SAT-028 Leptin, Leptin Soluble Receptor and FLI in Healthy and Preeclamptic Pregnancies

Context

Leptin is an adipokine involved in many pleiotropic and key physiological actions and circulates free and active, or inactive bound to the leptin binding protein and sOB-r. Thus, the ratio Leptin/sOB-r or free leptin index (FLI) is commonly used as a marker of leptin sensitivity in different pathologies.

Objective

Evaluate serum concentrations of leptin and sOB-r and determine FLI in healthy pregnant and mild pre – eclamptic women in the three trimesters of gestation.

Design

A nested case-control study within a prospective cohort study of pregnant women, enrolled in the Department of Obstetrics and Gynecology of the School of Medicine at Universidad Nacional.

Main Outcome Measure and Methods

From the initial cohort, 46 healthy pregnant women and 19 mild pre – eclamptic pregnant women were randomly selected. Anthropometric, biochemical and clinical parameters were determined during three stages of pregnancy [1^st (11.3±2.3 weeks), 2^nd (24.4±3.10 weeks) and 3^rd (34.84±4.41 weeks) periods of gestation]. Data were presented as mean ± SD. A p value <0.05 was considered to be statistically significant.

Results

Serum leptin levels and sOB-r levels rose significantly throughout pregnancy in both healthy women [Leptin (1^st 23.28±9.87 ng/mL; 2^nd 34.58±18.45 ng/mL; 3^rd 38.27±19.64 ng/mL trimester) (p=0.0001); sOB-r (1^st 32.12±7.29 ng/mL; 2^nd 43.26±9.25 ng/mL; 3^rd 45.16±10.70 ng/mL trimester) (p<0.0000)] and preeclamptic women [Leptin (1^st 29.91±9.91 ng/mL; 2^nd 47.10±25.70 ng/mL; 3^rd 63.00±3012 ng/mL trimester) (p<0.0000); sOB-r (1^st 32.09±6.97 ng/mL; 2^nd 37.54±6.33 ng/mL; 3^rd 36.96±7.66 ng/mL trimester) (p=0.0380)].

Serum leptin levels were significantly higher in preeclamptic pregnant women compared to healthy pregnant women at 2^nd (p=0.029) and 3^rd trimesters of pregnancy (p<0.000). Additionally, serum sOB-r levels were also significantly lower in pre - eclamptic pregnant women during the 2^nd (p=0.017) and 3^rd trimester (p=0.0036) of pregnancy compared to healthy pregnant women. As a result, the FLI index did not vary significantly during any of the three periods of pregnancy studied in healthy pregnant women [(1^st 7.99±4.85; 2^nd 8.72±6.5; 3^rd 9.15±5.84 trimester) (p >0.05)], whereas, in contrast, this index markedly increased throughout pregnancy in pre - eclamptic women [(1^st 8.69±4.96; 2^nd 13.54±8.78; 3^rd 18.06±10.35 trimester) (p=0.0044)]. Indeed, the FLI index was significantly higher at 2^nd (p=0.0186) and 3^rd (p<0.000) trimesters of pregnancy in pre - eclamptic women compared to healthy pregnant.

Conclusions

The present results demonstrate for the first time in a longitudinal study that FLI increases significantly in pre - eclamptic pregnant women towards the end of pregnancy. Hence, high FLI index values should be further explored as a potentially valuable indicator for the clinical manifestations of this pathology.

SAT-228 A Longitudinal Prospective Cohort Study of Fasting Glucose to Insulin Ratio and Fasting Insulin Resistance Index in Normal and Preeclamptic Pregnancies

Gestation is a diabetogenic state due to insulin resistance. Pregnant women with higher insulin resistance are at risk of developing preeclampsia and vascular dysfunction. Fasting glucose to insulin ratio (G₀/I₀) and Fasting Insulin Resistance Index (FIRI = (G₀&nbsp;x I₀)/25) are surrogate indices of insulin sensitivity of the euglycemic-hyperinsulinemic clamp. The aim of this study was to determine G₀/I_0&nbsp;and FIRI in normal (n = 142) and preeclamptic pregnancies (n = 18), during the three periods of gestation, and three months postpartum. Also, 52 healthy non-pregnant women were studied. The study was approved by the Ethics Committee of the Faculty of Medicine and the participants provided written informed consent. A serum biochemical analysis of fasting insulin, blood glucose, total cholesterol, triglyceride and HDL cholesterol was done. G₀/I₀&nbsp;and FIRI were calculated. Statistical analyzes were performed with R software. In healthy pregnancy, G₀/I₀&nbsp;decreased significantly in the second (8.5 ± 4.3) and third periods (6.7 ± 3.0), compared to the first one (11.1 ± 5.7), non-pregnant women (11.3 ± 7.0) and postpartum (13.1 ± 7.9) (p<0.01). In preeclamptic patients, G₀/I₀&nbsp;decreased significantly from the first period (7.1 ± 1.6) to the end of pregnancy (6.2 ± 4.2) (p<0.05). In these women, G₀/I₀&nbsp;rose in the postpartum period (7.6 ± 4.4) without reaching the values of non-pregnant women (11.3 ± 7.0). The difference in the G₀/I₀, between healthy pregnant and preeclamptic women was due to the increase in basal insulin. A significant correlation was found between G₀/I₀&nbsp;and QUICKI, HOMA-IR and FIRI indices, during the three gestation periods and postpartum in healthy and preeclamptic, and in non-pregnant women. In healthy pregnancy, FIRI decreased significantly (p <0.05) in the first period (27.4 ± 13.7), and increased in the third period (38.4 ± 16.1 compared with non-pregnant women 33.3 ± 16.0), and decreased significantly (p <0.05) in the postpartum (27.7 ± 17.3 (p<0.01)). In preeclamptic women, the FIRI increased significantly from the second period (47.3 ± 13.7) to the end of pregnancy (45.7 ± 21.5) (p <0.05) and in postpartum (48.5 ± 28.1), compared with non-pregnant women (33.3 ± 16.0). The FIRI was not different in the third period of gestation between healthy pregnant and preeclamptic women. The FIRI was correlated with QUICKI, HOMA-IR and G₀/I₀&nbsp;indices during the different periods of pregnancy and postpartum, in healthy pregnant and preeclamptic women, and with the TyG and TG/HDL-c indices only in postpartum in preeclamptic women. In conclusion, these different indices of surrogate insulin resistance (G₀/I₀, FIRI, QUICKI, HOMA-IR, TyG and TG/HDL-c) can be used to predict insulin resistance during pregnancy. Preeclamptic women had more insulin resistance from early pregnancy and this state persists longer than in healthy pregnant women.

Serum 25-hydroxyvitamin D levels throughout pregnancy: a longitudinal study in healthy and preeclamptic pregnant women

BACKGROUND

Worldwide there is a high prevalence of 25-hydroxyvitamin D (25OHD) deficiency and has been associated with adverse outcomes during pregnancy.

OBJECTIVE

This is a nested, case-control study in a longitudinal cohort to compare the serum 25OHD levels and other biomarkers throughout pregnancy in a group of 20 preeclamptic women and 61 healthy pregnant women. An additional group of 29 healthy non-pregnant women were also studied during the two phases of the menstrual cycle.

RESULTS

Mean 25OHD levels in non-pregnant women were 31.9 ng/mL and 34.9 ng/mL during follicular and luteal phase, respectively (P < 0.01). Mean serum 25OHD levels in healthy pregnant women were 26.5, 30.1 and 31.9 ng/mL, at first, second and third trimester, respectively (P < 0.001). The first trimester levels of 25OHD were lower than those of healthy non-pregnant women (P < 0.001), showing a significant recovery at third trimester. In the group of healthy pregnant women, the 25OHD levels were 25.7 ng/mL and 27.2 ng/mL at 3 and 6 months postpartum, respectively; both values were lower than those observed in the non-pregnant women (P < 0.001). In preeclamptic women, 25OHD serum levels were similar to those of healthy pregnant women; nevertheless, they remained almost unchanged throughout pregnancy.

CONCLUSION

There were no significant differences between healthy and preeclamptic pregnant women in terms of 25OHD levels throughout the pregnancy. Serum 25OHD levels in non-pregnant women were higher during luteal phase compared with follicular phase. The 25OHD levels of non-pregnant women tended to be higher than those of pregnant women.

Maternal Serum Meteorin Levels and the Risk of Preeclampsia

BACKGROUND

Meteorin (METRN) is a recently described neutrophic factor with angiogenic properties. This is a nested case-control study in a longitudinal cohort study that describes the serum profile of METRN during different periods of gestation in healthy and preeclamptic pregnant women. Moreover, we explore the possible application of METRN as a biomarker.

METHODS AND FINDINGS

Serum METRN was measured by ELISA in a longitudinal prospective cohort study in 37 healthy pregnant women, 16 mild preeclamptic women, and 20 healthy non-pregnant women during the menstrual cycle with the aim of assessing serum METRN levels and its correlations with other metabolic parameters. Immunostaining for METRN protein was performed in placenta. A multivariate logistic regression model was proposed and a classifier model was formulated for predicting preeclampsia in early and middle pregnancy. The performance in classification was evaluated using measures such as sensitivity, specificity, and the receiver operating characteristic (ROC) curve. In healthy pregnant women, serum METRN levels were significantly elevated in early pregnancy compared to middle and late pregnancy. METRN levels are significantly lower only in early pregnancy in preeclamptic women when compared to healthy pregnant women. Decision trees that did not include METRN levels in the first trimester had a reduced sensitivity of 56% in the detection of preeclamptic women, compared to a sensitivity of 69% when METRN was included.

CONCLUSIONS

The joint measurements of circulating METRN levels in the first trimester and systolic blood pressure and weight in the second trimester significantly increase the probabilities of predicting preeclampsia.