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Ardissino M, Slob EAW, Carter P, Rogne T, Girling J, Burgess S, Ng FS. Sex-Specific Reproductive Factors Augment Cardiovascular Disease Risk in Women: A Mendelian Randomization Study. J Am Heart Assoc 2023; 12:e027933. [PMID: 36846989 PMCID: PMC10111460 DOI: 10.1161/jaha.122.027933] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/23/2022] [Indexed: 03/01/2023]
Abstract
Background Observational studies suggest that reproductive factors are associated with cardiovascular disease, but these are liable to influence by residual confounding. This study explores the causal relevance of reproductive factors on cardiovascular disease in women using Mendelian randomization. Methods and Results Uncorrelated (r2<0.001), genome-wide significant (P<5×10-8) single-nucleotide polymorphisms were extracted from sex-specific genome-wide association studies of age at first birth, number of live births, age at menarche, and age at menopause. Inverse-variance weighted Mendelian randomization was used for primary analyses on outcomes of atrial fibrillation, coronary artery disease, heart failure, ischemic stroke, and stroke. Earlier genetically predicted age at first birth increased risk of coronary artery disease (odds ratio [OR] per year, 1.49 [95% CI, 1.28-1.74], P=3.72×10-7) heart failure (OR, 1.27 [95% CI, 1.06-1.53], P=0.009), and stroke (OR, 1.25 [95% CI, 1.00-1.56], P=0.048), with partial mediation through body mass index, type 2 diabetes, blood pressure, and cholesterol traits. Higher genetically predicted number of live births increased risk of atrial fibrillation (OR for <2, versus 2, versus >2 live births, 2.91 [95% CI, 1.16-7.29], P=0.023), heart failure (OR, 1.90 [95% CI, 1.28-2.82], P=0.001), ischemic stroke (OR, 1.86 [95% CI, 1.03-3.37], P=0.039), and stroke (OR, 2.07 [95% CI, 1.22-3.52], P=0.007). Earlier genetically predicted age at menarche increased risk of coronary artery disease (OR per year, 1.10 [95% CI, 1.06-1.14], P=1.68×10-6) and heart failure (OR, 1.12 [95% CI, 1.07-1.17], P=5.06×10-7); both associations were at least partly mediated by body mass index. Conclusions These results support a causal role of a number of reproductive factors on cardiovascular disease in women and identify multiple modifiable mediators amenable to clinical intervention.
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Affiliation(s)
- Maddalena Ardissino
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Eric A. W. Slob
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUnited Kingdom
- Department of Applied Economics, Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University RotterdamRotterdamThe Netherlands
| | - Paul Carter
- Department of MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Tormod Rogne
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenCT
- Department of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Joanna Girling
- Department of Obstetrics and GynaecologyChelsea and Westminster Hospital NHS Foundation TrustLondonUnited Kingdom
| | - Stephen Burgess
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUnited Kingdom
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Fu Siong Ng
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
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Gintoni I, Adamopoulou M, Yapijakis C. The Angiotensin-converting Enzyme Insertion/Deletion Polymorphism as a Common Risk Factor for Major Pregnancy Complications. In Vivo 2021; 35:95-103. [PMID: 33402454 DOI: 10.21873/invivo.12236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
Idiopathic pregnancy complications pose a major threat to both maternal and fetal health worldwide. Numerous studies have implicated the role of the renin-angiotensin system (RAS) in the development of obstetric syndromes, since it is crucial for the uteroplacental function. A major RAS component is the angiotensin-converting enzyme (ACE), which hydrolyses angiotensin I to angiotensin II, and not only regulates arterial pressure, but also fibrinolytic activity, indirectly, through the expression of plasminogen activator inhibitor-1. A key functional polymorphism of the ACE gene is the insertion/deletion (I/D) polymorphism, which affects gene expression and product levels, and can therefore lead to high blood pressure and/or reduced fibrinolytic activity. These can cause major pregnancy complications, such as preeclampsia, recurrent pregnancy loss and preterm birth. This review discusses how the ACE I/D is associated with susceptibility towards pregnancy complications, on its own or in combination with other functional gene polymorphisms such, as the angiotensin II receptor type 1 (AT1R) A1166CC, angiotensin II receptor type 2 (AT2R) G1332A, plasminogen activator inhibitor-1 (PAI-1) 4G/5G, matrix metallopeptidase-9 (MMP-9) C1562T, angiotensinogen (AGT) M235T, renin (REN) 83A/G, factor XIII (F13) Val34Leu and endothelial nitric oxide synthase (eNOS) 4a/b.
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Affiliation(s)
- Iphigenia Gintoni
- Unit of Orofacial Genetics, 1 Department of Paediatrics, School of Medicine, "Agia Sophia" Children's Hospital, National Kapodistrian University of Athens, Athens, Greece.,Department of Molecular Genetics, "Cephalogenetics" Center, Athens, Greece
| | - Maria Adamopoulou
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Christos Yapijakis
- Unit of Orofacial Genetics, 1 Department of Paediatrics, School of Medicine, "Agia Sophia" Children's Hospital, National Kapodistrian University of Athens, Athens, Greece; .,Department of Molecular Genetics, "Cephalogenetics" Center, Athens, Greece
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Thromboelastographic study of fibrin clot and molecular basis of maximum clot firmness. UKRAINIAN BIOCHEMICAL JOURNAL 2021. [DOI: 10.15407/ubj93.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Han X, Li C, Zhang S, Hou X, Chen Z, Zhang J, Zhang Y, Sun J, Wang Y. Why thromboembolism occurs in some patients with thrombocytopenia and treatment strategies. Thromb Res 2020; 196:500-509. [PMID: 33091704 DOI: 10.1016/j.thromres.2020.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
Abstract
Platelets play such an important role in the process of thrombosis that patients with thrombocytopenia generally have an increased risk of bleeding. However, abnormal thrombotic events can sometimes occur in patients with thrombocytopenia, which is unusual and inexplicable. The treatments for thrombocytopenia and thromboembolism are usually contradictory. This review introduces the mechanisms of thromboembolism in patients with different types of thrombocytopenia and outlines treatment recommendations for the prevention and treatment of thrombosis. According to the cause of thrombocytopenia, this article addresses four etiologies, including inherited thrombocytopenia (Myh9-related disease, ANKRD26-associated thrombocytopenia, Glanzmann thrombasthenia, Bernard-Soulier syndrome), thrombotic microangiopathy (thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome, hemolytic uremic syndrome, Hemolysis Elevated Liver enzymes and Low Platelets syndrome, disseminated intravascular coagulation), autoimmune-related thrombocytopenia (immune thrombocytopenic purpura, antiphospholipid syndrome, systemic lupus erythematosus), and acquired thrombocytopenia (Infection-induced thrombocytopenia and drug-induced thrombocytopenia, heparin-induced thrombocytopenia). We hope to provide more evidence for clinical applications and future research.
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Affiliation(s)
- Xiaorong Han
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Cheng Li
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Shuai Zhang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Xiaojie Hou
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, China.
| | - Zhongbo Chen
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Jin Zhang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Ying Zhang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Jian Sun
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Yonggang Wang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
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Deems NP, Leuner B. Pregnancy, postpartum and parity: Resilience and vulnerability in brain health and disease. Front Neuroendocrinol 2020; 57:100820. [PMID: 31987814 PMCID: PMC7225072 DOI: 10.1016/j.yfrne.2020.100820] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
Risk and resilience in brain health and disease can be influenced by a variety of factors. While there is a growing appreciation to consider sex as one of these factors, far less attention has been paid to sex-specific variables that may differentially impact females such as pregnancy and reproductive history. In this review, we focus on nervous system disorders which show a female bias and for which there is data from basic research and clinical studies pointing to modification in disease risk and progression during pregnancy, postpartum and/or as a result of parity: multiple sclerosis (MS), depression, stroke, and Alzheimer's disease (AD). In doing so, we join others (Shors, 2016; Galea et al., 2018a) in aiming to illustrate the importance of looking beyond sex in neuroscience research.
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Affiliation(s)
- Nicholas P Deems
- The Ohio State University, Department of Psychology, Columbus, OH, USA
| | - Benedetta Leuner
- The Ohio State University, Department of Psychology, Columbus, OH, USA.
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Othman M, Han K, Elbatarny M, Abdul-Kadir R. The use of viscoelastic hemostatic tests in pregnancy and puerperium: review of the current evidence - communication from the Women's Health SSC of the ISTH. J Thromb Haemost 2019; 17:1184-1189. [PMID: 31127695 DOI: 10.1111/jth.14461] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/28/2019] [Accepted: 04/11/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Canada
- School of Baccalaureate Nursing, St Lawrence College, Kingston, Canada
| | - Katharina Han
- School of Baccalaureate Nursing, St Lawrence College, Kingston, Canada
| | | | - Rezan Abdul-Kadir
- Katharine Dormandy Haemophilia and Thrombosis Centre and Department of Obstetrics and Gynaecology, The Royal Free NHS Foundation hospital, London, UK
- University College, London, UK
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Liang B, Zhong Y, Chen K, Zeng L, Li G, Zheng J, Jiang L, Xie Z, Que B, Lai G, Wu B, Yang X, Wu J, Xiao Y, Chen W, Huang Z. Serum plasminogen as a potential biomarker for the effects of low-dose benzene exposure. Toxicology 2018; 410:59-64. [DOI: 10.1016/j.tox.2018.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 12/29/2022]
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Eto H, Hasegawa A, Kataoka Y, Porter SE. Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres. Women Birth 2016; 30:e158-e164. [PMID: 27876367 DOI: 10.1016/j.wombi.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 10/25/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe aspects of expectant midwifery care for low-risk women conducted in midwifery-managed birth centres during the first two critical hours after delivery and to compare differences between midwifery care, client factors and postpartum blood loss volume. METHOD As a secondary analysis from a larger study, this descriptive retrospective study examined data from birth records of 4051 women who birthed from 2001 to 2006 at nine (21%) of the 43 midwifery centres in Tokyo. Nonparametric and parametric analyses identified factors related to increased blood loss. Interviews to establish sequence of midwifery care were conducted. FINDINGS The midwifery centres provided care based on expectant management principles from birth to after expulsion of the placenta. Approximately 63.3% of women were within the normal limits of blood loss volume under 500g. A minority of women (12.9%) experienced blood loss between 500 and 800g and 4% had blood loss exceeding 1000g. Blood loss volume tended to increase with infant birth weight and duration of delivery. The total blood loss volume was significantly higher for primiparas than for multiparas during the critical two hours after delivery and for immediately after delivery, yet blood loss volume was significantly higher for multiparas than for primiparas during the first hour after delivery. Preventive uterine massage and umbilical cord clamping after placenta expulsion resulted in statistically significant less blood loss. Identified were two patterns of midwifery care based on expectant management principles from birth to after expulsion of the placenta. The practice of expectant management was not a significant factor for increased postpartum blood loss. CONCLUSION These results detail specific midwifery practices and highlight the clinical significance of expectant management with low risk pregnant women experiencing a normal delivery.
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Affiliation(s)
- Hiromi Eto
- Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamotomachi, Nagasaki 852-8520, Japan.
| | - Ayako Hasegawa
- Gifu University, School of Medicine, Nursing Course, 1-1 Yanagito, Gifu 501-1194, Japan.
| | - Yaeko Kataoka
- St. Luke's International University, College of Nursing, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan.
| | - Sarah E Porter
- St. Luke's International University, College of Nursing, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan.
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Koh SCL, Arulkumaran S, Biswas A, Ratnam SS. The Influence of Labor and Placental Separation on Hemostasis in Term Pregnancy. Clin Appl Thromb Hemost 2016. [DOI: 10.1177/107602969800400409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied the hemostatic effects in 68 term preg nant subjects with normal pregnancy (n = 39), gestational diabetes mellitus (n = 21), pregnancy-induced hypertension (n = 8), during labor, after placental separation, and at 24 hours postpartum. During labor, a hypercoagulable state with en hanced fibrinolysis and platelet activation along with elevated plasminogen activator inhibitor-1 and plasminogen activator inhibitor-2 were seen. In all cases following placental separa tion, enhanced fibrinolysis persisted with further elevated tissue plasminogen activator antigen and D-dimer levels, increased thrombin generation and platelet activation with decreasing plasminogen activator inhibitor-1 levels. By 24 hours postpar tum, thrombin generation (thrombin-antithrombin complex) decreased to a nonpregnant level except for pregnancy induced hypertension, but enhanced prothrombin activation (F1+2) was evident in normal, gestational diabetes mellitus and pregnancy- induced hypertension. Reduced total protein S and antithrom bin III activity with normal protein C and elevated fibrinogen levels seen during labor were not affected by delivery. How ever, although factor VII showed a decreasing trend at 24 hours postpartum it remained elevated above the normal nonpregnant level. At 24 hours postpartum, a hypercoagulable state still persisted in normal, gestational diabetes mellitus and preg nancy-induced hypertension term pregnancy accompanied by enhanced fibrinolysis and elevated plasminogen substrate for fibrinolysis, suggesting a critical dynamic equilibrium between a thrombotic and hemorrhagic state.
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Affiliation(s)
- Stephen C. L. Koh
- National University of Singapore, Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Lower Kent Ridge Road, Singapore
| | - Sabaratnam Arulkumaran
- National University of Singapore, Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Lower Kent Ridge Road, Singapore
| | - Arijit Biswas
- National University of Singapore, Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Lower Kent Ridge Road, Singapore
| | - S. Shan Ratnam
- National University of Singapore, Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Lower Kent Ridge Road, Singapore
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Pulmonary embolism in the setting of HELLP syndrome. Int J Obstet Anesth 2015; 24:184-90. [PMID: 25794414 DOI: 10.1016/j.ijoa.2015.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/12/2015] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
Abstract
HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) complicates 0.5-0.9% of pregnancies and is frequently associated with multiorgan dysfunction. Treatment relies on prompt diagnosis, delivery and supportive care. The clinical presentation may make the concurrent diagnosis and management of other disease entities challenging. This case report describes a patient with postpartum HELLP syndrome complicated by severe multiorgan dysfunction and pulmonary embolism.
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Horn EH. Thrombosis and embolism. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1995; 9:595-618. [PMID: 8846559 DOI: 10.1016/s0950-3552(05)80384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Prevention offers the best approach to limiting morbidity and mortality from deep vein thrombosis and pulmonary embolism in obstetric patients. The use of anticoagulant drugs during pregnancy, however, can be problematic, from the maternal or the fetal point of view. Deciding on the best management is further limited by the lack of controlled clinical trials in the obstetric setting. From the data available, it can be recommended that anticoagulant prophylaxis should be targeted at groups of patients at high risk of thrombosis during pregnancy and the puerperium. Heparin is the agent of choice in most situations during pregnancy for the prophylaxis of venous thrombosis, while warfarin is still the most effective agent for the prevention of systemic embolism from artificial cardiac valves. Prophylactic measures against venous thrombosis are probably underused in the puerperium. Controlled clinical studies are urgently required to optimize prophylaxis of venous thromboembolism associated with pregnancy, and large studies may be more feasible in the puerperium when the incidence of thromboembolism is highest.
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Affiliation(s)
- E H Horn
- University Hospital, Nottingham, UK
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Lamarra M, Azzu AA, Kulatilake EN. Cardiopulmonary bypass in the early puerperium: possible new role for aprotinin. Ann Thorac Surg 1992; 54:361-3. [PMID: 1379035 DOI: 10.1016/0003-4975(92)91403-v] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A case of successful emergency reoperation for mitral valve replacement 2 hours after a cesarean section is reported. The use of aprotinin (Trasylol; Bayer AG, Leverkusen, Germany) greatly simplified the surgical procedure and was in our opinion the most important factor in an uncomplicated outcome.
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Affiliation(s)
- M Lamarra
- Department of Cardiac Surgery, University Hospital of Wales, Cardiff, United Kingdom
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Kavi J, Wise R. Group A beta-haemolytic Streptococcus causing disseminated intravascular coagulation and maternal death. Lancet 1988; 1:993-4. [PMID: 2896852 DOI: 10.1016/s0140-6736(88)91807-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Mackinnon S, Walker I, Davidson J, Walker J. Fibrinolytic activity in the healthy newborn infant at term. ACTA ACUST UNITED AC 1987. [DOI: 10.1016/0268-9499(87)90018-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Burgess-Wilson ME, Morrison R, Heptinstall S. Spontaneous platelet aggregation in heparinised blood during pregnancy. Thromb Res 1986; 41:385-93. [PMID: 3705014 DOI: 10.1016/0049-3848(86)90249-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A marked increase in spontaneous platelet aggregation in whole blood was found during pregnancy. The increased spontaneous aggregation was most evident in whole blood anticoagulated with heparin; it was less marked in blood that contained citrate as anticoagulant. Studies of blood that contained both anticoagulants indicated that it is heparin that potentiates aggregation in blood taken during pregnancy rather than citrate that inhibits it. Increased spontaneous aggregation was seen in normotensive pregnancy, in pregnancy complicated by essential hypertension and in pregnancy-induced hypertension. In normotensive pregnancy it was evident at 16 weeks gestation but in pregnancy complicated with essential hypertension it was not evident until 24 weeks gestation. For all the women spontaneous aggregation had returned to normal six weeks after delivery.
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Suarez CR, Walenga J, Mangogna LC, Fareed J. Neonatal and maternal fibrinolysis: activation at time of birth. Am J Hematol 1985; 19:365-72. [PMID: 2411128 DOI: 10.1002/ajh.2830190407] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Utilizing chromogenic synthetic substrate-based methods, determination of the plasma concentration of plasminogen, alpha 2-antiplasmin, alpha 2-macroglobulin, and B beta 15-42-related peptides were made at the time of birth in both newborns and mothers. Plasminogen levels were increased in the maternal group (150 +/- 26%), and markedly decreased in the newborn group (67 +/- 14%). The major inhibitors of fibrinolysis, alpha 2-antiplasmin and alpha 2-macroglobulin, were within normal range in both groups. Determination of B beta 15-42-related peptide showed markedly increased levels in the maternal group above control values (115 +/- 102, normal 29 +/- 12); the newborn group showed values only mildly elevated above control values (39 +/- 21). The results demonstrate increased fibrinolytic activity in both groups, though the degree of activation is significantly higher in the maternal group, as reflected by the higher levels of B beta 15-42-related peptides. Fibrinopeptide A levels confirm an activation of coagulation in both maternal and newborn groups (22 +/- 4 ng/ml and 138 +/- 22 ng/ml, respectively) with a significantly increased level in newborns (2-5 ng/ml normal).
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