high-sensitivity cytokine profiling array. Cardiovascular risk profiles were compiled on each participant for comparison against cytokine data.ResultsWomen with a history of PE exhibited increased blood pressure and plasma triglyceride levels compared to controls, although similar for parameters of obesity, fasting cholesterols, and glucose. While plasma levels of immunoregulatory cytokines were similar between control and PE subjects, PE subjects exhibited unique patterns of correlation between biophysical parameters and plasma cytokines. In particular, plasma IL-23, MIP-1α, IL-1β and IFN-γ levels were significantly correlated with parameters considered for MetS diagnosis in women without clinical evidence of the syndrome.ConclusionsWe report unique associations between pro-inflammatory markers and MetS criteria within a year following PE. Subclinical inflammation in women with a history of PE who are otherwise healthy may indicate a sensitization of these women toward metabolic disturbances, in particular MetS.     

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.     

Serum S100B in pregnancy complicated by preeclampsia: A case-control study

BackgroundSerum S100B is a protein produced and released primarily by astrocytes of the Central Nervous System (CNS). Elevated levels of serum S100B are associated with several types of pathological conditions of the brain, including the eclampsia in pregnant women. The aim of this study was to compare serum S100B concentrations in pregnant women with severe and mild preeclampsia (PE) with S100B serum levels in normotensive pregnant women.Material and methodsSerum S100B protein was measured in normotensive pregnant women (n = 15) and in women with mild PE (n = 12) or severe PE (n = 34). The serum S100B level (μg/L) was determined by an luminometric assay.ResultsSixty-one expectant mothers were studied, aged 26.6 ± 8.7 (mean ± SD) years and with a gestational age of 33.3 ± 4.2 weeks. The severe PE group demonstrated higher S100B levels (0.20 ± 0.19), as compared with mild PE (0.07 ± 0.05) or normotensive groups (0.04 ± 0.05).ConclusionElevated serum S100B levels in pregnant women with severe PE suggest that some kind of neural damage and subsequent astrocytic release of S100B is not dependent on the progression from severe preeclampsia to eclampsia.     

Prise en charge et issues des grossesses compliquées d’une rupture prématurée des membranes avant 26 semaines d’aménorrhée

ObjectiveTo evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg).Patients and methodsForty patients were included in a retrospective study from 1998 to 2008.ResultsFifty percent of PPROM occurred before 23 wg. Survival rate was 21.4% when PPROM occurred before 22 wg versus 54.5% when it occurred between 22 and 23 + 6 wg and reached 80% after 24 wg (P = 0.006). Perinatal mortality affected more frequently primigravida women (OR = 5.16; IC95%[0.99–36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1 ± 13.8 vs. 40.3 ± 2.3j; P = 0.01). Chorioamnionitis complicated all pregnancies terminated before 26wg versus 50% of pregnancies terminated after 26 wg (P = 0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6 mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P = 0.02; OR = 4.3; IC95%[0,99–22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid.Discussion and conclusionThe gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality.     

Maternal hemodynamics influence fetal hemodynamics in normal and hypertensive pregnancy

ObjectivesThis observational case-control study aims to test whether there is a relationship between maternal systemic hemodynamics, maternal renin-angiotensin system and fetal hemodynamics in normal and hypertensive pregnancy.Study designFour groups of non-pregnant women (n = 18), pregnant controls (n = 25), women with gestational hypertension (n = 21) and preeclampsia (n = 10) were included.Main outcome measuresMaternal echocardiography parameters, plasma renin and aldosterone were correlated with fetal Doppler parameters in third trimester pregnancy.ResultsHigher maternal mean arterial pressure and total peripheral vascular resistance were associated with lower fetal middle cerebral artery pulsatility index (PI) (r = ?.51, p < 0.01 and r = ?.49, p < 0.01, respectively); mean arterial pressure correlated negatively with ductus venosus PI (r = ?.35, p = 0.01); higher maternal plasma aldosterone levels were associated with lower maternal uterine artery resistance (r = ?0.33, p = 0.03).ConclusionsIt seems that maternal hemodynamics influence fetal hemodynamics with protective adaptation in fetal cerebral and ductus venosus blood flow observed as maternal blood pressure and vascular resistance increase.