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Guzeltas G, Ibanoglu MC, Engin-Üstün Y. Cysteinyl Leukotriene and Systemic Inflammatory Levels in Preeclampsia. Cureus 2023; 15:e37764. [PMID: 37213986 PMCID: PMC10194035 DOI: 10.7759/cureus.37764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Background In this study, we aimed to demonstrate the efficacy of cysteinyl leukotriene levels, which play a role in inflammation, in predicting the severity of preeclampsia (PE) and to determine whether this marker can be used as a screening tool. Methods In this cross-sectional analytic study, we classified pregnant women who were normotensive (control) or PE or severe PE (SPE) between March 2019 and July 2019. Singleton pregnant 60 women who met the following criteria for the diagnosis of PE were included in the study group. We identified 30 patients with PE and 30 patients with SPE. Normotensive pregnant women (n=30) who met this criterion were included as a control group by randomly selecting them on odd days of the week. Results All pregnant women who participated in the study had a singleton pregnancy, and maternal age ranged from 18 to 40 years, with a mean age of 28.77±6.37 years. The mean gestational week of the group was 35.54±3.247 weeks. Gestational age was higher in women in the control group (p=0.018), shock index was higher in women in the control group (p < 0.001), and body mass index (BMI) value was lower in this group than in the other groups (p=0.002). The values of mean arterial pressure (MAP) were found to have a strong correlation with shock index value and a weak and negative correlation with gestational week and platelet/lymphocyte ratio (p < 0.05). The mean cysteinyl leukotriene levels of 206.15 pg/mL for the control group, 273.2 pg/mL for PE, and 211.85 pg/mL for SPE were calculated. However, no statistically significant difference was found between the groups (p=0.707). Conclusion We found that cysteinyl leukotrienes were not clinically important in assessing the risk for developing PE and predicting SPE. Alanine aminotransferase, white blood cell, lymphocyte, C-reactive protein, platelet/lymphocyte ratio, and shock index were positively correlated with the value of MAP.
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Affiliation(s)
- Gokhan Guzeltas
- Obstetrics, University of Health Sciences Ankara City Hospital, Ankara, TUR
| | | | - Yaprak Engin-Üstün
- Obstetrics and Gynecology, University of Health Sciences Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, TUR
- Obstetrics and Gynecology, Zekai Tahir Burak Womens Health Research and Education Hospital, Ankara, TUR
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Suliman NA, Awadalla KE, Bakheit KH, Mohamed AO. Cancer antigen 125 and C-reactive protein inflammatory mediators and uric acid in association with preeclampsia in North Kordofan State, Western Sudan. PLoS One 2023; 18:e0280256. [PMID: 36689404 PMCID: PMC9870111 DOI: 10.1371/journal.pone.0280256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 12/07/2022] [Indexed: 01/24/2023] Open
Abstract
Pathophysiology of pre-eclampsia depends on a defective trophoblastic invasion of uteroplacental blood vessels that leads to placental ischemia and induction of an inflammatory process within the placenta. This process may trigger the expression of Cancer antigen 125 (CA 125), C-reactive protein (CRP) and uric acid (UA). This research aimed to evaluate the association of serum CA 125, CRP and uric acid with Preeclampsia. The study recruited 200 singleton Sudanese pregnant women, who were divided into three groups: controls (n = 100), mild preeclampsia (n = 46) and severe preeclampsia (n = 54). The study subjects were matched for maternal age, gestational age and body mass index. Blood samples were taken for measurement of the different variables using immune- assay and enzymatic automated chemical analysis. The levels of CA 125 in mild and severe preeclampsia were (21.94±0.749 IU/ml) and (40.78±1.336 IU/ml) respectively, which was significantly different (P<0.001) from the control mean (16.48±0.584 IU/ml). There was also a significant difference between the mean levels of CRP in mild and severe preeclampsia (15.17±0.788 mg/L), (31.50±1.709 mg/L) compared with controls (4.79±0.178 mg/L), (P<0.01). There was also a significant difference in the mean levels of UA in mild and severe cases (6.44±0.293 and7.37±0.272) in comparison with the controls (4.00±0.061); (P<0.001). There were significant differences between severe and mild groups (P<0.05). Cancer antigen 125, CRP and UA levels correlated positively with mean arterial blood pressure (MAP) where (r >0.7; P < 0.001). ROC curve validates the utility of these biomarkers for monitoring preeclampsia (AUC >0.8; P < 0.001). In conclusion CA 125, CRP and UA were significantly higher in preeclampsia compared with the controls. The rise of the analytes was directly associated with the severity of the disease.
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Affiliation(s)
| | - Khidir Elamin Awadalla
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of Kordofan, Elobaied, Sudan
| | - Khalid Hussein Bakheit
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Hamadeh R, Mohsen A, Kobeissy F, Karouni A, Akoum H. C-Reactive Protein for Prediction or Early Detection of Pre-Eclampsia: A Systematic Review. Gynecol Obstet Invest 2021; 86:13-26. [PMID: 33902044 DOI: 10.1159/000515530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pre-eclampsia (PE) is a serious disease of pregnancy and one of the major causes of morbidity and mortality for both the mother and baby. This systematic review aims to detect the role of high-sensitivity C-reactive protein (CRP) in the detection of PE. METHODS Thirty-four articles published between 2001 and 2019 were included in this review. The articles were extracted from OVID Medline and Embase. The study designs of these articles are randomized controlled, cohort, case-control, and cross-sectional studies evaluating CRP as a marker to predict or early diagnose PE. The quality assessment of these articles is made by the modified Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was not done because of clinical and statistical heterogeneity. RESULTS A positive association between CRP levels and the development of PE was confirmed in 18 studies. This positive effect was addressed in patients with normal BMI (<25 kg/m2) in 3 studies and in overweight patients in 2 studies. One study addressed this positive association in patients with a BMI ranging between 28 and 31 kg/m2. Three studies determined a cutoff level of CRP above which a significant risk of PE development should be suspected. These levels ranged between 7 and 15 mg/L. CONCLUSION CRP is a promising cost-effective biomarker that may be used in the prediction of PE. A CRP level higher than 15 mg/L may suggest initiation of low-dose aspirin in low-risk pregnancies.
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Affiliation(s)
- Rola Hamadeh
- Ecole Doctorale en Sciences et Technologie (EDST), Lebanese University, Beirut, Lebanon
| | - Amani Mohsen
- Consultant Obstetrics, Palestinian Red Crescent, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Ali Karouni
- Department of Engineering, Faculty of Technology, Lebanese University, Beirut, Lebanon
| | - Hikmat Akoum
- Faculty of Public Health, Lebanese University, Saida, Lebanon
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4
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Ultra-high sensitive C-reactive protein during normal pregnancy and in preeclampsia. J Hypertens 2019; 37:1012-1017. [DOI: 10.1097/hjh.0000000000002003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Preeclampsia (PE), a serious and variable pregnancy complication affecting 5%-10% of the obstetric population, has an undetermined etiology, yet inflammation is concomitant with its development, particularly in relation to endothelial dysfunction. OBJECTIVE The purpose of this systematic review was to examine the published evidence concerning an association between PE and inflammatory markers for their usefulness in the prediction or early identification of women with PE in antepartum clinical settings. METHODS In this systematic review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cumulative Index for Nursing and Allied Health and MEDLINE/OVID were the electronic databases used for identifying published articles. We placed no time limit on the publication year. RESULTS The search generated 798 articles. After removing duplicates, screening abstracts, and conducting full-text reviews, we retained 73 articles and examined 57 unique markers. This review shows that C-reactive protein and the cytokines, specifically the proinflammatory markers IL-6, IL-8, and tumor necrosis factor alpha, garner the most support as potential inflammatory markers for clinical surveillance of PE, particularly during the second and third trimesters. DISCUSSION Based on this review, we cannot recommend any single inflammatory marker for routine clinical use to predict/identify PE onset or progression. Research is recommended to examine a combination panel of these four inflammatory markers both with and without clinical risk factors toward the goal of translation to practice.
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Ferguson KK, Kamai EM, Cantonwine DE, Mukherjee B, Meeker JD, McElrath TF. Associations between repeated ultrasound measures of fetal growth and biomarkers of maternal oxidative stress and inflammation in pregnancy. Am J Reprod Immunol 2018; 80:e13017. [PMID: 29984454 PMCID: PMC6160349 DOI: 10.1111/aji.13017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/15/2018] [Indexed: 11/29/2022] Open
Abstract
PROBLEM Perturbations in normal fetal growth during pregnancy are associated with poor child and adult health outcomes. Inflammation and oxidative stress are recognized as important mechanisms in preeclampsia and preterm birth but have been examined less in relation to fetal growth. We hypothesized that maternal inflammation and oxidative stress in pregnancy would be associated with reduced fetal growth and sought to identify windows of vulnerability. METHOD OF STUDY In a secondary analysis of 482 women from the LIFECODES birth cohort study, we measured inflammation (C-reactive protein [CRP] and the cytokines IL-1β, IL-6, IL-10, and TNF-α) and oxidative stress (8-isoprostane and 8-hydroxydeoxyguanosine [8-OHdG]) biomarkers in plasma and urine, respectively, at four time points during pregnancy. We examined associations between repeated measures of each marker and ultrasound (head and abdominal circumference, femur length, and a summary measure of estimated fetal weight) as well as delivery (birthweight) metrics of growth. RESULTS In adjusted repeated-measures models, an interquartile range (IQR) increase in CRP was associated with a 0.12 standard deviation decrease in fetal weight z-score (95% confidence interval, CI, -0.21, -0.02), which corresponds to approximately 50 g at 40-week gestation. The association was greatest in magnitude (ie, most negative) with CRP measured later in pregnancy. Oxidative stress markers were not associated with fetal weight, although both were inversely associated with head circumference and femur length. CONCLUSION Inflammation and oxidative stress markers measured later in pregnancy were associated with reduced fetal growth as measured by repeated ultrasound scans.
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Affiliation(s)
- Kelly K. Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Elizabeth M. Kamai
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health
| | - David E. Cantonwine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School
| | - Bhramar Mukherjee
- Departments of Biostatistics and Epidemiology, University of Michigan School of Public Health
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health
| | - Thomas F. McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School
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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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Paternoster DM, Fantinato S, Stella A, Nanhornguè KN, Milani M, Plebani M, Nicolini U, Girolami A. C-Reactive Protein in Hypertensive Disorders in Pregnancy. Clin Appl Thromb Hemost 2016; 12:330-7. [PMID: 16959687 DOI: 10.1177/1076029606291382] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypertension is the most frequent medical complication of pregnancy. A recent report demonstrates the flogistic pathogenesis of pregnancy-induced hypertension. Because C-reactive protein (CRP) is a marker of inflammation, it can be used in the differential diagnosis of hypertensive disorders of pregnancy. A total of 322 pregnant women at 24 to 32 weeks’ gestation were enrolled. The control group (A) comprised 190 women. Sixty-three women had preeclampsia (PE, group B), 31 women presented transient hypertension (TH, group C), 19 had HELLP syndrome (HS, group D) and 19 had chronic hypertension (CH, group E). CRP serum concentrations were significantly higher in groups B, C, and D in comparison with the group A. In the whole population, systolic and diastolic pressure value inversely correlate with weight at delivery and weeks of gestation at delivery. CPR levels in patients with PE and HS inversely correlate with birth weight and gestational week at delivery. Normal plasma levels of CRP may be an important marker of differential diagnosis between TH and CH. In TH, PE, and HS, CRP levels were higher than in the control and CH groups, suggesting that inflammation may be the common pathogenetic cause of TH and PE. Finally CRP levels in preeclampsia are believed to correlate with preeclamptic process severity.
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Cheng PJ, Huang SY, Su SY, Hsiao CH, Peng HH, Duan T. Prognostic Value of Cardiovascular Disease Risk Factors Measured in the First-Trimester on the Severity of Preeclampsia. Medicine (Baltimore) 2016; 95:e2653. [PMID: 26844488 PMCID: PMC4748905 DOI: 10.1097/md.0000000000002653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recent studies have suggested that preeclampsia and cardiovascular disease may share common mechanisms. The purpose of this prospective nested case-controlled study was to characterize a variety of cardiovascular disease risk factors measured during the first trimester of pregnancy in predicting subsequent outcomes and the severity of preeclampsia.We ascertained the severity of preeclampsia at the onset of the disease, and the presence of intrauterine growth restriction (IUGR). We compared first trimester maternal serum cardiovascular disease risk factors in preeclampsia subjects versus normal pregnancies, early-onset versus late-onset preeclampsia, and preeclampsia with IUGR versus without IUGR. To identify the prognostic value of independent predictors on the severity of preeclampsia, we calculated the area under the receiver operating characteristics curve (AUC) using logistic regression analysis.There were 134 cases of preeclampsia and 150 uncomplicated pregnancies, and preeclampsia cases were classified as early-onset (53 cases) or late-onset (81 cases), or as with IUGR (44 cases) or without IUGR (90 cases). Among the cardiovascular disease risk factors, maternal serum high-sensitive C-reactive protein (hsCRP) and homocysteine were predictors of both early-onset preeclampsia and preeclampsia with IUGR. For the detection of early onset preeclampsia or preeclampsia with IUGR, the AUC for the combination model (0.943 and 0.952, respectively) was significantly higher than with serum hsCRP or serum homocysteine only.Patients with preeclampsia can be subdivided into different severities according to time of onset and fetal weight. Cardiovascular risk factors distinguish a subgroup of these patients.
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Affiliation(s)
- Po-Jen Cheng
- From the Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan (PJC, SYH, SYS, HHP); Department of Obstetrics and Gynecology, Taipei City Hospital, Taipei, Taiwan, R.O.C. (CHH); and Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, P.R. China (TD)
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Kell DB, Kenny LC. A Dormant Microbial Component in the Development of Preeclampsia. Front Med (Lausanne) 2016; 3:60. [PMID: 27965958 PMCID: PMC5126693 DOI: 10.3389/fmed.2016.00060] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia (PE) is a complex, multisystem disorder that remains a leading cause of morbidity and mortality in pregnancy. Four main classes of dysregulation accompany PE and are widely considered to contribute to its severity. These are abnormal trophoblast invasion of the placenta, anti-angiogenic responses, oxidative stress, and inflammation. What is lacking, however, is an explanation of how these themselves are caused. We here develop the unifying idea, and the considerable evidence for it, that the originating cause of PE (and of the four classes of dysregulation) is, in fact, microbial infection, that most such microbes are dormant and hence resist detection by conventional (replication-dependent) microbiology, and that by occasional resuscitation and growth it is they that are responsible for all the observable sequelae, including the continuing, chronic inflammation. In particular, bacterial products such as lipopolysaccharide (LPS), also known as endotoxin, are well known as highly inflammagenic and stimulate an innate (and possibly trained) immune response that exacerbates the inflammation further. The known need of microbes for free iron can explain the iron dysregulation that accompanies PE. We describe the main routes of infection (gut, oral, and urinary tract infection) and the regularly observed presence of microbes in placental and other tissues in PE. Every known proteomic biomarker of "preeclampsia" that we assessed has, in fact, also been shown to be raised in response to infection. An infectious component to PE fulfills the Bradford Hill criteria for ascribing a disease to an environmental cause and suggests a number of treatments, some of which have, in fact, been shown to be successful. PE was classically referred to as endotoxemia or toxemia of pregnancy, and it is ironic that it seems that LPS and other microbial endotoxins really are involved. Overall, the recognition of an infectious component in the etiology of PE mirrors that for ulcers and other diseases that were previously considered to lack one.
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Affiliation(s)
- Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, UK
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
- Centre for Synthetic Biology of Fine and Speciality Chemicals, The University of Manchester, Manchester, UK
- *Correspondence: Douglas B. Kell,
| | - Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
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Proteína C reactiva en pacientes con preeclampsia y gestantes normotensas sanas. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2014.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Flo K, Blix ES, Husebekk A, Thommessen A, Uhre AT, Wilsgaard T, Vårtun Å, Acharya G. A longitudinal study of maternal endothelial function, inflammatory response and uterine artery blood flow during the second half of pregnancy. Acta Obstet Gynecol Scand 2015; 95:225-32. [DOI: 10.1111/aogs.12802] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/07/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Kari Flo
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT- The Arctic University of Norway; Tromsø Norway
- Department of Obstetrics and Gynecology; University Hospital of North Norway; Tromsø Norway
| | - Egil S. Blix
- Department of Oncology; University Hospital of North Norway; Tromsø Norway
- Immunology research group; Department of Medical Biology; UiT- The Arctic University of Norway; Tromsø Norway
| | - Anne Husebekk
- Immunology research group; Department of Medical Biology; UiT- The Arctic University of Norway; Tromsø Norway
| | - Anders Thommessen
- Immunology research group; Department of Medical Biology; UiT- The Arctic University of Norway; Tromsø Norway
| | - Andreas T. Uhre
- Immunology research group; Department of Medical Biology; UiT- The Arctic University of Norway; Tromsø Norway
| | - Tom Wilsgaard
- Department of Community Medicine; Faculty of Health Sciences; UiT- The Arctic University of Norway; Tromsø Norway
| | - Åse Vårtun
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT- The Arctic University of Norway; Tromsø Norway
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT- The Arctic University of Norway; Tromsø Norway
- Department of Obstetrics and Gynecology; University Hospital of North Norway; Tromsø Norway
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Udenze I, Amadi C, Awolola N, Makwe CC. The role of cytokines as inflammatory mediators in preeclampsia. Pan Afr Med J 2015; 20:219. [PMID: 26113950 PMCID: PMC4470443 DOI: 10.11604/pamj.2015.20.219.5317] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 03/02/2015] [Indexed: 12/17/2022] Open
Abstract
Introduction This study is to determine the concentrations of IL-6, TNF α, and C reactive protein (CRP) in women with severe preeclampsia, and compare with those of gestational age- matched normotensive pregnant women and to correlate CRP levels with markers of organ damage in women with preeclampsia. Methods This was a case control study of fifty women with severe preeclampsia and fifty gestational age matched pregnant women with normal blood pressure. The women were drawn from The Antenatal Clinic of The Lagos University Teaching Hospital. Severe pre eclampsia was defined as systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110mmHg and ≥2+ of proteinuria. After obtaining an informed consent, each participant completed a structured questionnaire. The questionnaire sought information on socio-demographic and clinical data. From each participant, mid-stream urine was collected for urinalysis and culture, and blood sample was collected for biochemical analysis. Comparisons of continuous variables and categorical variables were done using the Student's t test and Chi square test respectively. Correlation analysis was used to determine the associations between variables. Statistical significance was set at P Results The women were similar in their socio demographic characteristics. There was a statistically significant difference in the systolic blood pressure (p < 0.0001), diastolic blood pressure ( p < 0.0001), uric acid ( p < 0.0001), AST ( p < 0.0001), ALP ( p < 0.0001), creatinine ( p < 0.0013), GGT ( p < 0.005), IL 6 ( p < 0.021), CRP ( p < 0.0002), and TNF α ( p < 0.023), between the group with severe preeclampsia and the group with normal blood pressure. This study also reports a significant association between CRP and systolic blood pressure, diastolic blood pressure, uric acid AST and ALP (p Conclusion The inflammatory cytokines, IL6, TNF α and CRP are elevated in severe preeclampsia and may mediate some of the clinical manifestations of the disorder. A role may exist for anti inflammatory agents in the management of women with preeclampsia.
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Affiliation(s)
- Ifeoma Udenze
- Department of Clinical Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Casimir Amadi
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Nicholas Awolola
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Christian Chigozie Makwe
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
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Onuegbu AJ, Olisekodiaka JM, Udo JU, Umeononihu O, Amah UK, Okwara JE, Atuegbu C. Evaluation of high-sensitivity C-reactive protein and serum lipid profile in southeastern Nigerian women with pre-eclampsia. Med Princ Pract 2015; 24:276-9. [PMID: 25896579 PMCID: PMC5588228 DOI: 10.1159/000381778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 03/19/2015] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate the serum C-reactive protein (CRP) and lipid profile in women with pre-eclampsia. MATERIALS AND METHODS Thirty-five women with and 35 women without pre-eclampsia, who were in the 3rd trimester of pregnancy, were enrolled in this study. Weight in kilogrammes and height in metres were measured to calculate the mean body mass index (BMI) for each group. The diastolic and systolic blood pressures were measured. Lipid profile tests and serum CRP assay were done for all patients. Total cholesterol, triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) were determined using enzymatic methods, while low-density lipoprotein cholesterol (LDL-C) was calculated using Friedewald's formula. RESULTS The mean values of the BMI were 29.47 ± 6.90 versus 26.14 ± 2.92, of the diastolic blood pressure 109.14 ± 15.41 versus 72.29 ± 9.42 mm Hg and of the systolic blood pressure 170.57 ± 19.55 versus 120.86 ± 17.72 mm Hg for women with and without pre-eclampsia, respectively, and the differences were statistically significant (p = 0.012, p = 0.001 and p = 0.001, respectively). The biochemical analysis also indicated that the women with pre-eclampsia had a significantly higher mean serum CRP (8.57 ± 2.68 vs. 6.46 ± 2.46 mg/l, p = 0.001), TG (2.84 ± 0.45 vs. 1.87 ± 0.38 mmol/l, p = 0.001) and total cholesterol (5.59 ± 0.92 vs. 4.63 ± 0.78 mmol/l, p = 0.001) level but a lower mean HDL-C (1.10 ± 0.12 vs. 1.26 ± 0.15 mmol/l, p = 0.001) level than the controls. There was no statistical difference in the mean LDL-C values between the 2 groups (1.58 ± 0.8 vs. 1.45 ± 0.78 mmol/l, p > 0.05). CONCLUSION Significant changes in CRP as well as TG, total cholesterol and HDL-C were associated with pre-eclampsia in these Southeastern Nigerian women.
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Affiliation(s)
- Anaelechi J. Onuegbu
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
- *Dr. Anaelechi J. Onuegbu, Department of Chemical Pathology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, PMB 5001, Nnewi, Anambra State (Nigeria), E-Mail
| | | | - John U. Udo
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Osita Umeononihu
- Department of Obstetrics and Gynaecology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Ubuoh K. Amah
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - John E. Okwara
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Chidiadi Atuegbu
- Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi, Nigeria
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Erkenekli K, Keskin U, Uysal B, Kurt YG, Sadir S, Çayci T, Ergün A, Erkaya S, Danişman N, Uygur D. Levels of neopterin and C-reactive protein in pregnant women with fetal growth restriction. J OBSTET GYNAECOL 2014; 35:225-8. [DOI: 10.3109/01443615.2014.948818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Early predictors of gestational hypertension in a low-risk cohort. Results of a pilot study. J Hypertens 2014; 31:2380-5. [PMID: 24145309 DOI: 10.1097/hjh.0b013e32836523f6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if the clinical or biochemical markers used in pregnancy can be applied as early predictors of gestational hypertension. DESIGN Prospective cohort study. POPULATION 315 pregnant women referred from the Prenatal Diagnosis Unit between weeks 10-13 of pregnancy and followed up to the childbirth. METHODS Biomarkers were measured in serum specimens in the first and second trimester of pregnancy. Blood pressure (BP) was measured in the first, second and third trimester. RESULTS The cumulative incidence of gestational hypertension was 6.01%. In the first trimester gestational hypertension predictors were uric acid greater than 3.15 mg/dl (P=0.01), BMI greater than 24 kg/m (P=0.003) SBP at least 120 mmHg (P=0.02) and DBP at least 71 mmHg (P=0.007). After applied multivariate analysis just uric acid and SBP were statistically significant. CONCLUSION In our cohort of healthy pregnant women uric acid above 3.15 mg/dl and SBP at least 120 mmHg are consistent predictors of gestational hypertension in the first trimester. The most important implication of our study is the possibility to identify in the first trimester women at risk to develop gestational hypertension using available markers.
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Inflammatory markers in the second trimester prior to clinical onset of preeclampsia, intrauterine growth restriction, and spontaneous preterm birth. Inflammation 2014; 36:907-13. [PMID: 23471783 DOI: 10.1007/s10753-013-9619-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Low-grade inflammation has been associated with pregnancy complications including preeclampsia (PE), intrauterine growth restriction (IUGR), and spontaneous preterm birth (SPB). In an unmatched, nested case-control study, we assessed the possible predictive association of maternal C-reactive protein (CRP), interferon-γ-inducible protein 10 (IP-10), and soluble urokinase plasminogen activator receptor (suPAR) in second trimester plasma samples in relation to later development of PE (n = 29), IUGR (n = 53), and SPB (n = 9). Inflammatory marker levels in these groups were compared to normotensive healthy pregnant controls (n = 127). We found no statistically significant difference in CRP, IP-10, or suPAR in second trimester plasma samples from pregnant women with later PE, IUGR, and SPB when compared to normotensive healthy controls. Second trimester plasma samples of CRP, IP-10, and suPAR cannot be used as a prognostic marker for PE, IUGR, and SPB.
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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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C-reactive protein and later preeclampsia: systematic review and meta-analysis taking into account the weight status. J Hypertens 2013. [PMID: 23188419 DOI: 10.1097/hjh.0b013e32835b0556] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aims to determine whether high C-reactive protein (CRP) concentration during pregnancy is associated with later preeclampsia and whether weight status (BMI) is a potential modifier of the relation between CRP and preeclampsia. METHODS Twenty-three studies were included in a systematic literature review and a subset of 18 in a meta-analysis. Weighted mean difference (WMD) [with their 95% confidence intervals (CI)] of CRP in preeclampsia and control groups was the estimator. A quality assessment was carried out using a scale specifically developed for this study. Meta-regression with estimates for study characteristics and inter-arm differences and sensitivity and subgroup analysis was employed. Statistical heterogeneity was investigated using I(2) statistic. RESULTS The pooled estimated CRP between 727 women, who developed preeclampsia and 3538 controls was 2.30 mg/l (95% CI: 1.27-3.34). The heterogeneity among studies was high (I(2) = 92.8). The WMD was found to be lower in studies comprising preeclampsia and control groups with similar BMI [WMD = 0.85 (95% CI: 0.10-1.61); I(2) = 25.3%] compared with studies among which BMI was significantly elevated in the preeclampsia group [2.01 (95% CI: 1.23-2.78); I(2) = 0.0%], which may explain the high heterogeneity of pooled data. Meta-regression results confirmed that difference in BMI between groups modifies the association of CRP and preeclampsia. High quality studies represented 30%. CONCLUSION The pooled WMD suggest that women with higher levels of CRP may have an increased risk of developing preeclampsia. This association seems to be modified by confounders, such as BMI. Further studies of high methodological quality are needed.
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Mosimann B, Wagner M, Poon LC, Bansal AS, Nicolaides KH. Maternal serum cytokines at 30-33 weeks in the prediction of preeclampsia. Prenat Diagn 2013; 33:823-30. [DOI: 10.1002/pd.4129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/20/2013] [Accepted: 03/23/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Beatrice Mosimann
- Harris Birthright Research Centre of Fetal Medicine; King's College Hospital; London UK
| | - Marion Wagner
- Harris Birthright Research Centre of Fetal Medicine; King's College Hospital; London UK
| | - Leona C.Y. Poon
- Harris Birthright Research Centre of Fetal Medicine; King's College Hospital; London UK
- Department of Obstetrics and Gynaecology; Imperial College Healthcare NHS Trust, St Mary's Hospital; London UK
| | - Amolak S. Bansal
- Department of Immunology; St Helier Hospital; Carshalton Surrey UK
| | - Kypros H. Nicolaides
- Harris Birthright Research Centre of Fetal Medicine; King's College Hospital; London UK
- Department of Fetal Medicine; University College Hospital; London UK
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Mosimann B, Wagner M, Birdir C, Poon LCY, Nicolaides KH. Maternal serum tumour necrosis factor receptor 1 (TNF-R1) at 30–33 weeks in the prediction of preeclampsia. J Matern Fetal Neonatal Med 2013. [DOI: 10.3109/14767058.2012.755168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Farzadnia M, Ayatollahi H, Hasan-Zade M, Rahimi HR. A comparative study of vascular cell adhesion molecule-1 and high-sensitive C-reactive protein in normal and preeclamptic pregnancies. Interv Med Appl Sci 2013; 5:26-30. [PMID: 24265885 DOI: 10.1556/imas.5.2013.1.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 01/11/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Preeclampsia is characterized by hypertension, dyslipidemia, and systemic inflammatory response. The aim of this study was to determine the level of serum level of soluble vascular cell adhesion molecule-1 (sVCAM-1) and high-sensitive C-reactive protein (hsCRP) in preeclampsia and to compare normal pregnant, mild preeclamptic, and severe preeclamptic women. METHODS A cross-sectional study was conducted to determine the plasma concentrations of sVCAM-1 and hsCRP in peripheral blood obtained from normal pregnant (n = 40), mild preeclamptic (n = 37), and severe preeclamptic women (n = 38). A concentration of soluble adhesion molecule was determined with enzyme-linked immunosorbent assay. hsCRP was measured with immunoturbidometric. RESULTS There was significant difference in the means serum hsCRP between normal pregnant women and mild preeclamptic women (P < 0.05). Serum concentration of hsCRP and sVCAM-1 (ng/mL) were significantly higher in severe preeclampsia (P < 0.05) than normal pregnancy. There were also significant differences in hsCRP and sVCAM-1 levels between mild and severe (P < 0.05). There was no difference in the mean sVCAM-1 between normal pregnant and mild preeclamptic women. CONCLUSION We have determined the serum concentration of VCAM-1 and hsCRP in normal pregnancy and preeclampsia. sVCAM-1 is elevated in severe preeclampsia compared with normal pregnancy, and hsCRP is elevated in severe preeclampsia compared with mild preeclampsia and normal pregnancy.
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Satué K, Calvo A, Gardón JC. Factors Influencing Serum Amyloid Type A (Saa) Concentrations in Horses. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojvm.2013.31010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Novakov Mikic A, Cabarkapa V, Nikolic A, Maric D, Brkic S, Mitic G, Ristic M, Stosic Z. Cystatin C in pre-eclampsia. J Matern Fetal Neonatal Med 2012; 25:961-5. [DOI: 10.3109/14767058.2011.601366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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C-reactive protein levels, blood pressure and the risks of gestational hypertensive complications. J Hypertens 2011; 29:2413-21. [DOI: 10.1097/hjh.0b013e32834c58e5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Verit FF, Hilali NG. Increased insulin resistance and C-reactive protein in women with complete hydatidiform mole. Gynecol Endocrinol 2011; 27:840-3. [PMID: 21204606 DOI: 10.3109/09513590.2010.538096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate (i) insulin resistance and C-reactive protein (CRP) levels in women with complete hydatidiform mole (CHM) and (ii) whether there were any correlations between these parameters and CHM. METHODS Thirty-two women with CHM and 30 healthy pregnant women were enrolled in the study. Fasting serum glucose and insulin levels, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) and C-reactive protein (CRP) were measured. Insulin resistance was calculated by the homeostasis model assessment ratio (HOMA-IR). RESULTS Fasting glucose, insulin, HOMA-IR, CRP, and TG levels were higher, and HDL was lower among patients with CHM compared with healthy pregnant group (p < 0.05 for all). There were positive associations between CHM status and glucose, insulin, HOMA-IR, CRP, TG levels and had a negative correlation with HDL (p < 0.05 for all). The receiver operating characteristic curve (ROC) analysis value for HOMA-IR in CHM was 0.96 (95% confidence interval (CI) = 0.92-1.00), sensitivity = 94%, and specificity = 87%. The area under ROC curve value for CRP was 0.72 (95% confidence interval (CI) = 0.58-0.84), sensitivity = 82%, and specificity = 60% in CHM. CONCLUSIONS Insulin resistance and CRP were found to be higher among patients with CHM. These parameters were also closely associated with CHM. Further studies are needed to investigate the nature of this link in this group.
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Affiliation(s)
- Fatma Ferda Verit
- Department of Obstetrics and Gynecology, Harran University Faculty of Medicine, Sanliurfa, Turkey.
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Scholl TO, Chen X, Goldberg GS, Khusial PR, Stein TP. Maternal Diet, C-Reactive Protein, and the Outcome of Pregnancy. J Am Coll Nutr 2011; 30:233-40. [PMID: 21917703 DOI: 10.1080/07315724.2011.10719965] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ertas IE, Kahyaoglu S, Yilmaz B, Ozel M, Sut N, Guven MA, Danisman N. Association of maternal serum high sensitive C-reactive protein level with body mass index and severity of pre-eclampsia at third trimester. J Obstet Gynaecol Res 2010; 36:970-7. [DOI: 10.1111/j.1447-0756.2010.01279.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Gammill HS, Powers RW, Clifton RG, Van Dorsten JP, Klebanoff MA, Lindheimer MD, Sibai B, Landon MB, Miodovnik M, Dombrowski M. Does C-reactive protein predict recurrent preeclampsia? Hypertens Pregnancy 2010; 29:399-409. [PMID: 20701468 PMCID: PMC3339658 DOI: 10.3109/10641950903214633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Evaluate association of the inflammatory marker C-reactive protein with recurrent preeclampsia. METHODS Serum samples collected longitudinally in women with previous preeclampsia from the Maternal-Fetal Medicine Units Network trial of aspirin to prevent preeclampsia were assayed for CRP. RESULTS Of 255 women studied, 50 developed recurrence. Baseline C-reactive protein concentration was similar between women who did and did not recur. After adjusting for confounders, neither elevated baseline C-reactive protein nor its change over gestation was associated with recurrence. CONCLUSION In this group of women with previous preeclampsia, neither baseline C-reactive protein concentration nor change in concentration over gestation was associated with recurrent preeclampsia.
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Affiliation(s)
- Hilary S Gammill
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA.
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Giguère Y, Charland M, Bujold E, Bernard N, Grenier S, Rousseau F, Lafond J, Légaré F, Forest JC. Combining biochemical and ultrasonographic markers in predicting preeclampsia: a systematic review. Clin Chem 2009; 56:361-75. [PMID: 20044446 DOI: 10.1373/clinchem.2009.134080] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Early identification of pregnant women at risk for preeclampsia is a priority to implement preventive measures. Some biochemical and ultrasonographic parameters have shown promising predictive performance, but so far there is no clinically validated screening procedure. CONTENT Using a series of keywords, we reviewed electronic databases (Medline, Embase, all records to May 2009) reporting the performance of biological and ultrasonographic markers to predict preeclampsia, both single markers and combinations of markers. We analyzed the data according to gestational age and risk levels of the studied populations. We evaluated the methodological quality of included publications using QUADAS (quality assessment of diagnostic accuracy studies). We identified 37 relevant studies that assessed 71 different combinations of biochemical and ultrasonographic markers. Most studies were performed during the second trimester on small-scale high-risk populations with few cases of preeclampsia. Combinations of markers generally led to an increase in sensitivity and/or specificity compared with single markers. In low-risk populations, combinations including placental protein 13 (PP13), pregnancy-associated plasma protein A (PAPP-A), a disintegrin and metalloprotease-12 (ADAM12), activin A, or inhibin A measured in first or early second trimester and uterine artery Doppler in second trimester appear promising (sensitivity 60%-80%, specificity >80%). In high-risk populations, the combination of PP13 and pulsatility index in first trimester showed 90% sensitivity and 90% specificity in a single study limited to severe preeclampsia. SUMMARY Combinations of biochemical and ultrasonographic markers improved the performance of early prediction of preeclampsia. From a perspective of integrative medicine, large population-based studies evaluating algorithms combining multiple markers are needed, if screening approaches are to be eventually implemented.
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Affiliation(s)
- Yves Giguère
- CHUQ Research Center/Hôpital Saint-François d'Assise, Québec City, Québec, Canada
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Abstract
OBJECTIVE To determine the relationship between the cancer antigen-125 (CA-125) and C-reactive protein (CRP) with preeclampsia and eclampsia. METHODS The study group included 54 preeclamptic/eclamptic women, and 56 healthy pregnant women served as the control group. Mean arterial pressure (MAP) and albumin levels were used to monitor the severity of disease. CRP and CA-125 levels were determined. The cut-offs for CRP and CA-125 were 5 mg/L and 35 IU/ml. The t-test, Pearson correlation and ANOVA were used for statistical analysis. Values of p < 0.05 were considered to be significant. RESULTS CRP and CA-125 parameters were significantly higher in the study group (p < 0.001), and were significantly higher in severe preeclampsia and eclampsia groups than in mild preeclampsia (p < 0.001). Significant correlations were found between CRP/MAP, CRP/albumin, CA-125/MAP and CA-125/albumin (p < 0.001). CONCLUSION CRP and CA-125 are elevating markers in preeclampsia.
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Affiliation(s)
- Fatma Bahar Cebesoy
- Obstetric and Gynecology Department, Gaziantep University Faculty of Medicine, Gaziantep/Turkey.
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Tjoa ML, Oudejans CBM, van Vugt JMG, Blankenstein MA, van Wijk IJ. Markers for Presymptomatic Prediction of Preeclampsia and Intrauterine Growth Restriction. Hypertens Pregnancy 2009; 23:171-89. [PMID: 15369650 DOI: 10.1081/prg-120028292] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Preeclampsia and intrauterine growth restriction are both characterized by placental malfunction. The pathological processes of abnormal trophoblast invasion, partial absence of maternal spiral artery modification, increased apoptosis of trophoblast cells, and placental ischemia are all associated with the release of specific molecules. These proteins, as well as cell-free fetal DNA and RNA might be detected in the maternal peripheral circulation, quantified, and used for early identification and prediction of preeclampsia and intrauterine growth restriction, prior to the appearance of the clinical symptoms. As preeclampsia and intrauterine growth restriction are associated with increased maternal, perinatal, and neonatal morbidity and mortality, early identification of these pregnancy associated complications will permit the design of appropriate preventive measures. In this review a variety of factors reported to be useful as potential markers for early detection of pregnancies at increased risk will be discussed. Molecules associated with the establishment of the placenta and essential in fetal-maternal interactions, like interleukin 2-receptor, insulinlike growth factor-1, and insulinlike growth factor binding protein-1, placenta growth factor, hepatocyte growth factor, inhibin A, activin A, and human chorionic gonadotrophin seem to be the most likely candidates for presymptomatic markers for preeclampsia and/or intrauterine growth restriction. Detection and discrimination of these molecules through the placental RNA in maternal plasma based strategy has become a realistic option.
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Affiliation(s)
- May Lee Tjoa
- Molecular Biology Laboratory, Department of Clinical Chemistry, VU University Medical Centre, Amsterdam, The Netherlands
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Karinen L, Leinonen M, Bloigu A, Paldanius M, Koskela P, Saikku P, Hartikainen AL, Järvelin MR, Pouta A. Maternal SerumChlamydia PneumoniaeAntibodies and CRP Levels in Women with Preeclampsia and Gestational Hypertension. Hypertens Pregnancy 2009; 27:143-58. [DOI: 10.1080/10641950701885188] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Adhesion molecules changes at 20 gestation weeks in pregnancies complicated by preeclampsia. Eur J Obstet Gynecol Reprod Biol 2007; 137:157-64. [PMID: 17706337 DOI: 10.1016/j.ejogrb.2007.06.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Revised: 05/20/2007] [Accepted: 06/19/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine soluble E-selectin, L-selectin, P-selectin, ICAM-1, and VCAM-1 levels in normotensive and preeclamptic pregnancies. To determine cut-offs useful for preeclampsia early detection. STUDY DESIGN A cohort of nulliparous women was recruited at family medicine clinics in Mexico City. Preeclampsia developed in 75 patients; 125 normotensive controls were matched. Adhesion molecules were assessed in serum obtained at 20 gestation weeks and in third trimester pregnancies. Predictive values and odds ratios for preeclampsia development were calculated with the 20 gestation week results. Threshold values were selected based on ROC curves values. RESULTS In women with subsequent preeclampsia, sL-selectin and sVCAM-1 concentrations were significantly lower, whereas sE-selectin, sP-selectin and sICAM-1 levels were significantly higher, compared with controls at mid-pregnancy (p<0.05). The odds ratio for low sL-selectin was 25.6 (95% CI, 8.9-73.5; cut-off, 1414 ng/ml). The sensitivity, specificity, and positive and negative predictive values of low sL-selectin for preeclampsia development were 84, 90, 39, and 98%, respectively, whereas its sensitivity, specificity, and positive and negative predictive values for severe preeclampsia development (cut-off, 1210 ng/ml) were 100, 98, 60, and 100%, respectively. CONCLUSIONS Early enhanced activation of endothelial cells, platelets and leukocytes seem to be present in preeclamptic patients, especially in those that develop severe preeclampsia. Low sL-selectin levels at 20 gestation weeks may be an indicator of preeclampsia development.
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Khoury J, Henriksen T, Seljeflot I, Mørkrid L, Frøslie KF, Tonstad S. Effects of an antiatherogenic diet during pregnancy on markers of maternal and fetal endothelial activation and inflammation: the CARRDIP study. BJOG 2007; 114:279-88. [PMID: 17217362 PMCID: PMC1974834 DOI: 10.1111/j.1471-0528.2006.01187.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To study the effect of an antiatherogenic diet on maternal and cord blood concentrations of systemic biomarkers of endothelial cell activation, haemostasis and inflammation. Design Single blinded randomised controlled clinical trial. Setting Obstetric outpatient clinic and maternity unit of a university hospital in Norway. Population Nonsmoking pregnant women aged 21–38 years carrying a single fetus and with no previous pregnancy-related complications. Methods Subjects (n = 290) were randomised to continue their usual diet or to adopt a diet low in saturated fat and cholesterol from gestational week 17–20 to birth. Soluble forms of cellular adhesion molecules, high-sensitivity C-reactive protein (CRP) and haemostatic markers were measured at 17–20 weeks of gestation (baseline) and subsequently up to week 36. All the above, except CRP, were also measured in cord blood. Main outcome measures Concentrations of maternal and fetal biomarkers and maternal CRP. Results All biomarkers except CRP levels increased significantly during the study period in both the intervention and control groups. None of the maternal or fetal biomarkers were influenced by the intervention (P > 0.05) except for a tendency to lower concentrations of cord blood tissue plasminogen activator antigen in the intervention group compared with the control group, median (interquartile range) 5.4 ng/ml (3.1–7.7) versus 5.8 ng/ml (3.5–11.8), P = 0.05. Conclusion An antiatherogenic diet in pregnancy did not significantly influence maternal or fetal blood concentrations of a range of biomarkers for inflammation. Thus, the previously reported effects of a cholesterol-lowering diet on maternal lipid profile and preterm delivery (<37 complete weeks of gestation) do not seem to involve changes in the systemic inflammatory responses of pregnancy.
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Affiliation(s)
- J Khoury
- Department of Obstetrics and Gynaecology, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway.
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Guven MA, Ertas IE, Kilinc M, Coskun A, Ekerbicer H. Combining mid-trimester maternal plasma homocysteine with uterine artery doppler velocimetry: is it useful? Arch Gynecol Obstet 2006; 275:439-43. [PMID: 17111155 DOI: 10.1007/s00404-006-0281-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 10/24/2006] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the possible association between mid-trimester maternal plasma homocysteine concentration, uterine artery Doppler measurements in a two-stage screening strategy, and outcome of pregnancy. MATERIALS AND METHODS This prospective observational study was conducted on healthy women undergoing screening for pre-eclampsia by uterine artery Doppler velocimetry at 20-22 and 24-26 weeks of gestation. Abnormal uterine artery blood flow was defined as an average resistance index (RI) > 0.58 and/or bilateral early diastolic notch. Homocysteine measurement was performed by two competitive immunoassay methods involving two steps at 20-22 and 24-26 weeks' gestation. RESULTS Sixty women enrolled. Abnormal Doppler findings were found in 18 of 60 (30%) women at 20-22 weeks of gestation. This proportion was reduced to 10% (6/60) at 24-26 weeks of gestation, and two of these six women developed pre-eclampsia later in pregnancy. There was no significant difference in the maternal plasma homocysteine levels in women with abnormal Doppler findings when compared with controls at first and second visits (p > 0.05). CONCLUSION Mid-trimester maternal homocysteine concentration is not elevated in women with abnormal uterine artery Doppler findings in a two-stage screening method.
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Affiliation(s)
- Melih A Guven
- Department of Obstetrics and Gynecology, School of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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Barden A. Pre-eclampsia: contribution of maternal constitutional factors and the consequences for cardiovascular health. Clin Exp Pharmacol Physiol 2006; 33:826-30. [PMID: 16922815 DOI: 10.1111/j.1440-1681.2006.04448.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
1. Pre-eclampsia is a serious complication of pregnancy that is potentially life threatening for both the mother and baby. It encompasses a number of abnormalities that may be present in other clinical conditions. 2. A placenta is essential for the development of pre-eclampsia and can be important in the pathogenesis of pre-eclampsia. Normal pregnancy is associated with remodelling of the maternal spiral arteries, which deliver blood to the placental villous space. Remodelling involves invasion by placental cytotrophoblasts that cause the maternal spiral arteries to lose their smooth muscle and become capacitance vessels; this process, known as placentation, is complete by 20 weeks of pregnancy. Poor placentation is associated with small-for-gestational-age fetuses and some cases of pre-eclampsia. It is thought that poor placentation can result in a hypoxic placenta that releases 'toxic substances' into the maternal circulation, contributing to the maternal syndrome. A number of candidate 'toxic substances' have been proposed, but none is universally raised in pre-eclampsia. 3. Although the placenta is necessary for the development of pre-eclampsia, the extent to which placental abnormalities contribute to the condition varies. It is becoming apparent that maternal constitutional factors may also be important in this syndrome. Underlying hypertension, diabetes and obesity strongly predispose to pre-eclampsia. However, a continuum of risk may exist for blood pressure, bodyweight, glucose and lipids, which, in combination with each other and some degree of placental abnormalities, may lead to the development of pre-eclampsia. 4. The present review will focus on the maternal constitutional factors that define the metabolic syndrome and examine their contribution to pre-eclampsia and the long-term consequences for cardiovascular health.
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Affiliation(s)
- Anne Barden
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
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Ness RB, Sibai BM. Shared and disparate components of the pathophysiologies of fetal growth restriction and preeclampsia. Am J Obstet Gynecol 2006; 195:40-9. [PMID: 16813742 DOI: 10.1016/j.ajog.2005.07.049] [Citation(s) in RCA: 310] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 05/25/2005] [Accepted: 07/13/2005] [Indexed: 12/22/2022]
Abstract
Intrauterine growth restriction (IUGR) and preeclampsia differ in their association with maternal disease but share a similar placental pathology. Moreover, mothers who have had pregnancies complicated by preeclampsia or IUGR are at elevated later-life cardiovascular risk. Why, then, do some women develop IUGR and others develop preeclampsia? In this clinical opinion, based on a review of the literature, we hypothesize that both women experiencing preeclampsia and IUGR enter pregnancy with some degree of endothelial dysfunction, a lesion that predisposes to shallow placentation. In our opinion, preeclampsia develops when abnormal placentation, through the mediator of elevated circulating cytokines, interacts with maternal metabolic syndrome, comprised of adiposity, insulin resistance/hyperglycemia, hyperlipidemia, and coagulopathy. IUGR develops in the absence of antenatal metabolic syndrome. Among these women, the baby is affected by shallow placentation but the mother does not develop clinically apparent disease. This conceptualization provides a testable framework for future etiologic studies of preeclampsia and IUGR.
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Affiliation(s)
- Roberta B Ness
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA.
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Belo L, Santos-Silva A, Rocha S, Caslake M, Cooney J, Pereira-Leite L, Quintanilha A, Rebelo I. Fluctuations in C-reactive protein concentration and neutrophil activation during normal human pregnancy. Eur J Obstet Gynecol Reprod Biol 2006; 123:46-51. [PMID: 16260340 DOI: 10.1016/j.ejogrb.2005.02.022] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Revised: 01/07/2005] [Accepted: 02/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To clarify the changes in serum C-reactive protein (CRP) levels and in the neutrophil activation state during normal human pregnancy. MATERIALS AND METHODS A longitudinal study (n=23) was performed during the three trimesters of pregnancy; a group of non-pregnant women (n=24) was used as control. Total and differential leukocyte count, serum concentration of CRP and plasma levels of granulocyte-macrophage colony stimulating factor (GM-CSF) and of lactoferrin and elastase (two indirect markers of neutrophil activation) were measured. RESULTS Pregnancy imposed an inflammatory response in the mother, observed by the significant increment in total white blood cell (WBC) and neutrophil counts and in the circulating levels of CRP, GM-CSF and lactoferrin, in all trimesters of gestation compared with non-pregnant controls. Plasma elastase concentration was also significantly higher in pregnant women, but only in the first trimester of gestation. Regarding the ratios of lactoferrin and elastase per neutrophil, they were significantly lower in pregnant women (all trimesters). During gestation, WBC and neutrophil count increased significantly from the first to the second trimester and remained high in the third period. In contrast, the ratios of lactoferrin and elastase per neutrophil decreased significantly from the first to the second trimester, remaining low in the last trimester. Concerning CRP levels, no consistent changes were observed throughout gestation; 12 cases (52.2%) presented fluctuations, whereas 7 (30.4%) showed progressive reductions and 4 (17.4%) progressive increments throughout pregnancy. CONCLUSIONS Changes in CRP levels vary in a wide manner between subjects along pregnancy, even though median values are consistently elevated throughout pregnancy. Moreover, circulating levels of neutrophil-activation products are higher in normal human gestation.
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Affiliation(s)
- Luís Belo
- Department of Biochemistry, Faculty of Pharmacy, University of Porto, 4099-030 Porto, Portugal.
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Ustün Y, Engin-Ustün Y, Kamaci M. Association of fibrinogen and C-reactive protein with severity of preeclampsia. Eur J Obstet Gynecol Reprod Biol 2005; 121:154-8. [PMID: 16054955 DOI: 10.1016/j.ejogrb.2004.12.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Revised: 12/03/2004] [Accepted: 12/10/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the levels of plasma fibrinogen and C-reactive protein (CRP) in preeclampsia and their association with the severity of the disease. STUDY DESIGN CRP and plasma levels of fibrinogen were investigated in 26 cases of normal pregnant women, 26 cases with mild preeclampsia and 26 cases with severe preeclampsia in the third trimester of pregnancy. Mean arterial pressure (MAP) was used as an indicator of the severity of the disease. Analysis of variance with the Kruskal-Wallis test was used when three groups were compared. For correlations, Spearman's rank correlation tests were used. A receiver operating characteristic curve was constructed to evaluate the sensitivity and specificity of CRP. RESULTS Plasma CRP and fibrinogen levels in mild and severe preeclampsia patients were markedly higher than that of normal third trimester pregnant women. There were significant correlations between MAP and CRP (r = 0.515, p = 0.0001) and MAP and fibrinogen parameters (r = 0.383, p = 0.005) in pregnancies complicated with preeclampsia. CONCLUSION We found higher levels of fibrinogen and CRP and presence of good correlation between CRP and MAP in preeclampsia.
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Affiliation(s)
- Yusuf Ustün
- Yüzüncü Yil University, Faculty of Medicine, Gynecology and Obstetrics Department, Van, Turkey.
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Teran E, Escudero C, Calle A. C-reactive protein during normal pregnancy and preeclampsia. Int J Gynaecol Obstet 2005; 89:299-300. [PMID: 15919407 DOI: 10.1016/j.ijgo.2005.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Accepted: 02/04/2005] [Indexed: 10/25/2022]
Affiliation(s)
- E Teran
- Experimental Pharmacology and Cellular Metabolism Unit, Biomedical Center, Central University of Ecuador, Quito, Ecuador.
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Barden A, Singh R, Walters BN, Ritchie J, Roberman B, Beilin LJ. Factors predisposing to pre-eclampsia in women with gestational diabetes. J Hypertens 2005; 22:2371-8. [PMID: 15614032 DOI: 10.1097/00004872-200412000-00020] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lipid abnormalities occur before the onset of pre-eclampsia but their role in its pathogenesis is unclear. We tested the hypothesis that lipid abnormalities precede and contribute to the development of pre-eclampsia using women with gestational diabetes (GDM) as a focus population. METHODS One hundred and eighty-four women with a diagnosis of GDM were studied. Anthropometry, blood pressure, fasting lipids, glucose homeostasis, markers of inflammation and endothelial damage were measured and family history of disease was assessed to determine those measures at diagnosis of GDM that best predicted the development of pre-eclampsia. RESULTS Twelve percent of women with GDM developed pre-eclampsia. At diagnosis of GDM, total cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides were not different in women who subsequently developed pre-eclampsia (GDM-PE). GDM-PE had elevated body mass index, blood pressure, fasting glucose, insulin, uric acid, and C-reactive protein (CRP), which have all been linked with the 'metabolic syndrome'. They had a greater degree of microalbuminuria and more frequently reported a family history of hypertension and maternal gestational diabetes. In logistic regression, the significant independent predictors for developing pre-eclampsia were fasting glucose, CRP, a family history of hypertension and the proband's mother having gestational diabetes. CONCLUSION The results suggest that, in GDM, increased severity of insulin resistance and related features of the 'metabolic syndrome', rather than lipid abnormalities, are precursors to the development of pre-eclampsia and hence are likely to be implicated in the pathophysiology of this disorder. Moreover, these women are likely to be at particularly high risk of long-term cardiovascular disease and Type 2 diabetes.
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Affiliation(s)
- Anne Barden
- Cardiovascular Research Centre, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia.
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Loukovaara MJ, Alfthan HV, Kurki MT, Hiilesmaa VK, Andersson SHM. Serum highly sensitive C-reactive protein in preterm premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2003; 110:26-8. [PMID: 12932866 DOI: 10.1016/s0301-2115(03)00084-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Low-grade inflammation may raise serum C-reactive protein (CRP) concentrations. We studied whether serum CRP is altered in preterm premature rupture of membranes (PPROM), which is frequently associated with an asymptomatic intrauterine infection. STUDY DESIGN CRP was quantitated with highly sensitive immunofluorometric (IFMA) and immunoenzymometric (IEMA) assays in 32 women with PPROM at 30.7+/-0.4 gestational weeks (mean+/-standard error of the mean) and in 27 gestational age-matched healthy women. The results were compared to those obtained by the conventional immunoturbidimetric method. RESULTS Twenty-three PPROM patients had a normal CRP value (</=12mg/l) by immunoturbidimetry. Their highly sensitive CRP value was not different from that of controls. During the observation period of 11+/-3 days after PPROM, an increase in the highly sensitive CRP was observed in patients whose immunoturbidimetric CRP remained normal (n=10). CONCLUSION The increase in the highly sensitive CRP in PPROM patients with constantly normal immunoturbidimetric CRP may reflect the presence of a subclinical inflammation.
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Affiliation(s)
- Mikko J Loukovaara
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland.
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Lyell DJ, Lambert-Messerlian GM, Giudice LC. Prenatal screening, epidemiology, diagnosis, and management of preeclampsia. Clin Lab Med 2003; 23:413-42. [PMID: 12848452 DOI: 10.1016/s0272-2712(03)00027-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The cause of preeclampsia remains unknown. The disease manifests itself across a broad clinical spectrum from mild to severe, conferring vastly different morbidities and suggesting possibly different disease processes. Oxidative stress, endothelial dysfunction, maternal-fetal immune incompatibility, and abnormal placental implantation are among the suggested causes. The need for a marker or set of markers that allow for definitive diagnosis and assessment of future risk of preeclampsia is tremendous. Ultrasound techniques and several markers have been identified that are increased among patients with preeclampsia, but no test is highly sensitive. In the future, a combination of markers likely will be used to assess risk and, establish the diagnosis, and test treatment strategies. Such an approach would allow for more refined treatment studies of patients who are at highest risk for preeclampsia.
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Affiliation(s)
- Deirdre J Lyell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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Tjoa ML, van Vugt JMG, Go ATJJ, Blankenstein MA, Oudejans CBM, van Wijk IJ. Elevated C-reactive protein levels during first trimester of pregnancy are indicative of preeclampsia and intrauterine growth restriction. J Reprod Immunol 2003; 59:29-37. [PMID: 12892901 DOI: 10.1016/s0165-0378(02)00085-2] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
C-reactive protein (CRP) is a marker of tissue damage and inflammation. Maternal levels of CRP are elevated in overt preeclampsia, but there is still debate about its use as a predictive marker for preeclampsia during the first and second trimesters of pregnancy. In this study, we measured CRP levels during the first trimester of pregnancy in women who later developed preeclampsia or gave birth to a growth-restricted baby. In total, 107 women from a low-risk population participated in the study, six women developed preeclampsia and nine gave birth to a growth-restricted baby. Although there is a large overlap in measured CRP levels between the three groups, mean CRP levels were significantly elevated in women who later developed preeclampsia (P=0.031) or delivered a growth-restricted baby (P=0.041) when compared with women from the control group, matched for maternal and gestational age, parity, and gravidity. This study shows that in a low-risk population, CRP levels are already elevated between weeks 10 and 14 in pregnant women who develop preeclampsia or deliver a growth-restricted baby.
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Affiliation(s)
- M L Tjoa
- Department of Clinical Chemistry, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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