The role of glutathione peroxidase maternal serum level in late onset of severe preeclampsia

Objective: This study was done to investigate the association between maternal serum glutathione peroxidase (GP) and late onset of severe preeclampsia. Methods: Cross-sectional study was undertaken comparing normal pregnancy and severe preeclampsia at 37–42 weeks of gestational age. Maternal venous blood was taken to assess the level of GP. Result: Twenty normal pregnancy and 20 severe preeclampsia patients were investigated. The median (max–min) of GP level for preeclampsia was 4.31 (0.03–327.41) mU/mL significantly lower than in normal pregnancy 318.90 (6.46–694.11) mU/mL (p < 0.001). A receiver operating characteristics (ROC) analysis showed that the cutoff point for GP to differentiate between normal pregnancy and severe preeclampsia was 41.74 mU/mL. Multivariate analysis was done to investigate the impact of BMI and parity showed that a low level of GP will increase the risk of severe preeclampsia. Conclusion: Low level of GP was associated with the diagnosis of severe preeclampsia.     

High Uric Acid Level During the First 20 Weeks of Pregnancy is Associated with Higher Risk for Gestational Diabetes Mellitus and Mild Preeclampsia

Objective. To examine the association between uric acid (UA) level during the first 20 weeks of pregnancy and the development of gestational diabetes mellitus (GDM) and preeclampsia in the second half of pregnancy. Methods. The study population included registered births (n = 5507) between 2001 and 2007 in a tertiary medical center. The UA levels during the first 20 weeks of pregnancy were sorted by UA ≤ 2.4 mEq/L; UA = 2.5–4.0 mEq/L, UA = 4.1–5.5 mEq/L, and UA > 5.5 mEq/L. The linear-by-linear chi-square test and ROC curves were used to determine the association between UA level during the first 20 weeks and pregnancy complications. Multivariate analyses were performed to demonstrate whether UA level is an independent factor for the prevalence of preeclampsia and GDM. Results. Significant linear association was documented between UA level in the first 20 weeks and the prevalence of GDM and mild preeclampsia. The lowest and the highest prevalence of GDM were found in the UA ≤ 2.4 mEq/L group (6.3%) and in the UA > 5.5 mEq/L group (10.5%) (p < 0.001), respectively. Mild preeclampsia was diagnosed in 2.1% of the patients from the UA ≤ 2.4 mEq/L group, 3.3% from the UA = 2.5–4.0 mEq/L group, 5.3% from the UA = 4.1–5.5 mEq/L group, and 4.5% from the UA > 5.5 mEq/L group (p < 0.001). Three multiple logistic regression models controlling for maternal age showed that UA level is an independent risk factor for both GDM and mild preeclampsia. Conclusions. UA levels in the highest quartile of the normal range during the first 20 weeks of pregnancy are associated with higher risk for the development of GDM and mild preeclampsia.     

Calcium level during the first trimester of pregnancy as a predictor of preeclampsia

Objective: To examine the association between calcium levels during the first trimester of pregnancy and preeclampsia. Methods: The study population included registered births (n?=?5233) in a tertiary medical center between 2001 and 2011. A comparison was performed between women with and without hypocalcemia during the first trimester of pregnancy. A second analysis was performed after correcting calcium levels for albumin. Multiple logistic regression models were used to control for confounders. Receiver operating characteristic curve analysis graphs were used to describe the relationship between the true-positive rate (sensitivity) and the false-positive rate for different values of calcium during the first half of pregnancy in the prediction of preeclampsia. Results: Of 5233 deliveries, 841 (16%) had hypocalcemia and 4392 (84%) had a normal calcium level. No significant difference were found between the groups regarding mild preeclampsia [odds ratio (OR) = 1.216; 95% confidence interval (CI) 0.831–1.779; p?=?0.312], severe preeclampsia (OR?=?1.618; 95% CI 0.919–2.849; p?=?0.092) and any hypertensive disorders (OR?=?1.324; 95% CI 0.963–1.821; p?=?0.083). Conclusions: Hypocalcemia during the first trimester of pregnancy is not a risk factor for preeclampsia.     

Lower circulation levels and activity of α-1 Antitrypsin in pregnant women with severe preeclampsia

Objective: α-1 antitrypsin (AAT) is an anti-protease, anti-inflammatory and tissue-protective molecule. Normal circulating levels are <3.5?mg/dl and rise during pregnancy. Although AAT deficiency is associated with several pregnancy and placental disorders, little is known regarding AAT levels and preeclampsia. Since unopposed inflammation might contribute to preeclampsia, we studied whether preeclampsia is associated with lower than normal levels and activity of AAT. Methods: In a prospective case-control study, we compared maternal serum AAT activity and levels between patients with severe preeclampsia (n = 23) and without preeclampsia (n = 18). Results: AAT levels were 1.91?±?0.08-fold lower in the preeclampsia group compared to healthy group (3.854?±?0.26 vs. 7.397?±?0.34?mg/ml; p < 0.001), and correlated with protease inhibitory capacity (46.56?±?2.08% vs. 67.08?±?1.74%; p < 0.001). Conclusions: Our findings show association between lower AAT levels and severe preeclampsia during pregnancy. Further studies are required to identify the mechanism behind the association, and the possibility of safe AAT augmentation for individuals with insufficient circulating AAT.     

Incidence of superimposed preeclampsia among pregnant Asian women with chronic hypertension

Objective: To determine the incidence and associated factors of superimposed preeclampsia among pregnant women with chronic hypertension.

Methods: A total of 300 pregnant women diagnosed with chronic hypertension were reviewed. Data were retrieved from medical records, including obstetric data, characteristics of hypertension, and pregnancy outcomes. Incidence of superimposed preeclampsia was estimated. Various characteristics were compared to determine associated risk factors.

Results: Mean age of the cohort was 34.3 years, 47% were nulliparous, 50% had hypertension before pregnancy, and the others presented with hypertension before 20 weeks. Incidence of superimposed preeclampsia was 43.3% (95% confidence interval (CI) 37.8–48.9). Women with superimposed preeclampsia were significantly more likely to have mean arterial pressure (MAP) ≥105 mmHg at 18–20 and 24–28 weeks. Adverse neonatal outcomes were significantly more common among women with superimposed preeclampsia, including small for gestational age, low birth weight, asphyxia, and neonatal intensive care unit admission. Logistic regression analysis demonstrated that only MAP ≥105 mmHg at 24–28 weeks was independently associated with the increased risk of superimposed preeclampsia by 1.8-fold (adjusted OR 1.8, 95% CI 1.1–3.1, p = 0.031).

Conclusion: Incidence of superimposed preeclampsia was 43.3% among pregnant women with chronic hypertension, with increased adverse neonatal outcomes. High MAP ≥105 mmHg during late second trimester might be an important predictor of the condition.     

Association of serum N-terminal pro-brain natriuretic peptide levels with the severity of preeclampsia

Objective: To investigate whether serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could be used as a marker to determine the severity of preeclampsia.

Methods: This prospective cohort study included pregnant women with preeclampsia and severe preeclampsia and normotensive pregnant controls admitted between January 2013 and July 2014. Preeclampsia was graded according to the recently revised criteria of the American College of Obstetricians and Gynecologists (ACOG). Serum NT-proBNP levels were compared among the groups.

Results: Of the 49 women with preeclampsia, 25 had severe preeclampsia. The controls were 27 normotensive pregnant women admitted during the same period. Serum NT-proBNP levels were significantly higher in the preeclampsia groups than in the control group (p?<?0.001). In addition, NT-proBNP levels were significantly higher in the severe preeclampsia group compared with both the preeclampsia group (p?<?0.001) and the control group (p?<?0.001).

Conclusion: The ACOG has recently revised the grading of hypertensive diseases of pregnancy and the criteria for severe preeclampsia. In line with these revised guidelines, serum NT-proBNP levels appear to be a useful marker to evaluate the severity of preeclampsia.     

Expression of Human Leukocyte Antigen-G during Normal Placentation and in Preeclamptic Pregnancies

Objectives. This study was undertaken to investigate the expression pattern of human leukocyte antigen-G (HLA-G) during normal placentation and determine whether altered expression of HLA-G is associated with severe preeclampsia. Methods. We investigated HLA-G protein levels in first (n = 27), second (n = 7), and third trimester placentas (n = 10) from normal pregnancies, and determined HLA-G levels in term placentas from normal (n = 15) and severe preeclamptic pregnancies (n = 14) using real-time RT-PCR and western blot analysis. Results. In normal placentas, HLA-G protein expression reached a peak level at gestational weeks 6 and 7, then gradually decreased from week 8 to third trimester (p < 0.05). In preeclamptic placentas, both HLA-G mRNA and protein levels were decreased significantly in comparison with normal term placentas (p < 0.05). Conclusion. HLA-G may contribute to placentation during early and mid-term pregnancy, and participate in maintaining gestation during term pregnancy. The reduced level of HLA-G may be associated with pathogenesis of preeclampsia.     

An analysis on the roles of angiogenesis-related factors including serum vitamin D,soluble endoglin (sEng), soluble fms-like tyrosine kinase 1 (sFlt1), and vascular endothelial growth factor (VEGF) in the diagnosis and severity of late-onset preeclampsia

Aim: The aim of this study was to evaluate the roles of proangiogenic factors including serum vitamin D and vascular endothelial growth factor (VEGF) and anti-angiogenic factors including soluble endoglin (sEng) and soluble fms-like tyrosine kinase 1 (sFlt1) in the diagnosis and severity of late-onset preeclampsia.

Materials and methods: The study was conducted at Yuzuncu Yil University Research and Education Hospital Department of Gynecology and Obstetrics. The study included a patient group of 40 women with late-onset preeclampsia who were pregnant at?≥32 weeks of gestation according to the last menstrual period (LMP) or ultrasonographic fetal biometric measurement and a control group of 40 healthy pregnant women who presented to our clinic for routine pregnancy examination and were at the same age and gestational period with those in the patient group. The two groups were compared in terms of maternal age, gravida, parity, week of gestation, systolic/diastolic blood pressure, total protein in spot urine sample, 24-h urine protein, white blood cell (WBC), hemoglobin (Hgb), platelet count, urea, creatinine, liver function tests (AST, ALT, LDH), vitamin D₃, 25(OH) vitamin D₃, 1,25(OH) vitamin D₃, sEng, sFlt1, and VEGF levels, mode of delivery, the infant APGAR score at 1 and 5?min after delivery, and infant weight at delivery.

Results: The groups were similar in terms of age, gravida, parity, week of gestation, serum vitamin D₃, 25(OH) vitamin D₃, 1,25(OH)₂ vitamin D₃ and VEGF levels, and infant weight at delivery (p?>?0.05). Systolic/diastolic blood pressure, total protein in spot urine sample, 24-h urine protein, WBC, Hgb, serum urea, creatine, AST, ALT, and LDH were significantly higher in the preeclamptic group compared to the healthy group (p?p?3, 25(OH) vitamin D₃, and 1,25(OH)₂ vitamin D₃ levels. The sEng level was higher in the women with severe preeclampsia compared to the women with mild preeclampsia (p?3, 25(OH) vitamin D₃, and 1,25(OH)₂ vitamin D₃ levels between the subgroups of preeclampsia (p?>?0.05).

Conclusion: Both sEng and sFlt1 levels are remarkably high in patients with late-onset preeclampsia; however, only sEng may be a useful tool in the determination of the severity of preeclampsia.     

Abnormal liver function test in hydatidiform moles: a retrospective study comparing the hyperthyroid state and the euthyroid state

Introduction: The effect of a hyperthyroid or euthyroid state on liver function tests in patients with hydatidiform moles (HM) is not known. The aim of this study was to determine the effect of hyperthyroidism on liver transaminases in HM.

Patients and methods: We retrospectively reviewed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in 80 patients with HM (23 complete moles and 57 partial moles).

Results: Of the 80 HM patients, 52 (65%) were euthyroid and 28 (35%) were hyperthyroid.

The number of gravida and the levels of serum β-human chorionic gonadotropin (β-HCG), AST, and ALT were significantly higher in the hyperthyroid state than in the euthyroid state (p?=?0.033, p?=?0.001, p?=?0.001 and p?=?0.001; respectively). Number of gravida, serum TSH and total T4 were significantly higher in complete HM than partial HM (p?p?p?Conclusions: Our results demonstrated that HM-related β-HCG may activate thyroid cells via TSH-related signalling, resulting in the release of high levels of FT4, FT3, TT3 and TT4, and a subsequent decrease in TSH.     

Clinical features and outcome of pregnancy with SLE-associated thrombocytopenia

Objective: To analyze the course of maternal diseases and compare pregnancy outcomes in patients with systemic lupus erythematosus (SLE)-associated thrombocytopenia to patients without.

Methods: Medical charts of 77 pregnancies in 73 SLE patients were systematically reviewed. Patients were divided into two groups according to the presence or absence of thrombocytopenia. Patients who are new onset SLE during pregnancy were also been studied.

Result: Thrombocytopenia was found in 18 (23.3%) of the pregnancies. SLE patients with thrombocytopenia during pregnancy had higher percentage of disease flaring (11/18 versus 14/59, p?=?0.003) and SLE-Pregnancy Disease Activity Index (7.89?±?6.192 versus 2.41?±?3.3.89, p?=?0.001) compared to patients without. Also, patients with thrombocytopenia had a higher percentage of pulmonary, cardiac and multiple organ system involvement. There was a statistically significant difference in preeclampsia and early onset hypertensive disorder induced before 34 weeks as well as the rate of live birth less than 34 weeks (33.3% versus 6.8%, p?=?0.003 & 38.9% versus 13.6%, p?=?0.018 & 16.7% versus 1.7%, p?=?0.038). Patients with thrombocytopenia suffered from higher rate of pregnancy loss (22.2% versus 3.4%, p?=?0.024) and neonatal death (33.3% versus 1.7%, p?=?0.000). In our study there were 17 patients with new-onset of SLE during pregnancy. The hematological system manifestation occurred in all of them and there was a significant increase in the incidence of thrombocytopenia (n?=?12, 70.6%).

Conclusion: Thrombocytopenia in SLE during pregnancy indicates higher disease activity, severe organ damage, early onset preeclampsia and higher pregnancy loss.     

Fibronectin is a Marker for Organ Involvement and may Reflect the Severity of Preeclampsia

Objective. We have studied whether plasma fibronectin is related to a rise in blood pressure during normal pregnancy, whether it can be used for the early prediction of preeclampsia, and whether plasma fibronectin is a marker for organ involvement in preeclampsia.

Study design. Two hundred twenty-eight healthy pregnant nullipara women were examined prospectively during pregnancy. Analyses of fibronectin in plasma were performed in pregnancy weeks 16, 24, 28, 32, and 36. During the same period, 177 patients with suspected preeclampsia and/or intrauterine growth retardation (IUGR) were tested for plasma fibronectin, mainly in the third trimester.

Results. In the normal population of pregnant women (n=222/228), fibronectin levels were 0.35 ± 0.06 g/L in pregnancy week 16 and 0.43 ±0.12 g/L in week 36. These levels showed a positive correlation to blood pressure elevation during pregnancy (r=0.21, p=0.006). The six patients in this group (n=6/228) who later developed preeclampsia had higher fibronectin values 0.42 ± 0.07 g/L already in week 16 (p=0.023). In the population of women with suspected preeclampsia (preeclampsia, n=129; IUGR alone, n=17; hypertension or proteinuria during pregnancy, n=31), fibronectin values were significantly higher, 0.75 ± 0.27 g/L than in the normal population. Patients with preeclampsia and laboratory signs of organ involvement (n=56) showed significantly higher fibronectin values (0.85 ± 0.27 g/L) compared to preeclampsia without organ involvement (n=73) [0.76 ± 0.22 g/L (p=0.03)].

Conclusion. Our data show that fibronectin is related to blood pressure in pregnancy. Fibronectin values in women who develop preeclampsia are elevated already in pregnancy week 16 and were higher in those with laboratory signs of organ involvement.     

Changes in Microparticle Numbers and Cellular Origin During Pregnancy and Preeclampsia

Background: Microparticles (MP) are pro-coagulant vesicles derived from various cells. Evidence is accumulating that MP are of pathophysiological relevance in autoimmune, cardiovascular, and thromboembolic diseases and inflammatory disorders. Therefore, their role in the development of preeclampsia was investigated and MP from preeclamptic patients influenced endothelial-dependent vasodilatation. Knowledge about changes in circulating MP numbers during pregnancy and preeclampsia is lacking. We determined this longitudinally and investigated whether these numbers related to the severity of preeclampsia. Methods: Samples were obtained from pregnant women and preeclamptic patients during pregnancy and postpartum. MP were isolated and studied by flow cytometry. Results: During pregnancy, MP were decreased at 12 weeks gestation and then returned to postpartum values. In patients with preeclampsia, MP numbers were reduced at 28 and 36 weeks (both p = 0.04). Monocyte-derived MP were elevated in preeclampsia at 28 (p = 0.007), 32 (p = 0.02), and 36 weeks (p = 0.01), as were erythrocyte-derived MP at 28 weeks (p = 0.04). Placenta-derived MP increased in pregnancy and preeclampsia. During pregnancy, a correlation was present between placenta-derived MP and systolic blood pressure (r = 0.33, p = 0.015). No other correlations were found. Conclusions: During pregnancy, numbers of MP initially decrease and subsequently normalize. Placenta-derived MP increase, possibly because of placental growth. In preeclampsia, reduced numbers of PMP are due to decreased platelet counts. Increased numbers of monocyte-derived MP reflect monocyte activation, which may be an expression of the systemic inflammation in preeclampsia. Lack of correlation between numbers of MP and severity of preeclampsia suggests that MP numbers alone do not explain the reported vascular effects of MP.     

Serum Lipid Levels at 28–32 Weeks Gestation and Hypertensive Disorders

Background: The etiology and pathogenesis of hypertensive disorders complicating pregnancy are poorly understood, and the definition of these disorders is controversial. Methods: In a prospective study, 470 primigravida women between 28 and 32 weeks of pregnancy were evaluated for serum levels of total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and triglyceride. Afterward, they were observed for any symptoms of preeclampsia and gestational hypertension until 40 weeks of gestational age. We than compared the serum lipid levels among women with preeclampsia and gestational hypertension with those of matched women with normal pregnancies. Results: The numbers of patients developing preeclampsia and gestational hypertension were 25 (5.3%) and 32 (6.8%), respectively. At the beginning of the study, the mean values of serum triglyceride levels between women who later experienced preeclampsia or gestational hypertension and those who did not differed significantly (p < 0.0001, p < 0.03). Conclusion: Although many cases of gestational hypertension represent latent essential hypertension based on the lipid levels, some of these women display true pregnancy-induced hypertension or nonproteinuric preeclampsia.     

Effect of early use of low-dose aspirin therapy on late-onset preeclampsia

Objective: Low-dose aspirin (LDA) therapy has been found to be effective in preventing the development of early-onset preeclampsia. However, its effect on late-onset preeclampsia has not been described. Our study was aimed at determining if LDA therapy prescribed from early in pregnancy modified the severity of late-onset preeclampsia.

Materials and methods: A retrospective analysis of all women who were screened for early-onset preeclampsia at 11–13⁺⁶ weeks’ gestation between April 2012 and October 2014 at our institution, and who subsequently developed late-onset preeclampsia. The treatment group consisted of women who were prescribed LDA therapy from early in pregnancy as a result of the screening. The control group consisted of women who did not receive LDA therapy.

Results: The aspirin group was associated with earlier delivery at 38.0 (37.5–38.5) weeks’ gestation versus 39.0 (38.7–39.4) weeks’ gestation for the nonaspirin group (p?p?p?=?.62]. No other significant difference was noted.

Conclusions: There was no difference in the clinical severity of late-onset preeclampsia between women screened as high risk for early-onset preeclampsia and subsequently prescribed LDA during their pregnancy, compared to women found to be at low risk and not prescribed LDA.     

Transabdominal uterine artery Doppler between 11 and 14 weeks of gestation for the prediction of outcome in high-risk pregnancies

Objective.?To assess the value of early transabdominal uterine artery Doppler ultrasound for the prediction of gestational outcomes in pregnancies at high risk for preeclampsia.

Methods.?This was an observational study. Doppler ultrasound of the uterine arteries at 11–14 weeks of gestation was performed in 76 women at high risk for preeclampsia. Abnormal uterine Doppler was defined by the presence of bilateral notching or by a mean resistance index (RI) >0.80. Adverse outcomes evaluated were preeclampsia, fetal growth restriction, placental abruption, intrauterine death, and complications requiring delivery before 34 weeks of gestation.

Results.?Among 76 women, 30 (39%) had abnormal uterine Doppler and 46 (61%) had normal Doppler waveform configuration and RI. Abnormal uterine flow was related to a significantly higher incidence of preeclampsia (17% vs. 0%; p = 0.0041), fetal growth restriction (27% vs. 0%; p = 0.0002), intrauterine death (13% vs. 0%; p = 0.0109), and iatrogenic preterm delivery (20% vs. 2%; p = 0.0086). When the Doppler was normal, the negative predictive value for complications requiring delivery before 34 weeks was 98%.

Conclusions.?Normal impedance to flow in uterine arteries between 11 and 14 weeks of gestation is strongly related to a normal pregnancy outcome in women at high risk for preeclampsia.     

Low molecular weight heparin treatment during subsequent pregnancies of women with inherited thrombophilia and previous severe pregnancy complications

Objectives.?The aim of this study was to investigate the effect of low molecular weight heparin (LMWH) on incidence of adverse outcome in women with thrombophilias and previous severe pregnancy complications.

Materials and methods.?The study included 116 women with history of severe preeclampsia, fetal growth restriction (FGR)?≤5th percentile, severe placental abruption and stillbirth?>20 weeks carrying factor V Leiden or prothrombin mutations, or protein S or C deficiency. Eighty-seven women referred to us for follow-up were treated with LMWH starting from weeks 5–15 (study group, A). Twenty-nine non-treated women referred only for delivery in our institution constituted the control group (B).

Results.?The incidence of severe pregnancy complications in previous pregnancies was similar in both groups. Following treatment with LMWH, the incidence of severe preeclampsia was 4.6% in group A compared to 21% in group B, p?=?0.007. The incidence of FGR was 2.3% in group A compared to 21% in group B, p?=?0.03. The incidence of stillbirth or placental abruption was 0% in group A compared to 7% in group B, p?=?0.06. The total incidence of adverse outcome was 7% in group A compared to 55% in group B, p?=?0.0001.

Conclusion.?LMWH treatment of women with previous severe pregnancy complications and thrombophilias significantly reduces the rate of recurrence.     

Measurement of aortic augmentation index in pregnant women with raised blood pressure and subsequent outcomes: a preliminary prospective cohort study

Objective: Preeclampsia is associated with arterial dysfunction and augmentation index (AIX%) is an established indicator of arterial dysfunction. Our aim was to investigate the relationship of AIX% with time-to-delivery and other outcomes in women admitted to an antenatal triage unit. Methods: We recruited 28 women with singleton pregnancies attending antenatal triage ward for assessment of hypertension. After 10?min rest, seated brachial blood pressure (Omron HEM-757) and AIX% (SphygmoCor applanation tonometry pulse wave analysis, PWA) were measured by a single investigator; other clinicians remained blinded to PWA results. Routine assessment included cardiotocography, urine analysis and blood tests. Subsequent outcomes were extracted from the obstetric records. Results: Mean AIX% was 19.7% (SD 11.5; range ?4% to?+36%), maternal age 31 years, gestation 37 weeks, brachial BP 145/95, proteinuria 39%. Nine women had preeclampsia at assessment and six subsequently developed preeclampsia. Median time-to-delivery was 10 d (IQR 1.6–25 d) and was shorter for AIX%?≥?20% (median 8.9 versus 19.8 d). AIX% was higher with preeclampsia (24.0%; SD 9.5) versus gestational hypertension (15.2%; SD 12.4); absolute difference 8.8% (95%CI 0.1–17.5; p?=?0.05). A one-point higher AIX% (adjusted for age, urate and gestation) was associated with 0.3 d (95%CI ?0.5 to 0.0; p?=?0.06) reduced time-to-delivery. A higher AIX% was also associated with induction for preeclampsia, severe preeclampsia, peripartum–anti-hypertensives and discharge-on-anti-hypertensives. Area under the curve (AUC) for AIX% predicting preeclampsia was 0.80 (95%CI 0.59–1.00; p?=?0.04). Conclusion: AIX% is associated with time-to-delivery and other outcomes in pregnancy.     

Preeclampsia and superimposed preeclampsia: The same disease? The role of angiogenic biomarkers

Objective: We aimed to compare sFlt-1 and placental growth factor (PlGF) levels and the sFlt-1/PlGF ratio between women with preeclampsia and superimposed preeclampsia to, respectively, normotensive and chronic hypertensive ones. Study design: We performed a prospective two-armed cohort in a tertiary teaching hospital in Sao Paulo, Brazil, including 37 normotensive and 60 chronic hypertensive pregnant women. We assessed the serum levels of sFlt-1 and PlGF at 20, 26, 32, and 36 gestational weeks by enzyme-linked immunosorbent assay. Main outcome measures: Having preeclampsia and superimposed preeclampsia. Results: Among normotensive and chronic hypertensive pregnancies, 4 (10.8%) and 14 (23.3%) women developed preeclampsia and superimposed preeclampsia, respectively. Compared with those who remained normotensive, the preeclampsia women presented higher sFlt-1 levels at 32 gestational weeks (4323.45 pg/mL vs. 2242.04 pg/mL, p = 0.019), lower PlGF levels at 20 (183.54 pg/mL vs. 337.38 pg/mL, p = 0.034), 32 (169.69 pg/mL vs. 792.53 pg/mL, p = 0.001), and 36 gestational weeks (252.99 pg/mL vs. 561.81 pg/mL, p = 0.029), and higher sFlt-1/PlGF ratios at 26 (9.02 vs. 1.84, p = 0.004), 32 (23.61 vs. 2.55, p = 0.001), and 36 gestational weeks (49.02 vs. 7.34, p = 0.029). On the other hand, compared with those who remained chronic hypertensive, the superimposed preeclampsia women only presented a higher sFlt-1/PlGF ratio at 32 gestational weeks (9.98 vs. 2.51, p = 0.039). Conclusion: Although angiogenic imbalance is clearly related to preeclampsia, it seems to play a more modest role in superimposed preeclampsia, in which other mechanisms should also be investigated.     

The effect of the D1-C785T polymorphism in the type 1 iodothyronine deiodinase gene on the circulating thyroid hormone levels in Romanian women with preeclampsia. Association with the degree of severity and pregnancy outcome of preeclampsia

Aim: To investigate the biochemical and genetic thyroid status in women with preeclampsia by the determination of serum FT3 and FT4 levels in association with D1-C785T genotypes. Methods: We genotyped using PCR–RFLP methods 50 women with preeclampsia and 50 normotensive pregnant women. Results: FT3 levels (pg/ml, 2.63?±?0.56 vs. 2.91?±?1.41) were low, and FT4 levels (ng/dl, 1.11?±?0.3 vs. 0.88?±?0.14) were high in women with preeclampsia compared to normal pregnant women. The association with severe preeclampsia was stronger for the homozygous T/T genotype (OR 6.57, p?=?0.029). Women with preeclampsia with the D1-T785 mutated allele had lower FT3 levels (pg/ml, 2.31?±?0.81 vs. 3.04?±?0.39, p?<?0.001), higher FT4 levels (ng/dl, 1.32?±?0.87 vs. 0.84?±?0.24, p?=?0.009) than women with preeclampsia with the D1-C/C genotype. Significant decrease in serum FT3 levels in positive women with severe preeclampsia compared to women negative for this genetic variation (pg/ml, 1.59?±?0.74 vs. 2.77?±?0.23, p?=?0.003) was observed. Women with severe preeclampsia, positive for the mutated T785 allele, delivered at a significantly lower gestational age (31.75?±?3.69 vs. 38.66?±?3.21 weeks, p?=?0.035) neonates with a lower birth weight (1861.11?±?869.9 vs. 3500?±?424.26?g, p?=?0.023) compared to women negative for the same allele. Conclusions: Thyroid hormone levels and the D1-C785T polymorphism, alone or in combination, correlate with the severity of preeclampsia. The D1-C785T polymorphism influences the outcome of pregnancy in severe preeclampsia.     

Perinatal outcome for pregnancies complicated with thrombocytopenia

Introduction: Thrombocytopenia affects about 10% of all pregnancies. Preeclampsia/HELLP syndrome induced thrombocytopenia may associate perinatal morbidity, preterm delivery, or low-birth-weight newborns. Objective: To assess perinatal outcome and complications of pregnancy in women presenting with thrombocytopenia. Methods: We retrospectively analyzed 936 consecutive pregnant women admitted during a 6-month period. Results: Incidence of thrombocytopenia in pregnancy was 11.11% (104/936). Thrombocytopenia represented a risk factor for premature delivery – highest risk for severe thrombocytopenia (RR?=?8.69, p?<?0.01). Thrombocytopenic preeclampsia or HELLP syndrome associated the highest rates of prematurity (RR?=?7.97, p?=?0.00, respectively 12.32). Thrombocytopenia also represented a risk factor for low-birth-weight newborns, especially severe thrombocytopenia – 2047.50?±?938.98?g (p?=?0.02) versus 3224.86?±?496.00?g in controls. Again, thrombocytopenic preeclampsia was significantly associated with low-birth-weight newborns (RR?=?11.94, p?=?0.00), with medium weight of 2462.05?±?794.54?g versus 2932.37?±?708.91?g in thrombocytopenic pregnancies, respectively 3224.86?±?496.00?g (p?=?0.00) in normal pregnancies. Conclusions: Thrombocytopenia in pregnancy was associated with perinatal morbidity, with the strongest association for preeclampsia and HELLP syndrome – for both prematurity and low-birth-weight: the lower the platelet count, the higher the risks for the fetus/newborn. Therefore, we strongly recommend close surveillance of thrombocytopenic mothers and their babies, in order to establish the etiology and the best moment for intervention.