基因多态性与妊娠期高血压疾病

妊娠期高血压疾病是妊娠期特有的疾病,发病率高,对妊娠妇女、胎儿及新生儿危害极大,是导致孕产妇和围生儿死亡率增加的主要原因.近半个世纪,国内外学者对其发病机制进行了大量研究,有过度炎症反应、血管内皮损伤、氧化应激、母胎免疫平衡失调、滋养细胞缺血及遗传基因易感性等学说,但至今病因尚未阐明.众多研究发现,妊娠期高血压疾病具有较高遗传倾向,与某些基因多态性有关,与多基因有关,且更易发生原发性高血压.相关基因的突变可导致基因表达异常,使基因产物出现数量及功能异常,而诱发妊娠期高血压疾病.     

三维能量多普勒超声产前检测胎盘研究进展

胎盘是妊娠期保证胎儿正常生长、发育的重要器官。围产期妊娠并发症,如妊娠期高血压疾病征、妊娠期肝内胆汁淤积症、妊娠期糖尿病会导致胎盘功能异常;不良妊娠结局,如胎儿生长受限、胎儿宫内缺氧、窒息也与之有关。就三维能量多普勒超声的原理、测量指标的相关性研究及其预测不良妊娠结局,检测胎盘异常的价值和发展前景等综述。     

人类白细胞抗原DRB1*03基因多态性与妊娠期高血压疾病的易感性

妊娠期高血压疾病是妊娠期特有的疾病,是导致孕产妇和围产儿病率和病死率升高的主要原因之一,其发病原因和发病机理目前尚不清楚.研究显示,妊娠期高血压疾病是一组多基因遗传所致的异质性疾病,来自父系的人类白细胞抗原(1ILA)基因通过胎儿作用于母体,因夫妇之间HLA相容性的影响,可能诱发妊娠期高血压疾病的发病,因此具有遗传性[1].本研究选择与妊娠期高血压疾病关系密切的等位基因DRBl*03进行多态性分析,旨在探讨妊娠期高血压疾病的遗传背景和基因基础.     

三维能量多普勒超声产前检测胎盘研究进展

胎盘是妊娠期保证胎儿正常生长、发育的重要器官。围产期妊娠并发症．如妊娠期高血压疾病征、妊娠期肝内胆汁淤积症、妊娠期糖尿病会导致胎盘功能异常;不良妊娠结局,如胎儿生长受限、胎儿宫内缺氧、窒息也与之有关。就三维能量多普勒超声的原理、测量指标的相关性研究及其预测不良妊娠结局．检测胎盘异常的价值和发展前景等综述。     

妊娠期高血压疾病患者的预后特点及其影响因素

妊娠期高血压疾病(PIH)是妊娠期严重威胁母婴生命安全的并发症之一.国内外研究结果表明,PIH可导致血压、血脂、血糖异常,肾功能损害等;其预后转归与病情、治疗方式、孕次等因素密切相关.本文就妊娠期高血压疾病患者的预后特点及其影响因素做一综述.     

妊娠期高血压疾病病因探析

妊娠期高血压疾病是一种对妊娠妇女有潜在生命威胁的疾病，是一种多系统功能紊乱并以高血压、尿蛋白水平升高、血小板减少为主要临床特征的疾病。一般妊娠20周以后发病，妊娠结束后恢复正常。以往对妊娠期高血压疾病病因的描述主要有：血管内皮细胞受损；内皮型一氧化氮合成酶表达异常；子宫胎盘滋养细胞浸润过浅；子宫螺旋动脉重铸障碍导致子宫胎盘缺血；一些细胞因子的表现异常；基因突变或基因多态性，炎症反应等。     

妊娠期糖尿病与妊娠期高血压疾病相关性的研究进展

妊娠期糖尿病与妊娠期高血压疾病是妊娠期特有且常见的疾病,对母婴都能产生不良影响。研究表明,妊娠期糖尿病患者并发妊娠期高血压疾病的危险性明显升高,这可能与胰岛素抵抗、高血糖、肥胖等因素密切相关。及早进行妊娠期糖尿病、妊娠期糖耐量异常的诊断,严密监测妊娠期血糖、血压,控制饮食,适量运动,可降低妊娠期糖尿病患者妊娠期高血压疾病的发生率。     

妊娠期高血压疾病孕妇瘦素与红细胞膜Ca~(2+)-ATP酶活性的研究

目的:探讨瘦素、红细胞膜Ca2+-ATP酶活性在妊娠期高血压疾病发病中的意义及相互关系。方法:采用放射免疫法测定38例妊娠期高血压疾病患者,36例正常孕妇的血清瘦素。采用生化方法提取红细胞膜,测定红细胞膜Ca2+-ATP酶活性。结果:妊娠期高血压疾病患者血清瘦素水平明显高于对照组(15.95±5.10ng/m l vs 11.33±2.93ng/m l),红细胞膜Ca2+-ATP酶活性明显低于对照组[1.38±0.19μmol.pi/(mg.h)vs 1.83±0.38μmol.pi/(mg.h)](P<0.01)。妊娠期高血压疾病患者血清瘦素与红细胞膜Ca2+-ATP酶活性呈负相关(r=-0.63)。结论:血清瘦素水平与妊娠期高血压疾病的发生有关;妊娠期高血压疾病患者红细胞膜Ca2+-ATP酶活性降低引起细胞内游离Ca2+浓度升高,导致妊娠期高血压疾病发生;妊娠期高血压疾病患者血清瘦素水平与红细胞膜Ca2+-ATP酶活性呈负相关,两者共同参与妊娠期高血压疾病的发病。     

妊娠期糖代谢异常孕妇身体参数和胰岛素抵抗对血压的影响

近年研究表明，胰岛素敏感性降低即胰岛素抵抗增加是肥胖伴发高脂血症、糖尿病和高血压的重要因素；临床观察孕妇人群发现，孕期不同程度糖代谢异常发生妊娠高血压疾病的几率显著高于无糖代谢异常者，具体原因尚不清楚。本研究通过检测妊娠期口服葡萄糖耐量试验（OGTF）异常者的身体参数及胰岛素水平变化并与正常对照组相比，探讨了身体参数及对胰岛素敏感性对妊娠期血压的影响。     

ACE基因插入/缺失多态性与妊娠期高血压疾病发病关系的Meta分析

目的:探讨不同人群中血管紧张素I转换酶(ACE)基因插入(I)/缺失(D)多态性与妊娠期高血压疾病发病的关系。方法:检索Pub Med、Cochrane、清华同方、重庆维普,时间从该数据库建立至2016年10月1日。全面收集有关妊娠期高血压疾病发病与ACE I/D基因多态性相关的研究文献,制定文献纳入及排除标准。应用Revman 5.1软件进行Meta分析,计数资料采用优势比(OR)及其95%CI表示。结果:纳入63篇符合条件的研究文献,其中42篇是对亚洲人群的研究,20篇是对欧洲人群的研究,1篇是非洲人群的研究,共纳入妊娠期高血压疾病患者12030例(病例组),健康正常人群14090例(对照组)。Meta分析结果显示,在总体人群、亚洲人群和欧洲人群中,D等位基因、DD基因型以及II基因型在病例组和对照组分布的差异性,D等位基因OR分别为1.42、1.47、1.34,P0.00001、P=0.0004、P0.0001;DD基因型OR分别为1.62、1.67、1.56,P0.00001、P=0.0007、P0.00001;II基因型OR分别为0.72、0.68、0.81,P=0.0003、P=0.002、P=0.10。结论:ACE D等位基因和DD基因型同妊娠期高血压疾病发病关系密切。在总体人群和亚洲人群中,II基因型是妊娠期高血压疾病发病的一种保护性因素;而欧洲人群未发现有关系。     

Subjective registration of fetal movements. Relation to typologic-psychologic markers in pregnant patients

The influence of psychic factors on the accuracy of counting of fetal movements (FM) by pregnant women is investigated. The typologic features extraversion/introversion, stability/lability and vegetative lability are the criterion of judgement. Introverted pregnant women note FM under the condition of extensive protection of external irritation more exactly than extraverted pregnant women. Under the influence of an external irritation by transcutaneous nerve stimulation (TNS) no differences are to be seen. Psychic stable pregnant women are not as much alterable by external irritations as unstable pregnant women. Psychic stable pregnant women count FM under the influence of TNS more exactly than psychic unstable pregnant women. Without the influence of TNS there is no difference between stable and instable pregnant women concerning perception of FM.     

Effect of normal and preeclamptic plasma on superoxide-anion production of neutrophils from healthy non-pregnant women

This study has examined whether production of superoxide-anion by granulocytes differs between non-pregnant, healthy pregnant and preeclamptic pregnant women. First, we assessed superoxide-anion production in 13 non-pregnant women, 11 healthy pregnant women and 14 preeclamptic pregnant women. Then, we examined the effect of plasma samples of healthy pregnant and preeclamptic pregnant women on superoxide production by neutrophils separated from healthy pregnant women. Superoxide generation was measured by ferricytochrome-c reduction. Phorbol-12,13-dibutyrate- and n-formyl-methionyl-leucyl-phenylalanine-stimulated superoxide-anion production was significantly decreased in healthy pregnant women's granulocytes compared with non-pregnant women. There was no significant difference between granulocyte superoxide-anion production in preeclamptic pregnant and non-pregnant women. When neutrophils from non-pregnant women were incubated in plasma from healthy pregnant women, the granulocyte phorbol-12,13-dibutyrate-stimulated superoxide-anion production was significantly inhibited. With the same stimulator, there were no significant differences between superoxide-anion production of neutrophils incubated in autologous, non-pregnant and preeclamptic pregnant plasma. If n-formyl-methionyl-leucyl-phenylalanine was used for stimulation, there were no significant differences in the superoxide-anion production of granulocytes in either group. Granulocyte superoxide-anion production decreases during pregnancy; this decrease does not occur in preeclampsia, and may cause endothelial damage. It is conceivable that there are unidentified factors in maternal circulation which inhibit superoxide-anion production by granulocytes in healthy pregnant women.     

Influenza Vaccine Programs and Pregnancy: New Canadian Evidence for Immunization

Among healthy pregnant women, excess deaths due to influenza were documented during pandemics, but the impact of influenza on pregnant women in non-pandemic years is not clear. In Canada, influenza immunization is recommended for pregnant women only if they have comorbidities known to place them at increased risk of complications or if they deliver during influenza season, therefore becoming a contact of a high-risk infant. The National Advisory Committee on Immunization has indicated that additional evidence, relevant to healthy pregnant Canadian women, is needed to support a recommendation for influenza immunization for all pregnant women. In this commentary we summarize new Canadian data supporting universal influenza immunization for pregnant women and discuss ways in which the Society of Obstetricians and Gynaecologists of Canada might take a leadership role in making influenza vaccination in pregnancy a priority to decrease influenza morbidity in pregnant Canadian women.     

Vasopressor activity in incubated plasma of normal and hypertensive pregnant women

The pressor activity generated in incubated plasma of nonpregnant, normal pregnant, and hypertensive pregnant women was measured by means of a sensitive bioassay technique. It was found that the plasma of normal pregnant women generated significantly higher amounts of active pressor principle than the plasma of nonpregnant women. The plasma of hypertensive pregnant women generated significantly lower amounts of active pressor principle than the plasma of normal pregnant women. Plasma obtained from the antecubital vein revealed no difference in pressor activity compared to plasma collected from the uterine vein at the time of cesarean section. These data suggest that active pressor principle is not involved in the pathogenesis of pregnancy-induced hypertension and that the pregnant uterus is not the source of active pressor principle.     

Evaluation of obstructive sleep apnea symptoms in pregnant women with chronic disease

Objective: Obstructive sleep apnea syndrome (OSAS) is a disease which is estimated to be undiagnosed to a large extent. Hence, the prevalence of OSAS in pregnant women is unknown. We aimed to evaluate the symptoms of obstructive sleep apnea in pregnant women with chronic diseases.

Methods: In the study, 97 pregnant women with chronic diseases and 160 healthy pregnant women were included. A form questioning socio-demographic characteristics and pregnancy characteristics, Epworth scale and the Berlin questionnaire to evaluate the risk of OSAS were applied to participants.

Results: It has been determined that 10–12.5% of healthy pregnant women, 34–45.4% of pregnants with chronic diseases and 20.6–23.3% of all pregnant women had a high risk of OSAS, the pregnants with chronic disease compared to healthy pregnant women had statistically significant higher risk of OSAS. The risk of OSAS was found to be significantly higher especially in pregnant women with hypertension and diabetes.

Conclusions: OSAS can lead to the adverse consequences in pregnancy, should be questioned for all pregnants especially those with chronic diseases. Pregnant women with OSAS should be monitored more carefully in terms of diabetes and hypertension in antenatal care.     

Plasma from women with pre-eclampsia induces an in vitro alteration in the endothelium-dependent behaviour of myometrial resistance arteries

Objective To compare the in vitro effect of plasma from normal pregnant women and women with pre-eclampsia on the endothelium-dependent behaviour of myometrial resistance arteries from normal pregnant women.
Design An in vitro comparative study.
Setting Nottingham City Hospital.
Sample Uterine biopsy specimens were obtained from normal pregnant women delivered by elective caesarean section at term. Plasma was collected from nulliparous women with pre-eclampsia (   n = 18  ), and from multiparous normal pregnant women (   n = 18  ), all samples being matched for maternal age and gestation at venepuncture. Pools of plasma from women with pre-eclampsia and normal pregnant women were formed from these samples and were used in all the experiments.
Methods Myometrial resistance vessels obtained from the uterine biopsies were incubated with normal pregnant plasma, plasma from women with pre-eclampsia, or without plasma. Wire myography was employed to study the effect of plasma on the endothelium-dependent behaviour of these vessels.
Results Incubation of vessels from normal pregnant women with plasma from women with pre-eclampsia resulted in a significant reduction in endothelium-dependent relaxation, compared with vessels incubated either with plasma from normal pregnant women or without plasma. This alteration in endothelial function occurred after an incubation period of one hour and required a threshold concentration for its effect to become established. Removal of the vascular endothelium abolished these changes in vessel behaviour. There were no plasma-induced alterations in the endothelium- independent behaviour of the vascular smooth muscle.
Conclusions This study supports the hypothesis that plasma from women with pre-eclampsia is capable of altering endothelium-dependent myometrial relaxation in vessels from pregnant women.     

Thyroid function tests in pregnant women with and without goiter in the eastern Black Sea region

Maternal thyroid function was investigated in 29 pregnant women with goiter and 51 pregnant women without goiter in the eastern Black Sea region of Turkey ,which is an endemic goiter area. Ten women with goiter and 10 healthy women without goiter were used as controls in the study. In all of the pregnant women ,increased concentrations of total and free thyroxine ,total and free triiodothyronine and thyroxine-binding globulin were found. Serum thyroid-stimulating hormone levels showed a decrease in pregnant women without goiter compared with non-pregnant women without goiter.     

Association between hypertension and quality of life in pregnancy

Purpose: To assess the association between hypertension in pregnancy and women’s quality of life (QoL) and the variation in the quality of life over gestational trimesters. Method: A questionnaire was applied to 194 hypertensive pregnant women and 195 pregnant women without complications. The questionnaire was composed of two parts: socioeconomic profile and specifically QoL, using the instrument Ferrans & Powers Quality of Life Index. All women included underwent a physical examination. Results: Blood pressure was found to be approximately 20 mmHg higher in hypertensive pregnant women compared to pregnant women without complications. All QoL domains of hypertensive pregnant women had lower scores than those of pregnant women without complications, with health/functioning rated the lowest, averaging 17.63. The least affected domain was family, having the best average score (26.0). The QoL had no significant variations in relation to gestational trimesters. Conclusions: Pregnancy causes intense changes, both physical and psychological, in women’s lives and hypertension was found to be a factor of high interference in pregnant woman’s QoL, causing lower scores in all QoL domains of hypertensive pregnant women, compared with pregnant woman without complications.     

Oxidative stress in diabetic pregnancy: SOD, CAT and GSH-Px activity and lipid peroxidation products.

Diabetic pregnancy is often complicated by a number of pathological conditions among which is increased oxidative stress. This study was conducted to investigate the parameters of oxidative stress in 90 patients divided into the three groups: pregnant women with Type 1 diabetes mellitus, healthy pregnant women and non-pregnant women. In pregnancy groups all parameters were followed in 1st, 2nd and 3rd trimester. Diabetic control was monitored by fasting blood glucose and glycosylated hemoglobin (HbA(1c)) and these values, as well as measured biochemical parameters (urea, creatinine, total cholesterol and uric acid), were appropriate throughout the study. The concentration of TBARS, as a measure of lipid peroxidation, and activity of antioxidant enzymes superoxide dismutase (Cu, Zn-SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) were investigated in hemolysate of erythrocytes. TBARS concentration increased significantly in pregnant women when compared with control group (non-pregnant women), as well as in pregnant diabetics compared with healthy pregnant women. The SOD activity was gradually increased in the group of normal pregnant women vs. non-pregnant group, but decreased significantly in the group of diabetic pregnant women. Catalase activity was significantly increased only in 3rd trimester diabetic pregnant women. Increased lipid peroxidation and reduced antioxidant status, despite good diabetic control, show that pregnant women are exposed to oxidative stress to a greater degree than controls.     

Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy.

Background and Objective: The occurrence of diabetic ketoacidosis (DKA) during pregnancy is considered a medical emergency. The aims of the present study were to evaluate the incidence of DKA in pregnant and non-pregnant women with diabetes; to compare the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women; and to show a case of euglycemic DKA in pregnancy. Methods: The subjects consisted of 90 cases of DKA in pregnant women with diabetes and 286 cases of non-pregnant female inpatients receiving treatment for diabetes during 2001 to 2005 in our hospital. The incidence of DKA in pregnant and non-pregnant women with diabetes and the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women were compared. Results: DKA had a higher incidence in pregnant women with diabetes (8/90, 8.9%) than in non-pregnant women with diabetes (9/286, 3.1%) (P < 0.05). The blood glucose levels (mmol/L) in pregnant women with DKA were significantly lower than those in non-pregnant women with DKA (16.3 +/- 4.6 vs 27.5 +/- 4.8, P < 0.001). A case of euglycemic DKA in pregnancy was described whose serum glucose level was only 6.9 mmol/L. Conclusions: DKA in pregnant women with diabetes may occur more frequently, and at lower blood glucose levels than DKA in non-pregnant women with diabetes.