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van der Pligt PF, Ebrahimi S, Kuswara K, Abbott GR, McNaughton SA, Islam SMS, Ellery SJ. Associations of adherence to the DASH diet and Mediterranean diet with maternal c-reactive protein levels during pregnancy. Nutr Metab Cardiovasc Dis 2024; 34:672-680. [PMID: 38172005 DOI: 10.1016/j.numecd.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIMS Elevated C-reactive protein (CRP) during pregnancy, a marker of inflammation, is associated with adverse outcomes. Better understanding the relationship between CRP and modifiable factors, including diet, is essential to assist early pregnancy lifestyle interventions. The aim of this study was to assess the relationship between adherence to the Dietary Approaches to Stop Hypertension diet (DASH-diet) and the Mediterranean diet (MED-diet) during pregnancy with maternal plasma CRP in early and late pregnancy. METHODS AND RESULTS Secondary analysis of the Creatine and Pregnancy Outcomes (CPO) study was undertaken. Women (n = 215) attending antenatal clinics through Monash Health, Melbourne were recruited at 10-20 weeks gestation. Medical history and blood samples were collected at 5 antenatal visits. Adapted DASH-diet and MED-diet scores were calculated from Food Frequency Questionnaires completed at early ([mean ± SD]) (15 ± 3 weeks) and late (36 ± 1 week) pregnancy. CRP was measured in maternal plasma samples collected at the same time points. Adjusted linear regression models assessed associations of early-pregnancy DASH and MED-diet scores with early and late pregnancy plasma CRP. There were no statistically significant changes in DASH-diet score from early (23.5 ± 4.8) to late (23.5 ± 5.2) pregnancy (p = 0.97) or MED-diet score from early (3.99 ± 1.6) to late pregnancy (4.08 ± 1.8) (p = 0.41). At early-pregnancy, there was an inverse relationship between DASH-diet scores and MED-diet scores with plasma CRP; (β = -0.04 [95%CI = -0.07, -0.00], p = 0.044), (β = -0.12 [95%CI = -0.21, -0.02], p = 0.023). CONCLUSION Adherence to the DASH-diet and MED-diet during early pregnancy may be beneficial in reducing inflammation. Assessment of maternal dietary patterns may assist development of preventive strategies, including dietary modification, to optimise maternal cardiometabolic health in pregnancy.
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Affiliation(s)
- Paige F van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, 3220, Australia; Department of Nutrition, Western Health, Footscray, Australia.
| | - Sara Ebrahimi
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria 3220, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Konsita Kuswara
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria 3220, Australia
| | - Gavin R Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, 3220, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, 3220, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, 3220, Australia
| | - Stacey J Ellery
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Bu C, Wang Z, Ren Y, Chen D, Jiang SW. Syncytin-1 nonfusogenic activities modulate inflammation and contribute to preeclampsia pathogenesis. Cell Mol Life Sci 2022; 79:290. [PMID: 35536515 PMCID: PMC11073204 DOI: 10.1007/s00018-022-04294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/03/2022]
Abstract
Maternal cellular and humoral immune responses to the allogeneic fetoplacental unit are a normal part of pregnancy adaptation. Overactive or dysregulated immune responses that often manifest as inflammation are considered a key element for the development of preeclampsia. Infiltration and activation of macrophages, nature killer cells, and T lymphocytes are frequently observed in the decidua and placenta associated with preeclampsia. In addition to local inflammation, systemic inflammatory changes including increased levels of TNF-α and interleukins (ILs) are detected in the maternal circulation. Syncytin-1 is an endogenous retroviral envelope protein that mediates the fusion of trophoblasts to form syncytiotrophoblasts, a cellular component carrying out most of placental barrier, exchange, and endocrine functions. In addition to these well-defined fusogenic functions that are known for their close association with preeclampsia, multiple studies indicated that syncytin-1 possesses nonfusogenic activities such as those for cell cycle and apoptosis regulation. Moreover, syncytin-1 expressed by trophoblasts and various types of immune cells may participate in regulation of inflammation in preeclamptic placenta and decidua. This review concentrates on the triangular relationship among inflammation, syncytin-1 nonfusogenic functions, and preeclampsia pathogenesis. Data regarding the reciprocal modulations of inflammation and poor vascularization/hypoxia are summarized. The impacts of syncytin-A (the mouse counterpart of human syncytin-1) gene knockout on placental vascularization and their implications for preeclampsia are discussed. Syncytin-1 expression in immune cells and its significance for inflammation are analyzed in the context of preeclampsia development. Finally, the involvements of syncytin-1 nonfusogenic activities in neuroinflammation and multiple sclerosis are compared to findings from preeclampsia.
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Affiliation(s)
- Chaozhi Bu
- Center of Reproductive Medicine, State Key Laboratory of Reproductive Medicine, Research Institute for Reproductive Health and Genetic Diseases, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002, China
| | - Zhiwei Wang
- Center of Reproductive Medicine, State Key Laboratory of Reproductive Medicine, Research Institute for Reproductive Health and Genetic Diseases, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002, China
- Center of Prenatal Diagnosis, Lianyungang Maternal and Child Health Hospital, Lianyungang, 222000, Jiangsu, China
| | - Yongwei Ren
- Center of Reproductive Medicine, State Key Laboratory of Reproductive Medicine, Research Institute for Reproductive Health and Genetic Diseases, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002, China
| | - Daozhen Chen
- Research Institute for Reproductive Health and Genetic Diseases, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002, China.
| | - Shi-Wen Jiang
- Center of Reproductive Medicine, State Key Laboratory of Reproductive Medicine, Research Institute for Reproductive Health and Genetic Diseases, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214002, China.
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Joshi K, Acharya N, Acharya S, Joshi S. Maternal Serum High-Sensitivity C-Reactive Protein (hsCRP) as a Prognostic Marker of Fetomaternal Outcome in Hypertensive Disorders of Pregnancy: A Novel Study. Cureus 2022; 14:e24327. [PMID: 35607538 PMCID: PMC9123406 DOI: 10.7759/cureus.24327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Hypertensive disorders of pregnancy (HDP) are a group of obstetric disorders causing profound fetomaternal compromise, leading to adverse obstetric outcomes. High-sensitivity c-reactive protein (hsCRP), an inflammatory marker of systemic inflammation, is elevated in HDP and correlates with the severity of the disease. However, prediction and prevention of HDP and its associated fetomaternal complications remain elusive to most obstetricians. The present study aimed to evaluate the use of hsCRP as a prognostic marker of adverse fetomaternal outcome in HDP. Methods: The study included 132 third-trimester pregnancies with HDP who underwent hsCRP quantification at the time of presentation to the out-patient department and followed up till delivery. HsCRP quantification was done using immunoturbidimetry method. Results: Of the 132 cases studied, 72 had normal hsCRP levels while the remaining 60 had raised hsCRP levels. It was observed that patients with raised hsCRP levels had poorer fetomaternal outcomes at delivery as compared to those with normal hsCRP levels. Conclusion: The obstetric outcomes of patients with HDP worsened with increasing levels of hsCRP, as shown in our study, when compared to normotensive patients. Thus, hsCRP delivers promising results as a prognostic marker of adverse fetomaternal outcomes in patients of HDP.
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Relation of Serum and Salivary Total Sialic Acid and Total Sialic Acid/Total Protein Ratio with Clinical Parameters of Disease Progression in Preeclampsia. Indian J Clin Biochem 2022; 37:113-118. [PMID: 35125701 PMCID: PMC8799822 DOI: 10.1007/s12291-021-00956-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/12/2021] [Indexed: 01/03/2023]
Abstract
Sialic acid is a terminal component of carbohydrate chains of glycoproteins and glycolipids. The present study estimated total sialic acid (TSA) and its ratio with total proteins (TP), in serum and saliva of preeclampsia. The study further investigated the association of these parameters with clinical variables of disease progression. 50 preeclampsia patients (32 mild preclampsia and 18 severe preeclampsia cases) and 50 pregnant controls were included in the study. Serum and salivary free sialic acid, protein bound sialic acid and TP were measured spectrophotometrically. Serum and salivary TSA and its ratio with TP were calculated. There was a significant increase in serum TSA and its ratio with TP in preeclampsia compared to the controls. The increase reflected with the severity of the disease. Serum TSA and TSA/TP showed a significant positive correlation with blood pressure, proteinuria and a significant negative correlation with infant birth weight. In saliva, there was no statistical difference between TSA in preeclampsia and controls. Salivary TSA/TP increased significantly in preeclampsia. However the increase was not in accordance to the disease severity. Salivary TSA and TSA/TP were not significantly associated with any of the clinical parameters of disease progression. Significant increase in seum TSA reflects the disturbance in sialyation of serum proteins in preeclampsia, that could not be depicted in the saliva of these patients. Disturbance in serum protein sialyation is further exaggerated with the severity of the disease. Serum TSA and TSA/TP and not the respective salivary parameters, could serve as useful indicators in assessment of clinical progression of the disease.
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Ugwu CE, Nwatah AJ, Ugwu GO, Meludu SC. Serum immunoglobulins, C-reactive protein, and trace element level in preeclamptic Nigerian subjects. Niger J Clin Pract 2022; 25:1405-1412. [DOI: 10.4103/njcp.njcp_1455_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brouillet S, Boursier G, Anav M, Du Boulet De La Boissière B, Gala A, Ferrieres-Hoa A, Touitou I, Hamamah S. C-reactive protein and ART outcomes: a systematic review. Hum Reprod Update 2020; 26:753-773. [DOI: 10.1093/humupd/dmaa012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/17/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
BACKGROUND
A dynamic balance between pro- and anti-inflammatory factors contributes to regulating human female reproduction. Chronic low-grade inflammation has been detected in several female reproductive conditions, from anovulation to embryo implantation failure. C-reactive protein (CRP) is a reliable marker of inflammation that is extensively used in clinical practice. Recent studies quantified CRP in the serum of infertile women undergoing ART and suggested its potential for the prediction of ART reproductive outcomes.
OBJECTIVE AND RATIONALE
The first objective of this systematic review of the available literature was to evaluate the association between pre-implantation circulating CRP concentration and pregnancy rates in women undergoing ART. The second objective was to describe serum CRP concentration changes after early embryo implantation. The changes in circulating CRP throughout the ART cycle, clinical implications of CRP quantification for the management of women undergoing ART, and future therapeutic options will also be discussed.
SEARCH METHODS
The MEDLINE database was systematically searched from inception to March 2019 using the following key words: (C-reactive protein) AND (assisted reproductive techniques OR ovulation induction OR insemination OR in vitro fertilization). Only articles in English were considered. Studies were selected based on title and abstract. The full text of potentially relevant articles was retrieved and assessed for inclusion by two reviewers (S.B. and S.H.). The protocol was registered in the International prospective register of systematic reviews (PROSPERO; registration number: CRD148687).
OUTCOMES
In total, 10 studies were included in this systematic review. Most of these studies reported lower circulating CRP values before the window of implantation and higher circulating CRP values during the peri-implantation period in women with successful ART outcome (biochemical or clinical pregnancy) compared to women without a successful outcome. Several lifestyle factors and/or drugs that reduce the concentration of circulating CRP significantly improve ART outcomes. Subgroup analyses according to female BMI and baseline circulating CRP concentration are highly recommended in future analyses.
WIDER IMPLICATIONS
These findings highlight a possible detrimental impact of preconception high circulating CRP concentration on ART outcomes. However, the biochemical or clinical pregnancy rate endpoints used in the studies examined here are insufficient (there were no data on live birth outcome), and the impact of major variables that can influence CRP and/or ART, for example maternal age, BMI, number of transferred embryos, and use of anti-inflammatory drugs, were not considered in the analyses. CRP quantification may be a potential marker of ART outcome, but its predictive value still needs to be investigated in large prospective studies. In future, the quantification of circulating CRP before starting ART could help to identify patients with a poor ART prognosis, leading to ART cycle cancellation or to preconception treatment to minimize the medical risks and costs.
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Affiliation(s)
- Sophie Brouillet
- Université Grenoble-Alpes, Inserm 1036, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut de Biosciences et Biotechnologies de Grenoble (BIG), Laboratoire Biologie du Cancer et de l’Infection (BCI), 38000 Grenoble, France
- Centre Hospitalier Universitaire de Grenoble, Hôpital Couple-Enfant, Centre Clinique et Biologique d’Assistance Médicale à la Procréation-Centre d'Étude et de Conservation des Oeufs et du Sperme Humains (CECOS), La Tronche, France
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Guilaine Boursier
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
| | - Margaux Anav
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Bertille Du Boulet De La Boissière
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Anna Gala
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Alice Ferrieres-Hoa
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Isabelle Touitou
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
- Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies, INSERM, Univ de Montpellier, Montpellier, France
| | - Samir Hamamah
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
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7
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Nikbakht R, Moghadam EK, Nasirkhani Z. Maternal serum levels of C-reactive protein at early pregnancy to predict fetal growth restriction and preterm delivery: A prospective cohort study. Int J Reprod Biomed 2020; 18:157-164. [PMID: 32309764 PMCID: PMC7142318 DOI: 10.18502/ijrm.v18i3.6710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/03/2019] [Accepted: 09/23/2019] [Indexed: 11/24/2022] Open
Abstract
Background A considerable evidence suggests that maternal inflammation dysregulation may play as a risk factor for both maternal and neonatal outcomes.
Objective: The study's objectives were designed to evaluate the correlation between serum C-reactive protein (CRP) levels, as an inflammation factor, preterm delivery, and small for gestational age (SGA) births. Materials and Methods This prospective cohort study was conducted on 120 singleton pregnant women with gestational age less than 20 wk. Maternal CRP serum concentration was measured before 20 wk gestation. Patients were followed-up until the delivery and final outcomes of pregnancy were recorded in terms of preterm delivery and SGA births.
Results: Serum CRP levels in participants with normal fetuses and SGA births were 4.09 ± 1.35 mg/l and 6.04 ± 3.29 mg/l, respectively (p = 0.19), while in cases of preterm delivery, it was 9.63 ± 5.78 mg/l (p < 0.001). By using receiver operating characteristic (ROC) curve, serum CRP levels (cut-off point 5.27 mg/l, area 0.836) had acceptable diagnostic accuracy value in distinguishing preterm delivery (sensitivity (75%), specificity (86.1%), positive predictive value (37.5%), negative predictive value (96.87%), accuracy (85%)) and serum CRP levels (cut-off point 6.67 mg/l, area 0.673) in distinguishing SGA births (sensitivity (50%), specificity (91.2%), positive predictive value (23.07%), and negative predictive value (97.19%), and accuracy (89.16 %)). Conclusion Higher maternal serum CRP levels measured early in pregnancy may associate with higher risk of preterm delivery and SGA.
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Affiliation(s)
- Roshan Nikbakht
- Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Karimi Moghadam
- Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zeinab Nasirkhani
- Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Yang Y, Kan H, Yu X, Yang Y, Li L, Zhao M. Relationship between dietary inflammatory index, hs-CRP level in the second trimester and neonatal birth weight: a cohort study. J Clin Biochem Nutr 2020; 66:163-167. [PMID: 32231414 DOI: 10.3164/jcbn.19-100] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/04/2019] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to investigate whether diet plays a role in the effect of inflammation on birth weight. The normal pre-pregnancy body mass index and healthy single pregnant women without classical inflammatory were recruited at 16-20 weeks of pregnancy and provided blood sample to measure plasma high sensitive C-reactive protein (hs-CRP) level. The Dietary Inflammatory Index (DII) score was calculated by a three-day 24 h recall method, and a cohort of 307 eligible pregnant women was established. According to birth weight, the subjects were divided into three groups: normal birth weight (NBW) group, low birth weight (LBW) group, and high birth weight (HBW) group. The hs-CRP level and DII score were significantly different between NBW and LBW groups. The risk of higher hs-CRP in the pro-inflammatory dietary group was 1.89 times than the control group (95% CI: 1.05, 3.42). The risk of LBW with higher hs-CRP was 3.81 times than normal hs-CRP (95% CI: 1.26, 11.56). The risk of LBW in the pro-inflammatory dietary group was 10.44 times than in the anti-inflammatory dietary group (95%CI: 1.29, 84.61). The pro-inflammatory dietary in the second trimester affects the hs-CRP level, showing a positive correlation. And both of two factors increase the risk of LBW.
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Affiliation(s)
- Yuying Yang
- School of Nursing, Anhui Medical University, Hefei 230032, China
| | - Hongyan Kan
- School of Nursing, Anhui Medical University, Hefei 230032, China.,The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Xiaoling Yu
- The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Yuanyuan Yang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Li Li
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Mei Zhao
- School of Nursing, Anhui Medical University, Hefei 230032, China
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Mangogna A, Agostinis C, Ricci G, Romano F, Bulla R. Overview of procalcitonin in pregnancy and in pre-eclampsia. Clin Exp Immunol 2019; 198:37-46. [PMID: 31081935 DOI: 10.1111/cei.13311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 12/19/2022] Open
Abstract
Procalcitonin (PCT), a precursor for calcitonin, is a prohormone involved in the inflammatory processes, which has been poorly studied in the context of pregnancy. During severe inflammation, PCT derives from almost all cell types, including monocytes and parenchymal tissues, making it a good predictive and diagnostic marker of an inflammatory state with rapidly increased serum levels in inflammation or sepsis. In normal pregnancy, PCT is basally expressed at very low level by decidual cells, even if decidual macrophages, which in normal pregnancy are skewed to M2 macrophages, are resistant to lipopolysaccharide (LPS)-induced production of PCT. As PCT increase is associated with an inflammatory state, several research groups investigated whether PCT can be considered a marker of pre-eclampsia, a pregnancy disease characterized by systemic inflammation. The first aim of this review is to summarize what is already known about the tissues synthesizing PCT, about the stimuli that cause the increase of circulating PCT levels and how PCT acts as a proinflammatory stimulus by itself. Secondly, we will describe the role of this prohormone in normal pregnancy and in pregnancies complicated by pre-eclampsia, highlighting the involvement of the decidual macrophages and the proinflammatory cytokine tumor necrosis factor-α in the modulation of PCT expression in the decidual microenvironment.
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Affiliation(s)
- A Mangogna
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - C Agostinis
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - G Ricci
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy.,Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - F Romano
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - R Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
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C-Reactive Protein Levels at the Midpregnancy Can Predict Gestational Complications. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1070151. [PMID: 30533423 PMCID: PMC6247639 DOI: 10.1155/2018/1070151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022]
Abstract
Although essential for a successful pregnancy, a growing body of evidence suggests that maternal inflammation, when dysregulated, may represent a risk factor for both maternal and neonatal outcomes. Here, we assessed the accuracy of maternal C-reactive protein (CRP) concentrations at the middle phase of pregnancy in the identification of maternal adverse outcomes (MAO) until delivery. A correlation between CRP and a complicated pregnancy including both maternal and neonatal adverse outcomes has been investigated, too. In this retrospective study, conducted at the Diabetology Unit of IRCCS Ospedale Policlinico San Martino, Genoa (Italy), 380 outpatient pregnant women have been enrolled at the prenatal visit before performing a 75 g oral glucose tolerance test at 24th-26th gestational week for gestational diabetes mellitus (GDM) screening. Demographic, medical, and reproductive history has been obtained by verbal interview. Data about pregnancy and delivery have been retrieved from medical records. The median value of maternal baseline serum CRP was 3.25 μg/mL. Women experiencing MAO were older, more frequently suffering from hypertension, and showed higher CRP concentrations, with a cutoff value >1.86 μg/mL found by a ROC curve analysis to be accurately predictive for MAO. By a logistic regression analysis, serum CRP levels >1.86 μg/mL have been found to predict MAO also considering maternal age, hypertension, and GDM. Maternal CRP levels have been positively associated with overall pregnancy adverse outcomes (maternal and neonatal), too. In conclusion, in pregnant women serum levels of CRP can early recognize subjects at higher risk for maternal and neonatal complications needing a more stringent follow-up.
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Chen H, Zhang J, Qin F, Chen X, Jiang X. Evaluation of the predictive value of high sensitivity C-reactive protein in pregnancy-induced hypertension syndrome. Exp Ther Med 2018; 16:619-622. [PMID: 30112027 PMCID: PMC6090476 DOI: 10.3892/etm.2018.6246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/08/2018] [Indexed: 11/06/2022] Open
Abstract
Relationship between serum high sensitive C-reactive protein (hs-CRP) and pregnancy-induced hypertension syndrome (PIH) was investigated. One hundred and twenty patients with PIH treated in the First People's Hospital of Chengdu (60 cases of mild preeclampsia, 60 cases of severe preeclampsia) were enrolled in the study. The control group included 60 women with normal singleton pregnancy. Serum hs-CRP and microalbuminuria (mALB) levels were measured by an AU5800 automatic biochemical analyzer (Beckerman Coulter), and the risk factors were analyzed by ROC curve analysis. Patients with PIH had higher levels of serum hs-CRP and mALB than the control group (P<0.01). Serum hs-CRP and mALB levels in the severe preeclampsia group were significantly higher than those in the mild preeclampsia group (P<0.05). ROC curve analysis showed that hs-CRP was a factor of high-risk. Area under the curve was 0.943, and the 95% confidence interval was 0.848–0.974. Detection of serum hs-CRP in patients with PIH can provide references for the prediction of the severity of the disease, and higher level of hs-CRP indicates worse condition.
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Affiliation(s)
- Hang Chen
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, Sichuan 610000, P.R. China
| | - Jun Zhang
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, Sichuan 610000, P.R. China
| | - Fang Qin
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, Sichuan 610000, P.R. China
| | - Xinyun Chen
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, Sichuan 610000, P.R. China
| | - Xiaojing Jiang
- Department of Cardiology, The First People's Hospital of Chengdu, Chengdu, Sichuan 610000, P.R. China
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12
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Yang K, Dong G, Tian Y, Li J. Effects of compound Danshen injection combined with magnesium sulfate on serum MPO and hs-CRP in patients with severe preeclampsia. Exp Ther Med 2018; 16:167-170. [PMID: 29896236 PMCID: PMC5995028 DOI: 10.3892/etm.2018.6173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/11/2018] [Indexed: 12/24/2022] Open
Abstract
Effects of compound Danshen injection combined with magnesium sulfate on serum myeloperoxidase (MPO) and hypersensitive C-reactive protein (hs-CRP) in patients with severe preeclampsia (PE) were investigated. Five hundred patients with severe PE were randomly divided into early-onset observation, early-onset control, late-onset observation and late-onset control groups. Control group was treated with magnesium sulfate, while patients in observation group were treated with magnesium sulfate combined with compound Danshen injection. Serum levels of MPO and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA) and turbidimetric assay. The effects of compound Danshen injection combined with magnesium sulfate on the above indexes were observed. Serum levels of MPO and hs-CRP significantly decreased in early-onset observation, late-onset observation, early-onset control and late-onset control groups after treatment (p<0.05). After treatment, levels of MPO and hs-CRP were significantly lower in early-onset observation group than in early-onset control group (p<0.05), and levels of MPO and hs-CRP were also significantly lower in late-onset observation group than in late-onset control group (p<0.05). Total effective rate of early-onset observation group and late-onset observation group were higher than that of early-onset control group and late-onset control group. Compound Danshen injection combined with magnesium sulfate achieved better treatment outcomes in the treatment of severe PE than magnesium sulfate alone. The combined treatment can effectively reduce the serum levels of MPO and hs-CRP.
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Affiliation(s)
- Kun Yang
- Department of Obstetrics, The Second People's Hospital of Liaocheng, Liaocheng, Shandong 252600, P.R. China
| | - Gaoxia Dong
- Department of Obstetrics, The Second People's Hospital of Liaocheng, Liaocheng, Shandong 252600, P.R. China
| | - Ying Tian
- Department of Obstetrics, Zhangqiu Maternity and Child Care Hospital, Jinan, Shandong 250200, P.R. China
| | - Jian Li
- Department of Obstetrics, Qingdao Central Hospital, Qingdao, Shandong 266042, P.R. China
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Accortt EE, Mirocha J, Dunkel Schetter C, Hobel CJ. Adverse Perinatal Outcomes and Postpartum Multi-Systemic Dysregulation: Adding Vitamin D Deficiency to the Allostatic Load Index. Matern Child Health J 2018; 21:398-406. [PMID: 28120286 DOI: 10.1007/s10995-016-2226-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Allostatic load (AL) is an index of multi-system physiological "wear-and-tear," operationalizing emergent chronic disease risk and predicting morbidity and mortality. AL has been proposed as an organizing framework for studying pregnancy outcomes and additional AL biomarkers for the study of maternal health would be valuable. Objectives To test whether adverse perinatal outcomes are associated with postpartum AL and if including vitamin D deficiency (serum 25(OH)D < 20 ng/ml) as an additional marker of postpartum AL increases the association. Methods The Community Child Health Network is a community-based participatory research network that enrolled women at birth and followed them for 2 years measuring ten biomarkers (body mass index, waist: hip ratio, pulse, systolic and diastolic blood pressures, cortisol slope, c-reactive protein, hgbA1c, HDL, and total cholesterol) at 6 and 12 months postpartum. A composite of four adverse perinatal outcomes (low birth weight, preterm birth, preeclampsia, and gestational diabetes) was collected from medical charts in a sample of 164 women from one site and serum 25(OH)D status was measured 24-39 weeks postpartum in this cohort. Results Twenty-nine percent experienced one or more of the four adverse perinatal outcomes. Serum 25(OH)D was significantly inversely correlated with the AL index (Spearman's r = -0.247, p = 0.002). Logistic regression results adjusting for maternal age and race showed that adverse outcome was significantly associated with higher postpartum AL (OR 1.53 for a 1-unit increase in AL, 95% CI 1.24-1.89). Adding 25(OH)D deficiency as an 11th component to the AL index improved the model fit (Delta (-2LogL) = 3.955, p = 0.047), and improved the Akaike information criterion (180.32 vs. 184.27). Conclusion Women with adverse perinatal outcomes have higher postpartum AL and adding vitamin D deficiency to the AL index strengthens this association.
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Affiliation(s)
- Eynav Elgavish Accortt
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, 280 West Tower, Los Angeles, CA, 90048, USA.
| | - James Mirocha
- Cedars-Sinai Biostatistics Core, Research Institute, Clinical & Translational Science Institute (CTSI), Clinical &Translational Research Center (CTRC), Burns and Allen Research Institute, Samuel Oschin Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Christine Dunkel Schetter
- Department of Psychology, University of California, 1285a Franz Hall, Los Angeles, CA, 90095-1563, USA
| | - Calvin J Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8631 West 3rd Street, 1001 East Tower, Los Angeles, CA, 90048, USA.
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Lowry P, Woods R. The placenta controls the physiology of pregnancy by increasing the half-life in blood and receptor activity of its secreted peptide hormones. J Mol Endocrinol 2018; 60:R23-R30. [PMID: 29212865 DOI: 10.1530/jme-17-0275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/24/2017] [Indexed: 11/08/2022]
Abstract
An efficient functioning placenta is essential for a healthy pregnancy and yet the way this is achieved has been the subject of much discussion and confusion, particularly with the occurrence of pathological conditions such as preeclampsia, morning sickness and hyperemesis/ptyalism gravidarum. We will attempt to explain the underlying physiology and the potential roles played by the placental tachykinins, neurokinin B and endokinin.
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Affiliation(s)
- Philip Lowry
- School of Biological SciencesUniversity of Reading, Reading, UK
| | - Russell Woods
- School of Biological SciencesUniversity of Reading, Reading, UK
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Jannesari R, Kazemi E. Level of High Sensitive C-reactive Protein and Procalcitonin in Pregnant Women with Mild and Severe Preeclampsia. Adv Biomed Res 2017; 6:140. [PMID: 29279838 PMCID: PMC5698977 DOI: 10.4103/2277-9175.218032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: In this study, we compare the level of two inflammatory markers, high sensitive C-reactive protein (hs-CRP) and procalcitonin (PCT), in pregnant women with mild and severe preeclampsia (PE) and women with normal pregnancy. Materials and Methods: In this case–control study, normal pregnant women and pregnant women with PE were enrolled. Pregnant women with diagnosed PE were selected as case group and classified into two groups with mild and severe PE. Serum samples for measurement of hs-CRP and PCT were obtained and compared in studied groups. Results: In this study, 50 normal pregnant women and 59 pregnant women with PE, 26 (44.1%) mild, and 33 (55.9%) severe were studied. Mean of hs-CRP and PCT was higher in pregnant women with PE than normal pregnant women (7.71 ± 6.19 vs. 5.44 ± 3.94, P = 0.02 for hs-CRP and 0.05 ± 0.03 vs. 0.04 ± 0.01, P = 0.001 for PCT). Area under curve for hs-CRP and PCT was 0.611 and 0.646, respectively. The optimal cut-off point for hs-CRP was 5.24 with a sensitivity of 62.7% and a specificity of 56%. The optimal cut-off point for PCT was 0.042 with a sensitivity of 71% and a specificity of 54%. Conclusion: The findings of this study indicated that higher level of hs-CRP and PCT in pregnant women with PE than those with normal pregnancy could potentially explain the exaggerated inflammation in PE. Regarding significantly increased level of hs-CRP in severe PE than mild PE, we could suggest that hs-CRP is more appropriate marker for investigating pregnant women with severe PE, and its clinical usefulness is superior to PCT in this regard.
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Affiliation(s)
- Reihane Jannesari
- Department of Pathology, Medical Faculty, Hormozgan University of Medical Sciences, Hormozgan, Iran
| | - Elham Kazemi
- Department of Pathology, Medical Faculty, Hormozgan University of Medical Sciences, Hormozgan, Iran
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16
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Reference Intervals for Non-Fasting CVD Lipids and Inflammation Markers in Pregnant Indigenous Australian Women. Healthcare (Basel) 2017; 5:healthcare5040072. [PMID: 29036887 PMCID: PMC5746706 DOI: 10.3390/healthcare5040072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 12/14/2022] Open
Abstract
Indigenous Australians experience high rates of cardiovascular disease (CVD). The origins of CVD may commence during pregnancy, yet few serum reference values for CVD biomarkers exist specific to the pregnancy period. The Gomeroi gaaynggal research project is a program that undertakes research and provides some health services to pregnant Indigenous women. Three hundred and ninety-nine non-fasting samples provided by the study participants (206 pregnancies and 175 women) have been used to construct reference intervals for CVD biomarkers during this critical time. A pragmatic design was used, in that women were not excluded for the presence of chronic or acute health states. Percentile bands for non-linear relationships were constructed according to the methods of Wright and Royston (2008), using the xriml package in StataIC 13.1. Serum cholesterol, triglycerides, cystatin-C and alkaline phosphatase increased as gestational age progressed, with little change seen in high-sensitivity C-Reactive Protein and γ glutamyl transferase. Values provided in the reference intervals are consistent with findings from other research projects. These reference intervals will form a basis with which future CVD biomarkers for pregnant Indigenous Australian women can be compared.
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17
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Maternal pregnancy C-reactive protein predicts offspring birth size and body composition in metropolitan Cebu, Philippines. J Dev Orig Health Dis 2017; 8:674-681. [PMID: 28720162 DOI: 10.1017/s2040174417000502] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The gestational milieu is an important influence on fetal development and long-term disease risk. Here we assess relationships between maternal pregnancy inflammation, indicated by C-reactive protein (CRP), and offspring anthropometric outcomes measured soon after birth. Data come from female participants (n=327, age 24.4-30.2 years) in a longitudinal study located in Metropolitan Cebu, Philippines. Between 2009 and 2014, pregnancy interviews (n=429) were conducted during which questionnaire and anthropometric data were obtained along with dried blood spot cards for CRP measurement. Offspring body weight, length, head circumference and five skinfold thickness measures were obtained soon after birth. Maternal pregnancy CRP was borderline (-1.11±0.64 days/log-mg/l; P<0.1) inversely related to gestational age at delivery, but did not increase the likelihood of preterm delivery. After adjusting for maternal pre-pregnancy body mass index, height, pregnancy adiposity, age, parity and other covariates, CRP was significantly, inversely related to offspring body weight (-0.047±0.017 kg/log-mg/l), length (-0.259±0.092 cm/log-mg/l) and sum of skinfolds (-0.520±0.190 mm/log-mg/l) (all P<0.05), and borderline inversely related to offspring head circumference (-0.102±0.068 cm/log-mg/l; P<0.1). Notably, relationships were continuous across the full CRP range, and not limited to unusually high levels of inflammation. These findings point to an important role of maternal non-specific immune activation as a predictor of offspring birth outcomes. In light of evidence that early life microbial, nutritional and stress experiences influence adult inflammatory regulation, these findings point to inflammation as a potential pathway for the intergenerational transmission of maternal experience to offspring health.
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18
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Alma LJ, Bokslag A, Maas AHEM, Franx A, Paulus WJ, de Groot CJM. Shared biomarkers between female diastolic heart failure and pre-eclampsia: a systematic review and meta-analysis. ESC Heart Fail 2017; 4:88-98. [PMID: 28451444 PMCID: PMC5396047 DOI: 10.1002/ehf2.12129] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022] Open
Abstract
Evidence accumulates for associations between hypertensive pregnancy disorders and increased cardiovascular risk later. The main goal of this study was to explore shared biomarkers representing common pathogenic pathways between heart failure with preserved ejection fraction (HFpEF) and pre‐eclampsia where these biomarkers might be potentially eligible for cardiovascular risk stratification in women after hypertensive pregnancy disorders. We sought for blood markers in women with diastolic dysfunction in a first literature search, and through a second search, we investigated whether these same biochemical markers were present in pre‐eclampsia.This systematic review and meta‐analysis presents two subsequent systematic searches in PubMed and EMBASE. Search I yielded 3014 studies on biomarkers discriminating women with HFpEF from female controls, of which 13 studies on 11 biochemical markers were included. Cases had HFpEF, and controls had no heart failure. The second search was for studies discriminating women with pre‐eclampsia from women with non‐hypertensive pregnancies with at least one of the biomarkers found in Search I. Search II yielded 1869 studies, of which 51 studies on seven biomarkers were included in meta‐analyses and 79 studies on 12 biomarkers in systematic review.Eleven biological markers differentiated women with diastolic dysfunction from controls, of which the following 10 markers differentiated women with pre‐eclampsia from controls as well: C‐reactive protein, HDL, insulin, fatty acid‐binding protein 4, brain natriuretic peptide, N terminal pro brain natriuretic peptide, adrenomedullin, mid‐region pro adrenomedullin, cardiac troponin I, and cancer antigen 125.Our study supports the hypothesis that HFpEF in women shares a common pathogenic background with pre‐eclampsia. The biomarkers representing inflammatory state, disturbances in myocardial function/structure, and unfavourable lipid metabolism may possibly be eligible for future prognostic tools.
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Affiliation(s)
- Lisa J Alma
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Anouk Bokslag
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Angela H E M Maas
- Department of CardiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Arie Franx
- Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Walter J Paulus
- Department of PhysiologyVU University Medical CenterAmsterdamThe Netherlands
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Kahyaoglu S, Yumuşak OH, Ozyer S, Pekcan MK, Erel M, Cicek MN, Erkaya S, Tasci Y. Clomiphene Citrate Treatment Cycle Outcomes of Polycystic Ovary Syndrome Patients Based on Basal High Sensitive C-Reactive Protein Levels: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 10:320-326. [PMID: 28042411 PMCID: PMC5134747 DOI: 10.22074/ijfs.2016.4849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/07/2016] [Indexed: 12/03/2022]
Abstract
Background Polycystic ovary syndrome (PCOS) is highly associated with an ovulatory
infertility, features of the metabolic syndrome, including obesity, insulin resistance and
dyslipidemia. Serum concentrations of high sensitive C-reactive protein (hs-CRP) were
significantly higher in obese than in non-obese PCOS patients at baseline, suggesting a
relationship between elevated hs-CRP levels and obesity. The aim of this study was to
evaluate whether cycle day 3 hs-CRP levels before clomiphene citrate (CC) treatment
would predict cycle outcomes in women with PCOS. Materials and Methods This cross-sectional study was conducted among 84 infertile
women with PCOS who were treated with CC at Zekai Tahir Burak Women’s Health
Education and Research Hospital, Ankara, Turkey, between January 2014 and January
2015. Based on the exclusion criteria, cycle outcomes of remaining 66 infertile women
with PCOS treated with CC were analyzed. The hs-CRP levels and insulin resistance indexes
were evaluated on day 3 of the CC treatment cycle. The primary outcome measures
were number of preovulatory follicles measuring≥17 mm and pregnancy rates. Results The mean ± SD age of the patients was 24.0 ± 3.8 years (range 18-36). The mean
± SD body mass index (BMI) of the patients was 25.7 ± 4.9 (range 17-43). Fifty patients
developed dominant follicle (75%) and 5 patients established clinical pregnancy during
the study (clinical pregnancy rate: 7%). The mean ± SD baseline hs-CRP, fasting insulin
and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) values of the
patients with and without dominant follicle generation during treatment cycle were 6.42 ±
7.05 and 4.41 ± 2.95 (P=0.27), 11.61 ± 6.94 and 10.95 ± 5.65 (P=0.73), 2.68 ± 1.79 and
2.41 ± 1.30 (P=0.58), respectively. The mean ± SD baseline hs-CRP, fasting insulin and
HOMA-IR values of the patients with and without clinical pregnancy establishment
following treatment cycle were 6.30 ± 2.56 and 5.90 ± 6.57 (P=0.89), 11.60 ± 7.54 and 11.44
± 6.61 (P=0.95), 2.42 ± 1.51 and 2.63 ± 1.70 (P=0.79), respectively. Conclusion In this study, we did not observe a predictive value of cycle day 3 hs-CRP
levels on preovulatory follicle development and pregnancy rates among infertile PCOS
patients treated with CC. Also, no relationship between HOMA-IR values and dominant
follicle generation or clinical pregnancy establishment was demonstrated in our study,
confirming the previous studies emphasizing the neutral effect of metformin utilization
before and/or during ovulation induction to pregnancy rates.
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Affiliation(s)
- Serkan Kahyaoglu
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Omer Hamid Yumuşak
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sebnem Ozyer
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Meryem Kuru Pekcan
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Merve Erel
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Mahmut Nedim Cicek
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Yasemin Tasci
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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20
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Mihu D, Razvan C, Malutan A, Mihaela C. Evaluation of maternal systemic inflammatory response in preeclampsia. Taiwan J Obstet Gynecol 2016; 54:160-6. [PMID: 25951721 DOI: 10.1016/j.tjog.2014.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the systemic inflammatory response in preeclampsia compared to normal pregnancy. MATERIALS AND METHODS The following serum parameters were determined in three groups of patients: leukocytes, neutrophils, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and certain markers of oxidative stress. Fetal status was assessed based on the gestational age at which birth occurred, on the Apgar score, and on fetal weight. RESULTS In preeclampsia, a higher systemic inflammatory status was found compared to normal pregnancy. Gestational age at birth, fetal weight, and Apgar score were significantly lower in the group with preeclampsia compared to normal pregnancy. CONCLUSION In preeclampsia, there is an increased systemic inflammatory response compared to normal pregnancy, which can influence fetal status at birth.
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Affiliation(s)
- Dan Mihu
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Ciortea Razvan
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Andrei Malutan
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania.
| | - Carmen Mihaela
- Department of Histology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
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21
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Schreurs MP, Cipolla MJ, Al-Nasiry S, Peeters LLH, Spaanderman MEA. Formerly eclamptic women have lower nonpregnant blood pressure compared with formerly pre-eclamptic women: a retrospective cohort study. BJOG 2015; 122:1403-9. [PMID: 25753846 DOI: 10.1111/1471-0528.13285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare nonpregnant blood pressure and circulating metabolic factors between formerly pre-eclamptic women who did and did not deteriorate to eclampsia. DESIGN Retrospective observational cohort study. SETTING Tertiary referral centre. POPULATION Formerly pre-eclamptic women with (n = 88) and without (n = 698) superimposed eclampsia. METHODS Women who experienced pre-eclampsia with or without superimposed eclampsia during their pregnancy or puerperium were tested for possible underlying cardiovascular risk factors at least 6 months postpartum. We measured blood pressure and determined cardiovascular and metabolic risk markers in a fasting blood sample. Groups were compared using Mann-Whitney U test, Spearman's Rho test or Fisher's Exact test (odds ratios). MAIN OUTCOME MEASURES Differences in postpartum blood pressures and features of the metabolic syndrome between formerly pre-eclamptic and formerly eclamptic women. RESULTS Formerly pre-eclamptic women who developed eclampsia differed from their counterparts without eclampsia by a lower blood pressure (P < 0.01) with blood pressure correlating inversely with the likelihood of having experienced eclampsia (P < 0.001). In addition, formerly eclamptic women had higher circulating C-reactive protein levels than formerly pre-eclamptic women (P < 0.05). All other circulating metabolic factors were comparable. Finally, 40% of all eclamptic cases occurred in the puerperium. CONCLUSIONS Formerly pre-eclamptic women with superimposed eclampsia have lower nonpregnant blood pressure compared with their counterparts without neurological sequelae with blood pressure negatively correlated to the occurrence of eclampsia. As about 40% of all eclamptic cases occur postpartum, routine blood pressure monitoring postpartum should be intensified.
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Affiliation(s)
- M P Schreurs
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht, the Netherlands
| | - M J Cipolla
- Department of Obstetrics, Gynaecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA.,Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | - S Al-Nasiry
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht, the Netherlands
| | - L L H Peeters
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht, the Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht, the Netherlands
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22
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Affiliation(s)
- Markus G Mohaupt
- From the Departments of Nephrology, Hypertension, Clinical Pharmacology, and Clinical Research, University of Bern, Berne, Switzerland.
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23
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Parchim NF, Wang W, Iriyama T, Ashimi OA, Siddiqui AH, Blackwell S, Sibai B, Kellems RE, Xia Y. Neurokinin 3 receptor and phosphocholine transferase: missing factors for pathogenesis of C-reactive protein in preeclampsia. Hypertension 2014; 65:430-9. [PMID: 25452470 DOI: 10.1161/hypertensionaha.114.04439] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
C-reactive protein (CRP), an innate immune mediator, is elevated in the circulation before symptoms in patients with preeclampsia, a severe hypertensive pregnancy disorder with high mortality and morbidity. However, the specific sources underlying increased CRP and the role of elevated CRP in preeclampsia are undefined. Here, we report that circulating CRP levels are significantly increased in a large cohort of normotensive pregnant individuals when compared with nulligravid women and is further increased in patients with preeclampsia. These findings led us to discover further that placental syncytiotrophoblasts are previously unrecognized cellular sources of CRP and underlie elevated CRP in normotensive pregnant women and the additional increase in patients with preeclampsia. Next, we demonstrated that injection of CRP induces preeclampsia features, including hypertension (157 mm Hg CRP treated versus 119 mm Hg control), proteinuria (35.0 mg/μg CRP treated versus 14.1 mg/μg control), kidney, and placental damage and increased levels of sFlt-1 in pregnant mice but not in nonpregnant mice. Our study implicates that phosphocholine transferase, a placental-specific enzyme post-translationally modifying neurokinin B, is essential for the pathogenic role of CRP in preeclampsia through activation of the neurokinin 3 receptor. Overall, our studies have provided significant new insight on the pathogenic role of CRP in preeclampsia and highlighted innovative therapeutic strategies.
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Affiliation(s)
- Nicholas F Parchim
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Wei Wang
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Takayuki Iriyama
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Olaide A Ashimi
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Athar H Siddiqui
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Sean Blackwell
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Baha Sibai
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Rodney E Kellems
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.)
| | - Yang Xia
- From the Departments of Biochemistry and Molecular Biology (N.F.P., W.W. T.I., A.H.S., R.E.K., Y.X.), Obstetrics, Gynecology, and Reproductive Sciences (O.A.A., S.B., B.S.), Graduate School of Biomedical Science (N.F.P., R.E.K. Y.X.), University of Texas, Houston; Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China (W.W., Y.X.); Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (T.I.); and School of Medical Sciences, University of Hyderabad, Gachibowli, Hyderabad, India (A.H.S.).
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Adekola H, Romero R, Chaemsaithong P, Korzeniewski SJ, Dong Z, Yeo L, Hassan SS, Chaiworapongsa T. Endocan, a putative endothelial cell marker, is elevated in preeclampsia, decreased in acute pyelonephritis, and unchanged in other obstetrical syndromes. J Matern Fetal Neonatal Med 2014; 28:1621-32. [PMID: 25211383 PMCID: PMC4412749 DOI: 10.3109/14767058.2014.964676] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Endocan, a dermatan sulphate proteoglycan produced by endothelial cells, is considered a biomarker for endothelial cell activation/dysfunction. Preeclampsia is characterized by systemic vascular inflammation, and endothelial cell activation/dysfunction. Therefore, the objectives of this study were to determine whether: (1) plasma endocan concentrations in preeclampsia differ from those in uncomplicated pregnancies; (2) changes in plasma endocan concentration relate to the severity of preeclampsia, and whether these changes are specific or observed in other obstetrical syndromes such as small-for-gestational age (SGA), fetal death (FD), preterm labor (PTL) or preterm prelabor rupture of membranes (PROM); (3) a correlation exists between plasma concentration of endocan and angiogenic (placental growth factor or PlGF)/anti-angiogenic factors (soluble vascular endothelial growth factor receptor or sVEGFR-1, and soluble endoglin or sEng) among pregnancies complicated by preeclampsia; and (4) plasma endocan concentrations in patients with preeclampsia and acute pyelonephritis (both conditions in which there is endothelial cell activation) differ. Method: This cross-sectional study included the following groups: (1) uncomplicated pregnancy (n = 130); (2) preeclampsia (n = 102); (3) pregnant women without preeclampsia who delivered an SGA neonate (n = 51); (4) FD (n = 49); (5) acute pyelonephritis (AP; n = 35); (6) spontaneous PTL (n = 75); and (7) preterm PROM (n = 64). Plasma endocan concentrations were determined in all groups, and PIGF, sEng and VEGFR-1 plasma concentrations were measured by ELISA in the preeclampsia group. Results: (1) Women with preeclampsia had a significantly higher median plasma endocan concentration than those with uncomplicated pregnancies (p = 0.004); (2) among women with preeclampsia, the median plasma endocan concentration did not differ significantly according to disease severity (p = 0.1), abnormal uterine artery Doppler velocimetry (p = 0.7) or whether diagnosis was made before or after 34 weeks gestational age (p = 0.3); (3) plasma endocan concentration in women with preeclampsia correlated positively with plasma anti-angiogenic factor concentrations [sVEGFR-1: Spearman rho 0.34, p = 0.001 and sEng: Spearman rho 0.30, p = 0.003]; (4) pregnancies complicated by acute pyelonephritis with bacteremia had a lower median plasma endocan concentration than pregnancies complicated by acute pyelonephritis without bacteremia (p = 0.004), as well as uncomplicated pregnancies (p = 0.001); and (5) there was no significant difference in the median plasma endocan concentration between uncomplicated pregnancies and those complicated by FD, delivery of an SGA neonate, PTL or preterm PROM (other members of the “great obstetrical syndromes”; each p > 0.05). Conclusion: Median maternal plasma endocan concentrations were higher preeclampsia and lower in acute pyelonephritis with bacteremia than in uncomplicated pregnancy. No significant difference was observed in the median plasma endocan concentration between other great obstetrical syndromes and uncomplicated pregnancies. The difference in the direction of change of endocan in preeclampsia and acute pyelonephritis with bacteremia may be consistent with the view that both disease entities differ in pathogenic mechanisms, despite their associations with systemic vascular inflammation and endothelial cell activation/dysfunction.
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Affiliation(s)
- Henry Adekola
- a Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda , MD (Detroit, MI) , USA
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25
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Systolic blood pressure and fatty acid-binding protein 4 predict pregnancy-induced hypertension in overweight nulliparous women. Placenta 2014; 35:797-801. [PMID: 25130095 DOI: 10.1016/j.placenta.2014.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The insulin-sensitivity regulator adipocyte fatty acid-binding protein 4 (FABP4) integrates metabolic and inflammatory responses. We hypothesize that there is relationship between FABP4 and factors related to metabolic syndrome in pregnancy-induced hypertension (PIH). METHODS In this prospective observational study, among the 72 relatively overweight (BMI ≥24 kg/m2) nulliparous women, 14 developed non-proteinuric PIH and 12 developed proteinuric PIH (preeclampsia), whereas 46 had normotensive pregnancies. Insulin sensitivity was assessed via the whole-body insulin sensitivity index (ISI) and the homeostatic model of assessment - insulin resistance (HOMA-IR) at 24 weeks of gestation. Maternal serum levels of FABP4, high-sensitive C-reactive protein (hs-CRP), total testosterone, and non-protein-bound calculated free testosterone (cfT) were determined at 24 and 32 weeks. RESULTS Measures of ISI, HOMA-IR, hs-CRP, testosterone and lipids did not differ at 24 and/or at 32 weeks in women who were subsequently hypertensive. SBP was higher at all time points and FABP4 levels tended to be higher at 24 and 32 weeks in patients compared to controls. In logistic regression analysis, baseline FABP4 (OR [95% CI] 1.069 [1.020-1.121], P = 0.006) and SBP after 10 min standing (OR [95% CI] 1.087 [1.029-1.149], P = 0.003) were associated with the development of PIH. FABP4 levels at 24 weeks did not correlate with insulin sensitivity. Neither was correlation seen between FABP4 levels at 24 and 32 weeks, vs. those of hs-CRP and testosterone. DISCUSSION AND CONCLUSIONS Serum FABP4 concentration and SBP after 10 min standing in an orthostatic test at 24 weeks are associated with subsequent development of PIH.
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26
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Chaemsaithong P, Chaiworapongsa T, Romero R, Korzeniewski SJ, Stampalija T, Than NG, Dong Z, Miranda J, Yeo L, Hassan SS. Maternal plasma soluble TRAIL is decreased in preeclampsia. J Matern Fetal Neonatal Med 2013; 27:217-27. [PMID: 23688319 DOI: 10.3109/14767058.2013.806906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Preeclampsia (PE) is characterized by systemic intravascular inflammation. Women who develop PE are at an increased risk for cardiovascular disease in later life. Tumor necrosis factor related apoptosis-inducing ligand (TRAIL) has anti-atherosclerotic effects in endothelial cells and can mediate neutrophil apoptosis. Low soluble TRAIL (sTRAIL) and high C-reactive protein (CRP) concentrations are associated with an increased risk of future cardiovascular disease in non-pregnant individuals. The aim of this study was to determine whether maternal plasma concentrations of sTRAIL and CRP differ between women with PE and those with uncomplicated pregnancies. METHOD This cross-sectional study included women with an uncomplicated pregnancy (n = 93) and those with PE (n = 52). Maternal plasma concentrations of sTRAIL and CRP concentrations were determined by ELISA. RESULTS 1) The median plasma sTRAIL concentration (pg/mL) was significantly lower and the median plasma CRP concentration was significantly higher in women with PE than in those with an uncomplicated pregnancy (25.55 versus 29.17; p = 0.03 and 8.0 versus 4.1; p = 0.001, respectively); 2) the median plasma concentration sTRAIL/CRP ratio was two-fold lower in women with PE than in those with an uncomplicated pregnancy (p < 0.001); and 3) women with plasma sTRAIL and CRP ratio in the lowest quartile were 8 times more likely to have PE than women with concentrations in the upper three quartiles (OR 8.9; 95% CI: 2.8-27.8). CONCLUSION Maternal plasma sTRAIL concentrations are lower (while those of CRP are higher) in women with PE than in those with uncomplicated pregnancies. These findings are consistent with the evidence of intravascular inflammation in this disorder.
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Affiliation(s)
- Piya Chaemsaithong
- Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit, MI , USA
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27
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Kashanian M, Aghbali F, Mahali N. Evaluation of the diagnostic value of the first-trimester maternal serum high-sensitivity C-reactive protein level for prediction of pre-eclampsia. J Obstet Gynaecol Res 2013; 39:1549-54. [DOI: 10.1111/jog.12105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 12/12/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Maryam Kashanian
- Department of Obstetrics & Gynecology; Tehran University of Medical Sciences; Tehran Iran
| | - Farnaz Aghbali
- Department of Obstetrics & Gynecology; Tehran University of Medical Sciences; Tehran Iran
| | - Neda Mahali
- Department of Obstetrics & Gynecology; Tehran University of Medical Sciences; Tehran Iran
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28
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Du M, Basu A, Fu D, Wu M, Centola M, Jenkins AJ, Hanssen KF, Garg SK, Hammad SM, Scardo JA, Aston CE, Lyons TJ. Serum inflammatory markers and preeclampsia in type 1 diabetes: a prospective study. Diabetes Care 2013; 36:2054-61. [PMID: 23393212 PMCID: PMC3687330 DOI: 10.2337/dc12-1934] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Inflammation and endothelial dysfunction have been associated with the immunobiology of preeclampsia (PE), a significant cause of adverse pregnancy outcomes. The prevalence of PE is elevated several fold in the presence of maternal type 1 diabetes mellitus (T1DM). Although cross-sectional studies of pregnancies among women without diabetes have shown altered inflammatory markers in the presence of PE, longitudinal studies of diabetic women are lacking. In maternal serum samples, we examined the temporal associations of markers of inflammation with the subsequent development of PE in women with T1DM. RESEARCH DESIGN AND METHODS We conducted longitudinal analyses of serum C-reactive protein (CRP), adhesion molecules, and cytokines during the first (mean ± SD, 12.2 ± 1.9 weeks), second (21.6 ± 1.5 weeks), and third (31.5 ± 1.7 weeks) trimesters of pregnancy (visits 1-3, respectively). All study visits took place before the onset of PE. Covariates were BMI, HbA1c, age of onset, duration of diabetes, and mean arterial pressure. RESULTS In women with T1DM who developed PE versus those who remained normotensive, CRP tended to be higher at visits 1 (P = 0.07) and 2 (P = 0.06) and was significantly higher at visit 3 (P < 0.05); soluble E-selectin and interferon-γ-inducible protein-10 (IP-10) were significantly higher at visit 3; interleukin-1 receptor antagonist (IL-1ra) and eotaxin were higher and lower, respectively, at visit 2 (all P < 0.05). These conclusions persisted following adjustment for covariates. CONCLUSIONS In pregnant women with T1DM, elevated CRP, soluble E-selectin, IL-1ra, and IP-10 and lower eotaxin were associated with subsequent PE. The role of inflammatory factors as markers and potential mechanisms of the high prevalence of PE in T1DM merits further investigation.
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Affiliation(s)
- Mei Du
- Harold Hamm Diabetes Center and Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Reimer T, Rohrmann H, Stubert J, Pecks U, Glocker MO, Richter DU, Gerber B. Angiogenic factors and acute-phase proteins in serum samples of preeclampsia and HELLP patients: a matched-pair analysis. J Matern Fetal Neonatal Med 2012; 26:263-9. [PMID: 23020582 DOI: 10.3109/14767058.2012.733747] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To investigate the serum level distribution of angiogenic markers (PlGF, endoglin, sFlt-1) and acute-phase proteins (SAA, CRP) in patients with HELLP syndrome or preeclampsia (PE) including matched controls. METHODS The matching procedure revealed 46 controls for 23 HELLP cases, and 81 controls for 42 preeclamptic patients. Maternal serum concentrations were determined by immunoassays. RESULTS SAA and CRP levels were significantly higher in HELLP patients compared with controls. This finding was not observed in preeclamptic subgroup. Pro-angiogenic PlGF is significantly lower in PE and HELLP syndrome. Anti-angiogenic endoglin is significantly higher in PE and HELLP syndrome. The sFlt-1 analysis supports the anti-angiogenic shift in HELLP and preeclamptic patients, but with smaller differences between subgroups. The SAA/PlGF ratio showed the highest ROC value of all tested parameters in discrimination between HELLP and HELLP controls. CONCLUSIONS These findings support the concept that patients with HELLP syndrome have both an anti-angiogenic state and a pronounced inflammatory response, while patients with PE are characterized only by an anti-angiogenic shift.
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Affiliation(s)
- Toralf Reimer
- University of Rostock, Department of Obstetrics and Gynecology, Rostock, Germany.
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