Does preeclampsia have any adverse effect on fetal heart?

Objective: To determine whether preeclampsia causes fetal cardiac cell damage by assessing umbilical artery NT-proBNP, cardiac troponin I and homocysteine.

Methods: A cross-sectional study with 73 fetuses between 26 and 40 weeks of gestation was performed. Thirty-three healthy mothers’ fetuses were control group (Group I). While 12 mildly pre-eclamptic mothers’ fetuses constituted Group II, 28 fetuses of severe pre-eclamptic mothers were Group III.

Results: Umbilical cord mean NT-proBNP levels of Group I, II and III are 520.8?±?404.5 pg/ml; 664.2?±?215.9 pg/ml; and 1932.8?±?2979.5 pg/ml, respectively (p?=?0.0001). The number of neonates with NT-proBNP?>?500 pg/mL that indicates severe cardiac damage is higher in Group III (p?=?0.001). The mean homocysteine levels are also statistically significantly higher in Group III. Cardiac troponin I levels are not different between the groups (p?=?0.46).

Conclusion: Increased NT-proBNP and homocysteine might not only indicate some degree of in-utero cardiac cell damage but also feto–placental endothelial injury in the fetuses of severe pre-eclamptic mothers. Our finding that shows no evidence of correlation between cardiac troponin I levels with cell damage and endothelial injury requires further research.     

Plasma lipocalin-2 levels in pregnant women with pre-eclampsia,and their relation with severity of disease

Objective.?To compare lipocalin-2 (LCN2) levels in pre-eclamptic women with those in healthy pregnant women, and to determine whether there is a correlation between LCN2 levels and the severity of the disease.

Methods.?The study included 66 pregnant women: 22 healthy pregnant women (Group 1), 23 women with mild pre-eclampsia (Group 2), and 21 women with severe pre-eclampsia (Group 3). Pre-eclamptic women and normal controls were carefully matched for maternal age, gestational age, and body mass index (BMI). The maternal levels of plasma LCN2 were determined by enzyme-linked immunosorbent assay.

Results.?Plasma LCN2 levels in the pre-eclamptic group were significantly lower than those in the healthy control group (p?<?0.05). Although plasma LCN2 level was lower in the severe compared to the mild pre-eclamptic group, the difference was not statistically significant (p?>?0.05). There was no significant correlation between LCN2 levels and the homeostasis model assessment of insulin resistance (HOMA-IR), BMI, triglyceride, gestational week at delivery, birth weight, and systolic and diastolic blood pressure in pre-eclamptic and healthy pregnant women (p?>?0.05).

Conclusions.?Our results show that there are decreased concentrations of plasma LCN2 in pre-eclamptic subjects and this may indicate that LCN2 plays a role in the pathogenesis of pre-eclampsia. However, further experiments are needed to clarify this role.     

The relationship between epicardial adipose tissue thickness and oxidative stress parameters in patients with isolated polycystic ovary syndrome

Abstract

Purpose: The aim of this study is to evaluate the correlation between epicardial adipose tissue thickness and oxidative stress parameters in patients with polycystic ovarian syndrome.

Methods: The study included 35 patients with PCOS and 35 healthy women. Transthoracic echocardiography was used to measure the epicardial adipose tissue thickness (EATT) of all patients. For all patients, serum TOS, TAS, hs-CRP, and insulin levels were measured according to the literature, and the HOMA-IR values were calculated. Independent samples t-test, Pearson’s correlation analysis, multivariate logistic regression analysis, and receiver operator characteristic curve (ROC) analysis were used in the statistical analysis.

Results: Between the patient group and the control group, EATT was significantly higher in the PCOS group compared to the control group (5.4?±?1.4?mm and 3.9?±?1.6?mm, respectively; p?<?0.001). Similarly, TOS, TAS, and hs-CRP levels were significantly higher in the PCOS group compared to the control group (p?<?0.01 for all). The correlation analysis showed a significant positive correlation between EATT and TAS and hs-CRP (r?=?0.349, p?<?0.01 and r?=?0.352, p?<?0.01, respectively). Multivariate regression analysis showed a significant correlation between PCOS and EATT, TAS, and diastolic blood pressure (p?<?0.05 for all).

Conclusions: Epicardial adipose tissue may play a major role in PCOS pathogenesis by leading to an increase in oxidative stress.     

Association between maternal serum 25-hydroxyvitamin D level and pre-eclampsia

Objectives: The objective of the study was to evaluate the association of maternal plasma levels of 25-hydroxyvitamin D (25(OH)D) at late second and third trimester and the risk of pre-eclampsia.

Methods: In this prospective cohort study, maternal plasma 25(OH)D levels were measured at late second and third trimester in 77 women who later developed pre-eclampsia (31 non-severe and 46 severe cases) and 180 women without pre-eclampsia.

Results: The mean gestational age of the timing of the blood sampling was 31.1?±?4.4 at control group, 32.6?±?5.7 at non-severe pre-eclamptic group and 32.3?±?5.4 at severe pre-eclamptic group. The mean 25(OH)D concentration was significantly low in severe pre-eclampsia group (5.8?±?4.5?ng/ml) than non-severe pre-eclampsia (11.8?±?7.3?ng/ml, p?=?0.039) and control groups (14.9?±?12.0?ng/ml, p?<?0.0001). There was no statistically significant difference in 25(OH)D concentration between non-severe pre-eclamptic and control groups (p?=?0.404). In women with 25(OH)D concentration <20?ng/ml, a 12.45-fold increase in the odds of severe pre-eclampsia were detected.

Conclusion: Women with severe pre-eclampsia had low serum 25(OH)D levels. The correlation between maternal 25(OH)D levels and aspartate aminotransferase, alanine transaminase, serum creatinine levels, platelet count were not determined. 25(OH)D levels may be used as an independent predictive marker of severe pre-eclampsia.     

Maternal blood pressure and dominant sleeping position may affect placental localization

Abstract

Objective: This study investigates whether maternal socio-demographic and clinical characteristics influence the site of placental implantation so that placental localization and associated abnormalities can be predicted.

Methods: This study reviews 500 healthy women with singleton pregnancy that were consecutively admitted to the study center and eventually delivered healthy newborns.

Results: The most frequently observed sites of placentation were anterior uterine wall (53.2%), posterior uterine wall (28.8%), lateral uterine walls (10.0%) and uterine fundus (8.0%), respectively. The women with fundal placentation had significantly higher systolic and diastolic blood pressures (p?=?0.044 and p?=?0.040, respectively). Supine sleeping position was more frequent in women with anterior placenta and (OR: 11.568, 95% CI: 2.720–49.193) and prone sleeping position was more frequent in women with posterior placenta (OR: 15.449, 95% CI: 2.151–52.978) (p?=?0.001). The women who favored to sleep in right lateral position were more likely to have lateral placentation, while the women who used to sleep in left lateral position were more likely to have fundal placentation (p?=?0.001).

Conclusions: Sleeping position in early pregnancy may influence placental implantation site. The probable mechanism may refer to the alterations in uterine perfusion which is induced by the change in systemic blood pressure and dominant sleeping position.     

The assessment of placental volume and mean gray value in preeclamptic placentas by using three-dimensional ultrasonography

Objectives: We aimed to evaluate the placental volume and placental mean gray value in preeclampsia and healthy placentas by using three-dimensional (3D) ultrasonography and Virtual Organ Computer-aided AnaLysis (VOCAL).

Methods: This case–control prospective study consisted of 27 singleton pregnancies complicated by preeclampsia and 54 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm³) was analyzed using the VOCAL imaging program, and 3D histogram was used to calculate the volumetric mean gray value (%).

Results: Preeclamptic and control group consisted of 27 (mean age: 28.90?±?5.95 years, mean gestation: 32.0?±?4.55 weeks) and 54 (mean age: 29.48?±?5.78 years, mean gestation: 32.61?±?4.23 weeks) singleton pregnancies, respectively. Placental volume was significantly smaller in preeclampsia (250.62?±?91.69 versus 370.98?±?167.82?cm³; p?=?0.001). Volumetric mean gray value of the placenta was significantly higher in preeclampsia (38.24?±?8.41 versus 33.50?±?8.90%; p?=?0.043). Placental volume was significantly correlated with the estimated fetal weight (r?=?0.319; p?=?0.003). There was negative significant relation between placental volume and umbilical artery pulsatility index, resistance index and systolic/diastolic ratio (r?=?–0.244, p?=?0.024; r?=?–0.283, p?=?0.005; r?=?–0.241, p?=?0.024, respectively).

Conclusions: Placental volume diminishes significantly in preeclampsia, whereas volumetric mean gray values increases. This may reflect the early alterations in preeclamptic placentas, which may help to understand the pathophysiology better.     

Intravenous carbetocin shot is superior to oxytocin infusion for placental delivery in second trimester abortion: a pilot randomized controlled trial

Objective: To study the efficacy of 100?μg intravenous shot of carbetocin compared to 20?IU oxytocin intravenous infusion to prevent placental retention in second trimester medical termination of pregnancy.

Methods: A double-blinded randomized controlled trial was conducted at Ain Shams University Maternity Hospital from 1 April 2013 to 30 November 2013. A total of 132 women between 14 and 24 weeks gestation indicated for termination were randomized to receive either 20?IU oxytocin infusion (n?=?66) or 100?μg carbetocin shot (n?=?66) after fetal expulsion. Patients were observed for time elapsed between fetal and placental expulsion, presence of placental retention and blood loss.

Results: Third stage was 33.4?±?20.4?min in oxytocin group & 23.1?±?16.8?min in carbetocin group (p?=?0.002). Eight patients (12.1%) in oxytocin group had complete placental retention versus two patients (3.0%) in carbetocin group (p?=?0.05). Eight patients (13.8%) received oxytocin had remnants of placenta compared to four patients (6.2%) received carbetocin (p?=?0.04). Sixteen patients (24.2%) received oxytocin and six patients (9%) received carbetocin needed surgical curettage (p?=?0.04). Third stage blood loss was 87.2?±?33.7?ml in carbetocin and 206.9?±?35.2?ml in oxytocin groups (p?=?0.001).

Conclusion: Carbetocin is superior to oxytocin infusion for management of placental delivery in second trimester abortion.     

Effect of vascular endothelial growth factors A,C, and D in HIV-associated pre-eclampsia

Objective: To measure and correlate the level of vascular endothelial growth factors A, C, and D in HIV-associated pre-eclampsia.

Methods: VEGF-A, VEGF-C, and VEGF-D were measured in serum of 76 normotensive and pre-eclamptic pregnant women stratified by HIV status using Bio-Plex.

Results: No significant difference was shown between pre-eclamptic and normotensive and between HIV negative and positive women. A strong significant positive correlation was demonstrated between VEGF-A and VEGF-C, VEGF-A and VEGF-D, and VEGF-C and VEGF D (p < 0.0001).

Conclusion: This study demonstrates a significant correlation between VEGF-A, VEGF-C, and VEGF-D and no difference in pre-eclamptic and normotensive pregnant women stratified by HIV status suggesting some neutralization of the immune response in HIV-associated pre-eclampsia.     

The effect of resveratrol on blood pressure in a rat model of preeclampsia

Objective: To examine the hypothesis that resveratrol administration could result in blood pressure and blood flow decrease in a rat preeclampsia model. Materials and Methods: Desoxycorticosterone acetate (DOCA) was used to produce hypertension. The Wistar albino rats were divided randomly into three groups: control (n?=?12), DOCA injected (n?=?11), and DOCA injected and resveratrol treated (n?=?13). Rats were sacrificed on gestational day 16–20. The systolic blood pressure was measured by the tail-cuff method. Urine protein was expressed as protein/creatinine. Laser Doppler measurements of the blood flow were made in one placenta, the left kidney and both parietal lobes of brain. Placentas were examined by light microscopy. Results: DOCA injected group exhibited significant differences in blood pressure and protein/creatinine. Mean blood pressure in DOCA-treated rats was 130.1?±?12.9 mmHg at baseline and 148.4?±?20.1 mmHg at the time of euthanization (p?=?0.044). Resveratrol did not significantly affect blood pressure, placental and renal blood flows. There were also no significant differences in placental pathology parameters among the three groups. Conclusion: The present study demonstrated that resveratrol did not decrease blood pressure, and did not result in a significant response in blood flows and placental pathology parameters.     

Studying the correlation of renin-angiotensin-system (RAS) components and insulin resistance in polycystic ovary syndrome (PCOs)

Abstract

Objective: It is estimated that 5–7% of women of reproductive age have polycystic ovary syndrome (PCOS). Chronic anovulation, hyperandrogenism, and insulin resistance (IR) are the main characters of this complex syndrome. IR, diabetes and obesity are all strongly correlated with PCOS; moreover, the possibility of direct androgen mediated renin-angiotensin system (RAS) stimulation in women with PCOS is also reported. The aim of the present study was to investigate the correlation between RAS, IR and PCOS

Study design: Thirty one women with PCOS, diagnosed by the Rotterdam criteria, were compared with thirty six control subjects. Both case and control groups were evaluated regarding to their basal hormonal profile, fasting blood sugar, IR, angiotensin converting enzyme (ACE) activity, plasma renin activity (PRA) and angiotensin ?? (Ang??) levels.

Results: Compared to controls both ACE activity (p?=?0.04) and AngΙΙ levels (p?=?0.01) were significantly higher in case group. No significant differences between patients and controls were found in PRA. The results demonstrated that IR (p?=?0.02) and fasting insulin (p?=?0.004) were higher in case group, there was also a positive correlation between ACE activity and IR in case group (p?=?0.02, r?=?0.2).

Conclusion: These results may suggest that there is an important correlation between ACE activity and IR in patients with PCOS.     

Preterm at birth is not associated with greater cardiovascular risk in adolescence

Objective: To determine the effects of preterm birth and gender on subsequent cardiovascular risk factors among urban adolescents in a capital in the Brazilian northeast and to compare them with a group of adolescents term at birth.

Methods: In a retrospective double cohort, data of birth weight were extracted from hospital registers of children born in a same day of birth, between 1992 and 2002. We classified the preterm as a unique group born before 37 weeks of gestation. A total of 134 adolescents, aged 10–20 years were found and investigated. We measured anthropometric and clinical data, blood lipid profile and glucose after overnight fasting.

Results: Preterm subjects had less years of scholar education, especially between females (p?=?0.01). Preterm females also had lower height (p?=?0.00) and waist-hip circumference ratio (p?=?0.01). Preterm males had lower cesarean delivery (p?=?0.05) and greater family history of cardiovascular disease (p?=?0.05). Although the differences on clinical or laboratorial measurements were small and non-significant for cardiovascular risk factors, systolic blood pressure (SBP) and diastolic blood pressure (DBP) tended to be higher in preterm groups, especially for females (SBP?=?4.1?mmHg and DBP?=?1.6?mmHg, p?=?0.12 and p?=?0.38, respectively).

Conclusion: Premature did not increase cardiovascular risk adolescents in this sample. The lower association between premature and poor health outcomes among adolescents in a low average socioeconomic status population from a capital in the Brazilian northeast corroborates previous findings in other countries.     

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

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

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

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

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

Alteration of vascularization in preeclamptic placentas measured by three-dimensional power Doppler ultrasound

Abstract

Objective: To evaluate the alteration of vascularization in preeclamptic placentas measured by three-dimensional (3D) power Doppler ultrasound.

Methods: We performed a prospective study of placental vascularization and placental volume in 27 singleton pregnancies complicated by preeclampsia and 41 normal pregnancies from 27 to 39 weeks of gestation. The placental volume was analyzed using the VOCAL imaging analysis program and 3D power histogram was used to calculate the placental vascular indices including vascularization index (VI), flow index (FI) and vascularization flow index (VFI).

Results: Of the 27 preeclamptic pregnancies, 9 were complicated by intrauterine growth restriction and 15 were severe preeclampsia. Furthermore, nine of the preeclamptic pregnancies had abnormal end diastolic flow in the umbilical artery. No significant correlation was noted between the placental vascular indices and gestational age in normal pregnancies. The placental vascular indices including VI, FI and VFI were significantly lower in preeclamptic placentas compared with controls (VI, p?<?0.001; FI, p?=?0.022; VFI, p?<?0.001). Preeclamptic placental volume was also decreased compared with that of the controls (p?=?0.002). After adjustment for confounding factors, significant differences were observed in VI and placental volume. However, no correlation was found between 3D power Doppler vascular indices and umbilical artery flow velocities, and neither intrauterine growth restriction nor the severity of preeclampsia could be predicted by the vascular indices.

Conclusion: VI and placental volume are reduced in preeclamptic placenta. Placental vascular indices using 3D power Doppler ultrasound provide insights of placental vascularization in preeclampsia.     

Adropin concentrations in term pregnancies with normal,restricted and increased fetal growth

Objective: To determine levels of adropin (implicated in insulin resistance and endothelial dysfunction) in intrauterine growth restricted (IUGR), large (LGA) and appropriate for gestational age (AGA) pregnancies.

Methods: Cord-blood (UC) adropin and insulin concentrations were measured in 30 IUGR, 30 LGA and 20 AGA full-term infants and their mothers (MS).

Results: No significant differences in adropin concentrations were observed between the three groups. In the IUGR group MS adropin was significantly decreased when neonates had higher birth weights [b?= ?0.003, 95% CI??0.006 to 0.0, p?=?0.043]. In all groups, MS adropin levels were positively correlated with UC ones (r?=?0.282, p?=?0.011) and were significantly increased in female neonates [b?=?0.977, 95% CI 0.122–1.832, p?=?0.026]. In the LGA group, MS insulin was negatively correlated with UC adropin (r?= ?0.362 p?=?0.049).

Conclusions: Increased maternal adropin levels in severe IUGR cases might represent a regulatory feedback mechanism against endothelial placental dysfunction. The positive correlation between maternal and umbilical cord adropin levels implies its transplacental transfer. Increased maternal adropin levels in female neonates could be attributed to interaction of adropin with fetal estrogens through vascular endothelial growth factor (VEGF). The negative correlation between maternal insulin and fetal adropin levels in the LGA group is probably attributed to their respective insulin resistance.     

Post-partum evaluation of maternal cardiac function after severe preeclampsia

Abstract

Objective: To evaluate the post-partum maternal cardiac function in patients with history of severe preeclampsia.

Methods: A series of women with previous singleton pregnancy complicated by severe preeclampsia underwent transthoracic echocardiography at 6–12 months from delivery. A group of women with previous uncomplicated pregnancy was selected as controls.

Results: Sixteen women with history of severe preeclampsia were enrolled in the study group whereas 18 patients were selected as controls. In the study group systolic (p?=?0.002) and diastolic blood pressure (p?=?0.044) were significantly higher. Significant differences were observed in systolic left ventricular (LV) parameters, such as cardiac output (p?=?0.034), LV mass indexed to BSA (p?=?0.024) and longitudinal contraction, expressed by tissue Doppler (TD) S₁ wave, which resulted relatively impaired in former preeclamptic women (p?=?0.049). As regards as diastolic parameters, pulsed Doppler A-wave velocity was increased (p?=?0.036). TD E-wave velocity was significantly lower in study group (p?<?0.001) and E/E₁ ratio (E?=?peak early diastole transmitral wave velocity/E₁?=?peak early diastolic velocity at mitral valve annulus at TD) was higher respect to controls (p?<?0.001).

Conclusions: LV contractility and diastolic function, although within normal reference ranges, show slight but significant impairment among women who experienced a severe preeclampsia. TD seems to be a sensible tool to identify these precocious signs of potential LV dysfunction.     

Three-dimensional ultrasonographic placental volume in gestational diabetes mellitus

Objectives: We aimed to evaluate the placental volume and placental mean gray value in gestational diabetes mellitus (GDM) and healthy placentas using three-dimensional (3D) ultrasound and Virtual Organ Computer-aided AnaLysis (VOCAL).

Methods: This case-control prospective study consisted of 39 singleton pregnancies complicated by GDM and 42 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm³) was analyzed using the VOCAL imaging analysis program and 3D histogram was used to calculate the volumetric mean gray value (%).

Results: Placental volume was significantly larger in GDM (411.59?±?170.82 versus 343.86?±?128.94?cm³; p?=?0.046). There was no significant difference in mean gray value between GDM and healthy placentas (36.65?±?7.02 versus 38.71?±?7.91, respectively; p?=?0.277). Placental volume was significantly correlated with gestational week (r?=?0.219, p?=?0.035) and parity (r?=?0.228, p?=?0.048). There was negative significant relation between placental volume and umbilical artery systolic/diastolic ratio, pulsatility index and resistance index (r?=??0.278, p?=?0.007; r?=??0.315, p?=?0.002; r?=??0.322, p?=?0.001, respectively).

Conclusions: Placental volume increases significantly in GDM, whereas mean gray values do not alter significantly. These data may reflect the placental changes in GDM placentas that may help to understand the pathophysiology better.     

DNA damage and oxidative stress in patients with mild preeclampsia and offspring

Objective

Oxidative stress has been shown to play an important role in the pathogenesis of pre-eclampsia, and DNA damage frequently occurs in cells exposed to such stress. The aim of the present study was to investigate DNA damage and oxidative stress in mildly pre-eclamptic women and their offspring.

Study design

We studied 25 mildly pre-eclamptic mothers, 20 healthy controls, and their infants. Mononuclear leukocyte DNA damage, total antioxidant status (TAS), and total oxidant status (TOS) were determined and the oxidative stress index (OSI) was calculated.

Results

DNA damage, and TOS and OSI levels were significantly increased, and TAS levels significantly decreased, in maternal and cord blood samples of the mildly pre-eclamptic group. A positive correlation between the extent of DNA damage and diastolic blood pressure was evident in pre-eclamptic mothers and there was a negative correlation between the extent of DNA damage and TOS.

Conclusion

Both oxidative stress and DNA damage are elevated in mildly pre-eclamptic patients and their offspring. Increased oxidative stress may be important in inducing DNA damage in pre-eclamptic patients.     

Analysis of correlations between the placental expression of glucose transporters GLUT-1, GLUT-4 and GLUT-9 and selected maternal and fetal parameters in pregnancies complicated by diabetes mellitus

Purpose: The aim of the study was to analyze the correlations between the expression of glucose transporters GLUT-1, GLUT-4, and GLUT-9 in human term placenta and selected maternal and fetal parameters in pregnancies complicated by diabetes mellitus (DM).

Materials and methods: Placental samples were obtained from healthy control (n?=?25) and diabetic pregnancies, including diet-controlled gestational diabetes mellitus (GDMG1) (n?=?16), insulin-controlled gestational diabetes mellitus (GDMG2) (n?=?6), and pregestational DM (PGDM) (n?=?6). Computer-assisted quantitative morphometry of stained placental sections was performed to determine the expression of selected glucose transporter proteins. For the purposes of correlation analysis, the following parameters were selected: type of diabetes, gestational age, maternal prepregnancy body mass index (BMI), gestational weight gain, third trimester glycated hemoglobin concentration, placental weight, fetal birth weight (FBW) as well as ultrasonographic indicators of fetal adiposity, including subscapular (SSFM), abdominal (AFM), and midthigh (MTFM) fat mass measurements.

Results: In the PGDM group, the analysis demonstrated positive correlations between the placental expression of GLUT-1, GLUT-4, and GLUT-9 and FBW, AFM, and SSFM measurements (p?p?p?p?Conclusions: The study results revealed that placental expression of GLUT-1, GLUT-4, and GLUT-9 may be involved in the intensification of the fetal growth in pregnancies complicated by GDM/PGDM.     

Pregnancy outcome and placental pathology in emergent cesarean deliveries for non-reassuring fetal heart rate in laboring versus non-laboring women

Objective: The objective of this study is to correlate between pregnancy outcome and placental pathology in emergent cesarean deliveries (ECD) for non-reassuring-fetal-heart-rate (NRFHR) performed in women in their active phase of labor versus those performed in non-laboring women.

Methods: A retrospective cohort study. Data were reviewed for all pregnancies necessitating ECD for NRFHR between January 2009 and December 2013. Maternal outcome, neonatal outcome, and placental pathology parameters were compared between ECDs performed during active phase of labor and those performed before the active phase of labor (non-labor group).

Results: During the study period, a total of 661 ECDs were performed due to NRFHR. Compared with the active labor group (n?=?335), the non-labor group (n?=?326) had more pre-eclampsia (p?=?0.033), small for gestational age (SGA) (p?=?0.016), and preterm labor (p?<?0.001). Worse composite neonatal outcome was observed in the non-labor group compared with the active labor group, p?<?0.001. By a stepwise logistic regression model, non-labor was independently associated with adverse neonatal outcome (1.88 OR CI; 1.19–2.96, p?=?0.007). Placental inflammatory lesions were more common in the active labor group (p=?0.043), and abnormal cord insertions were more common in the non-labor group (p?=?0.002) as well as placental weight?<10th% (p?=?0.019).

Conclusion: Higher rate of pregnancy complications, abnormal cord insertion, smaller placentas, and worse neonatal outcome are associated with ECD for NRFHR when performed before the phase of active labor.     

Serum hepcidin is associated with parameters of glucose metabolism in women with gestational diabetes mellitus

Abstract

Objectives: Hepcidin is considered a major regulator of iron metabolism. Despite previous studies showing elevated ferritin and hepcidin levels in type 2 diabetes mellitus (DM), no study has investigated hepcidin levels in pregnant women with gestational DM (GDM).

Methods: A case-control study was conducted in 30 cases of GDM, 47 pregnant women with impaired glucose tolerance (IGT) and 72 pregnant women with normal glucose tolerance (control) between April 2009 and July 2011. Serum hepcidin and other iron metabolism parameters were analyzed in all groups.

Results: Serum ferritin and serum iron were significantly elevated in the GDM group compared to controls (p?=?0.014, p?=?0.018, respectively) and to the IGT group (p?=?0.021, p?=?0.008, respectively). Hepcidin levels were elevated significantly in the diabetic patients compared to the IGT group (p?=?0.011) and controls (p?=?0.002). We found no correlation between hepcidin and other iron metabolism parameters (Hb, serum iron and ferritin), whereas positive correlations were found between hepcidin and parameters of glucose metabolism (fasting blood glucose, fasting insulin level and glucose value response to glucose challenge test).

Conclusions: Serum hepcidin concentrations were increased in pregnant women with IGT and GDM and this was not related to inflammation parameters.