Pre-eclampsia Concentrations Research Articles

Mineral levels in Women with Pre-Eclampsia in Third Trimester of Pregnancy

Background: Preeclampsia, a systemic illness of late pregnancy seen in approximately 6% of prim-igravid women, is an important cause of maternal and fetal morbidity. The levels of calcium and magnesium in pregnancy may implicate in the possible role in pregnancy induced hypertension (PIH). This study as-sessed serum Ca2+, Mg2+, Na+ and K+ levels in women with PIH. Materials and Methods: We evaluated se-rum potassium, sodium, magnesium and calcium levels in 100 normal pregnant women and 100 women with pre-eclampsia. Result: We found elevated serum potassium levels and reduced calcium, sodium and magnesium levels in pregnant mothers with preeclampsia. Conclusion: Lowered plasma or serum magnesi-um concentrations in pre-eclampsia may contribute to the development in hypertension in pregnancy. In addition, a disturbed Calcium homeostasis is observed in pre-eclampsia. Keywords: Pre-eclampsia, PIH, calcium, magnesium, sodium, potassium

Effects of normal and high circulating concentrations of activin A on vascular endothelial cell functions and vasoactive factor production.

Activin A, a TGFβ family member, circulates in the maternal blood at increasing concentrations throughout gestation during a healthy pregnancy. The circulating concentration of activin A is further increased in pre-eclampsia (PE), a hypertensive disorder of pregnancy that is marked by systemic maternal vascular endothelial cell dysfunction. The effect of increasing activin A concentrations on the maternal vascular endothelium is unknown. The study aim was to investigate the effect of physiological and pathological activin A concentrations observed in normotensive and PE pregnancies respectively, on vascular endothelial cell function. Immunostaining demonstrated the presence of the activin A receptor, ACVR2A, in SGHEC-7 cells used to model the vascular endothelium. SGHEC-7 cells were treated with activin A concentrations representative of concentrations throughout gestation in normotensive (0-10ng/ml) and PE (50ng/ml) pregnancies. xCELLigence functional assays revealed that normotensive activin A concentrations increased SGHEC-7 proliferation and migration, which was inhibited by PE concentrations. Additionally, fluorescence based assays showed that PE concentrations increased endothelial permeability. None of the tested activin A concentrations affected cell apoptosis. PE concentrations also resulted in an imbalance of the vasoactive factors eNOS, PTGIS and EDN1, as determined by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assays. Compared with normotensive activin A concentrations, the higher PE activin A concentrations resulted in abnormal endothelial functions, which may contribute to the systemic maternal vascular endothelial cell dysfunction observed in the disorder.

Maternal serum ratio of ghrelin to obestatin decreased in preeclampsia.

Ghrelin, an endogenous for the growth hormone secretagogue receptor, has been shown to participate in blood pressure regulation. Obestatin, encoded by the same gene as ghrelin, is described as a physiological opponent of ghrelin. We hypothesized that ghrelin/obestatin imbalance played a role in the pathogenesis. This study was designed to determine the alterations of ghrelin and obestatin concentrations and ghrelin/obestatin ratio in maternal serum in preeclampsia. This retrospective case-control study included 31 preeclampsia and 31 gestational week-matched normal pregnancies. Ghrelin and obestatin concentrations in maternal serum were determined by radioimmunoassay, and the ghrelin/obestatin ratio was calculated. The ghrelin concentration and ghrelin/obestatin ratio in maternal serum were significantly lower in preeclampsia than in normal pregnancies (214.34±14.27pg/mL vs 251.49±16.15pg/mL, P=0.041, 1.07±0.09 vs 0.82±0.08, P=0.023). The obestatin concentration in maternal serum was significantly higher in preeclampsia than in normal pregnancies (276.35±15.38pg/mL vs 223.53±18.61pg/mL, P=0.019). The systolic blood pressure in preeclampsia was negatively correlated with ghrelin concentration and ghrelin/obestatin ratio (r=-0.549, P=0.003; r=-0.491, P=0.004) and was positively correlated with obestatin concentrations in preeclampsia (r=0.388, P=0.013). The findings of this study suggested disturbance of ghrelin and obestatin in maternal serum in preeclampsia, and ghrelin/obestatin imbalance might play a role in the pathogenesis of preeclampsia.

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Objectives This study was conducted assess the relation between alteration of the amino acids profile and plasma albumin in preeclampsia. Methods We performed a cross sectional study using 10 patients with preeclampsia albumin ⩽3 gr/dL and 9 patients with preeclampsia albumin >3 gr/dL. Plasma albumin was analyzed by photometric using Dyalis reagent, and plasma amino acids were analyzed by ion exchange chromatography (IEC). Results There were alterations of amino acids in patients with an albumin ⩽ 3 gr/dL compare with those with an albumin >3 gr/dL. Essential amino acids and non-essential amino acids were significantly different (Hotteling T0.05). Regression analysis revealed that 94% of the alteration of 10 amino acids influenced albumin concentration. Conclusions Alteration of the plasma amino acid profile influenced albumin concentration in preeclampsia. Plasma albumin changes were influenced by more than one amino acids rather than single. Disclosures A. Aditiawarman: None. E.G. Dachlan: None.

Lipid Profile Pattern of Pre-Eclamptic and Eclamptic Patients Attending University of Maiduguri Teaching Hospital

Background: Pre-eclampsia and Eclampsia are the most common complications of pregnancy. They are said to be the most common cause of fetal and maternal morbidity and mortality worldwide. These complications are the consequences of the effects of pregnancy on metabolic processes involving lipid and lipoproteins among others Objective: This study aimed to evaluate the pattern of lipid profile alterations in pregnant women with preeclampsia and eclampsia. Method: This is a cross-sectional study in which 100 subjects were recruited; 40 pre-eclamptic, 20eclamptic and 40 normotensive (Control group) pregnant women. Fasting serum lipid profile (Total cholesterol, LDL cholesterol, HDL - cholesterol and triglyceride of were determined. Result: Mean serum TG concentrations in pre-eclampsia (2.4 ± 0.9 vs 1.9 ± 0.6) and in eclampsia (2.8 ± 1.2 vs 1.9 ± 0.6) were significantly high when compared to normal control (p < 0.05). Mean Serum TC concentration (4.9 ± 1.3 vs 6.0 ± 2.1) and HDL-Cholesterol concentration (1.8±0.4 vs 3.0 ± 2.2) were significantly low in women with eclampsia when compared with control group (p<0.05). Conclusion: The result of the study showed that, although increased plasma lipid (hyperlipidaemia) is associated with normal pregnancy, this is exaggerated in both preeclampsia and eclampsia. The increase is also associated with severity of the disease.

Association between High Serum Homocystine and Preeclampsia

Background: Hyperhomocysteinemia is an important biological marker for adverse outcome of pregnancy. Objective: The aim of the present study was to see the association of high serum homocysteine with preeclampsia (PE). Methodology: This cross sectional study was carried out in the Department of Obstetrics and Gynaecology at Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka. All pregnant women with or without eclampsia admitted at the hospital were included in this study. Pregnant women with diabetes mellitus, chronic hypertension, multiple pregnancies, chronic renal disease and patients taking anti-folate drugs were excluded from this study. Fasting serum total homocysteine (tHomocysteine) concentration was estimated by Fluorescence Polarization Immunoassay (FPIA) method. Result: A total number of 50 PE patient [Severe PE (23) &amp; Mild PE (27)] and 50 pregnant women without PE were selected purposively. Fasting serum total homocysteine (tHomocysteine) concentration was estimated by fluorescence polarization immunoassay (FPIA) method. Mean serum homocysteine concentration in severe PE, mild PE and pregnant women without PE were 11.5 4.58 mol/L, 10.43 5.12 and 5.70 1.30 respectively. Serum homocysteine was significantly increased in severe PE and mild PE in comparison to without PE group . Howere severe PE and mild PE group cases did not differ with respect to serum homocysteine. Conclusion: Significant positive correlation was found between serum homocysteine concentration and urinary total protein, uric acid level, systolic blood pressure and diastolic blood pressure. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16200 J Shaheed Suhrawardy Med Coll, 2013;5(1):21-25

Maternal plasma concentrations of sST2 and angiogenic/anti-angiogenic factors in preeclampsia

Objectives: Angiogenic/anti-angiogenic factors have emerged as one of the promising biomarkers for the prediction of preeclampsia. Since not all patients with preeclampsia can be identified by these analytes, the search for additional biomarkers continues. The soluble form of ST2 (sST2), a protein capable of binding to interleukin (IL)-33 and thus contributing to a Th1-biased immune response, has been reported to be elevated in maternal plasma of women with preeclampsia. The aims of this study were to examine: (1) differences in maternal plasma concentrations of sST2 and IL-33 between women diagnosed with preeclampsia and those having uncomplicated pregnancies; (2) the relationship between sST2, umbilical and uterine artery Doppler velocimetry, and the severity of preeclampsia; and (3) the performance of sST2 and angiogenic/anti-angiogenic factors in identifying patients with preeclampsia at the time of diagnosis.Methods: This cross-sectional study included women with preeclampsia (n = 106) and women with an uncomplicated pregnancy (n = 131). Plasma concentrations of sST2, IL-33, soluble vascular endothelial growth factor receptor (sVEGFR)-1, soluble endoglin (sEng) and placental growth factor (PlGF) were determined by enzyme linked immune sorbent assay. Area under the receiver operating characteristic curve (AUC) for the identification of preeclampsia was examined for each analyte.Results: (1) Patients with preeclampsia had a higher mean plasma concentrations of sST2 than those with an uncomplicated pregnancy (p < 0.0001), while no significant difference in the mean plasma concentration of IL-33 between the two groups was observed; (2) the magnitude of this difference was greater in early-onset, compared to late-onset disease, and in severe compared to mild preeclampsia; (3) sST2 plasma concentrations did not correlate with the results of uterine or umbilical artery Doppler velocimetry (p = 0.7 and p = 1, respectively) among women with preeclampsia; (4) sST2 correlated positively with plasma concentrations of sVEGFR1-1 and sEng (Spearman’s Rho = 0.72 and 0.63; each p < 0.0001), and negatively with PlGF (Spearman’s Rho = −0.56, p < 0.0001); and (5) while the AUC achieved by sST2 and angiogenic/anti-angiogenic factors in identifying women with preeclampsia at the time of diagnosis were non-significantly different prior to term (<37 weeks of gestation), thereafter the AUC achieved by sST2 was significantly less than that achieved by angiogenic/anti-angiogenic factors.Conclusions: Preeclampsia is associated with increased maternal plasma concentrations of sST2. The findings that sST2 concentrations do not correlate with uterine or umbilical artery Doppler velocimetry in women with preeclampsia suggest that elevated maternal plasma sST2 concentrations in preeclampsia are not related to the increased impedance to flow in the utero-placental circulation. The performance of sST2 in identifying preeclampsia at the time of diagnosis prior to 37 weeks of gestation was comparable to that of angiogenic/anti-angiogenic factors. It remains to be elucidated if an elevation of maternal plasma sST2 concentrations in pregnancy is specific to preeclampsia.

Umbilical cord activin A concentration in pregnancies complicated by mild preeclampsia and relationship between activin A levels and Doppler

To evaluate the significance of umbilical cord activin A concentration in preeclampsia and also explore the relationship between activin A levels and Doppler findings. Methods. The study population was constituted 40 pregnancies complicated with term mild preeclampsia and control group constituted 40 pregnancies with uneventful, term gestation. Umbilical cord blood samples were collected immediately after fetus delivery. Umbilical artery and middle cerebral artery flow velocity waveform were determined just before delivery. Activin A levels were high in preeclamptic group (p<0.0001). Marked increase of umbilical artery S/D rate and pulsatility index (PI)(p<0.0001) and also decrease of middle cerebral artery PI (p<0.05) were detected in preeclamptic group. No significant changes in middle cerebral artery S/D rate were observed between two groups (p>0.05). There were no correlation between Doppler examination and activin A level. Umbilical cord activin A levels reflected directly fetoplacental unit resistance in preeclampsia. <br/><a href=

Thyroid hormones and their placental deiodination in normal and pre-eclamptic pregnancy

Pre-eclampsia is associated with lower serum selenium concentrations and glutathione peroxidase expression/activity; total thyroid hormones are also lower. Objectives, study design and main outcome measuresWe hypothesised that the placental selenoprotein deiodinase (D3) will be protected in pre-eclampsia due to the hierarchy of selenoprotein biosynthesis in selenium deficiency. Venous blood and tissue from three standardised placental sites were obtained at delivery from 27 normotensive and 23 pre-eclamptic women. mRNA expression and enzyme activity were assessed for both deiodinases (D2 and D3); protein expression/localisation was also measured for D3. FT4, FT3 and TSH concentrations were measured in maternal and umbilical cord blood. ResultsNo significant differences in D3 mRNA or protein expression between normotensive and pre-eclamptic pregnancies. There was a significant effect of sampling site on placental D3 activity only in pre-eclamptic women (P = 0.034; highest activity nearest the cord). A strong correlation between D3 mRNA expression and enzyme activity existed only in the pre-eclamptic group; further strengthened when controlling for maternal selenium (P < 0.002). No significant differences were observed between groups for any of the maternal thyroid hormones; umbilical TSH concentrations were significantly higher in the pre-eclamptic samples (P < 0.001). ConclusionsD3 mRNA and protein expression appear to be independent of selenium status. Nevertheless, the positive correlation between D3 mRNA expression and activity evident only in pre-eclampsia, suggests that in normotensive controls, where selenium is higher, translation is not affected, but in pre-eclampsia, where selenium is low, enzyme regulation may be altered. The raised umbilical TSH concentrations in pre-eclampsia may be an adaptive fetal response to maximise iodide uptake.

PTX3 as a potential endothelial dysfunction biomarker for severity of preeclampsia and IUGR

Endothelial dysfunction typical of preeclampsia (PE) is the result of an excessive maternal inflammatory response to pregnancy. We investigated PTX3 in maternal, fetal and placental compartments in complicated pregnancies.Maternal blood samples were collected during the third trimester in 53 PE, 43 IUGR (intrauterine growth restriction) and 50 normal pregnancies. Fetal samples were collected from the umbilical vein in 26 PE, 23 IUGR and 26 normal pregnancies at elective cesarean section. Pattern and site of expression of PTX3 were studied by immunohistochemistry (IHC) on placenta, decidual bed and maternal peritoneum.PE and IUGR pregnancies had significantly higher maternal PTX3 levels compared to normal pregnancies, with IUGR significantly lower than PE. Maternal peritoneum expressed a significantly higher signal in the endothelium of pathological compared to normal pregnancies.The maternal increase of PTX3 correlated with the severity of disease with higher PTX3 concentrations in severe PE. Increased PTX3 levels in PE and IUGR mothers, together with IHC data represent the expression of altered endothelial function on the maternal side. IUGR fetuses had higher PTX3 values than controls and the increase was related to IUGR severity, likely reflecting the hypoxic environment.These data confirm the relevance of PTX3 in support the hypothesis that PE is a disease associated with altered maternal endothelial function. The PTX3 increase in IUGR fetuses deserves further investigation.

Preeclampsia Is Associated With Compromised Maternal Synthesis of Long-Chain Polyunsaturated Fatty Acids, Leading to Offspring Deficiency

Obesity and excessive lipolysis are implicated in preeclampsia (PE). Intrauterine growth restriction is associated with low maternal body mass index and decreased lipolysis. Our aim was to assess how maternal and offspring fatty acid metabolism is altered in mothers in the third trimester of pregnancy with PE (n=62) or intrauterine growth restriction (n=23) compared with healthy pregnancies (n=164). Markers of lipid metabolism and erythrocyte fatty acid concentrations were measured. Maternal adipose tissue fatty acid composition and mRNA expression of adipose tissue fatty acid–metabolizing enzymes and placental fatty acid transporters were compared. Mothers with PE had higher plasma triglyceride (21%, P &lt;0.001) and nonesterified fatty acid (50%, P &lt;0.001) concentrations than controls. Concentrations of major n−6 and n−3 long-chain polyunsaturated fatty acids in erythrocytes were 23% to 60% lower (all P &lt;0.005) in PE and intrauterine growth restriction mothers and offspring compared with controls. Subcutaneous adipose tissue Δ−5 and Δ−6 desaturase and very long-chain fatty acid elongase mRNA expression was lower in PE than controls (respectively, mean [SD] control 3.38 [2.96] versus PE 1.83 [1.91], P =0.030; 3.33 [2.25] versus 1.03 [0.96], P &lt;0.001; 0.40 [0.81] versus 0.00 [0.00], P =0.038 expression relative to control gene [square root]). Low maternal and fetal long-chain polyunsaturated fatty acid concentrations in PE may be the result of decreased maternal synthesis.

Decreased Maternal Plasma Apelin Concentrations in Preeclampsia

Background. Preeclampsia is a hypertensive disorder that complicates 3–7% of pregnancies. The development of preeclampsia has not been completely elucidated and current therapies are not broadly efficacious. The apelinergic system appears to be involved in hypertensive disorders and experimental studies indicate a role of this system in preeclampsia. Thus, an epidemiological evaluation of apelin protein concentration in plasma was conducted in case–control study of pregnant women. Methods. Data and maternal plasma samples were collected from pregnant women with confirmed preeclampsia (n = 76) or normotensive controls (n = 79). Concentrations of apelin peptides were blindly measured using enzyme-linked immunosorbent assay. Data were subjected to statistical analyses. Results. Plasma apelin concentrations, measured at delivery, were lower in preeclampsia cases compared with controls (mean ± standard deviation: 0.66 ± 0.29 vs. 0.78 ± 0.31 ng/mL, p = 0.02). After controlling for confounding by maternal age, smoking status, and pre-pregnancy body mass index, odds of preeclampsia were 48% lower for women with high versus low plasma apelin (≥0.73 vs. <0.73 ng/mL) concentrations. Conclusion. Reduced circulating apelin peptides may be associated with preeclampsia. The apelinergic system should be further investigated to elucidate its role in preclampsia and other hypertensive maternal disorders.

Circulating ficolin-2 and ficolin-3 in normal pregnancy and pre-eclampsia

Ficolins are soluble molecules of the innate immune system that recognize carbohydrate molecules on microbial pathogens, apoptotic and necrotic cells. They act through two distinct routes: initiating the lectin pathway of complement activation and mediating a primitive opsonophagocytosis. In this study, we measured plasma levels of ficolin-2 and ficolin-3 in 60 pre-eclamptic patients, 60 healthy pregnant women and 59 healthy non-pregnant women by enzyme-linked immunosorbent assay (ELISA). Circulating levels of complement activation products (C4d, C3a, SC5b9), angiogenic factors (soluble fms-like tyrosine kinase-1, placental growth factor) and markers of endothelial activation (von Willebrand factor antigen), endothelial injury (fibronectin) and trophoblast debris (cell-free fetal DNA) were also determined. Plasma levels of ficolin-2 were significantly lower in healthy pregnant than in healthy non-pregnant women, while ficolin-3 levels did not differ significantly between the two groups. Furthermore, pre-eclamptic patients had significantly lower ficolin-2 and ficolin-3 concentrations than healthy non-pregnant and pregnant women. In the pre-eclamptic group, plasma ficolin-2 levels showed a significant positive correlation with serum placental growth factor (PlGF) concentrations and significant inverse correlations with serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1), blood urea nitrogen and creatinine, serum lactate dehydrogenase activities, as well as with plasma VWF:antigen, fibronectin and cell-free fetal DNA concentrations. In conclusion, circulating levels of ficolin-2 are decreased in the third trimester of normal pregnancy. There is a further decrease in plasma ficolin-2 concentrations in pre-eclampsia, which might contribute to the development of the maternal syndrome of the disease through impaired removal of the trophoblast-derived material released into the maternal circulation by the hypoxic and oxidatively stressed pre-eclamptic placenta.

Increased urinary excretion of nephrin, podocalyxin, and βig-h3 in women with preeclampsia

Emerging evidence has shown that podocyte injury and reduced specific podocyte protein expressions contribute to proteinuria in preeclampsia. We collected urine specimens from women with preeclampsia to study whether podocyte-specific protein shedding is associated with renal barrier dysfunction. Urine specimens from women with normal pregnancies and from pregnant women complicated by chronic hypertension were used for comparison. We determined soluble podocyte slit protein nephrin levels in the urine specimens. Podocalyxin, βig-h3, and VEGF concentrations were also measured. We found that nephrin and podocalyxin were barely detectable in the urine specimens from normal pregnant women and from women with chronic hypertension. In preeclampsia, urinary nephrin and podocalyxin concentrations were significantly increased and highly correlated to each other, r(2) = 0.595. Nephrin and podocalyxin were also correlated with urine protein concentrations. βig-h3 was detected in the urine specimens from women with preeclampsia, and it is highly correlated with nephrin and podocalyxin concentrations in preeclampsia. βig-h3 was undetectable in normal pregnancy and pregnancy complicated by chronic hypertension. Elevated VEGF levels were also found in women with preeclampsia compared with those of normal pregnancy and pregnancy complicated by chronic hypertension. These results provide strong evidence that podocyte protein shedding occurs in preeclampsia, and their levels are associated with proteinuria. The finding of urinary βig-h3 excretion in preeclampsia suggests that increased transforming growth factor activity might also be involved in the kidney lesion in this pregnancy disorder.

Association between matrix metalloproteinase (MMP)-2 polymorphisms and MMP-2 levels in hypertensive disorders of pregnancy

We examined whether two functional polymorphisms (g.-1306C>T and g.-735C>T) in matrix metalloproteinase (MMP)-2 gene are associated with preeclampsia (PE) or gestational hypertension (GH), and whether they modify MMP-2 or tissue inhibitor of metalloproteinase (TIMP)-2 plasma concentrations in these hypertensive disorders of pregnancy. We studied 130 healthy pregnant (HP), 130 pregnant with GH, and 133 pregnant with PE. Genomic DNA was extracted from whole blood and genotypes for g.-1306C>T and g.-735C>T polymorphisms were determined by Real Time-PCR, using Taqman allele discrimination assays. Haplotypes were inferred using the PHASE program. Plasma MMP-2 and TIMP-2 concentrations were measured by ELISA. The main findings were that pregnant with PE have higher plasma MMP-2 and TIMP-2 concentrations than HP (P<0.05), although the MMP-2/TIMP-2 ratios were similar (P>0.05). Moreover, pregnant with GH have elevated plasma MMP-2 levels and MMP-2/TIMP-2 ratios compared to HP (P<0.05). While MMP-2 genotypes and haplotypes are not linked with hypertensive disorders of pregnancy, MMP-2 genotypes and haplotypes are associated with significant alterations in plasma MMP-2 and TIMP-2 concentrations in preeclampsia (P<0.05). Our findings may help to understand the relevance of MMP-2 and its genetic polymorphisms to the pathophysiology of hypertensive disorders of pregnancy. It is possible that patients with PE and the MMP-2 haplotype combining the C and T alleles for the g.-1306C>T and g.-735C>T polymorphisms may benefit from the use of MMPs inhibitors such as doxycycline. However, this possibility remains to be determined.

Uteroplacental arterio-venous difference in soluble VEGFR-1 (sFlt-1), but not in soluble endoglin concentrations in preeclampsia

The aim was to determine plasma levels of sFlt-1 and sEng on the arterial and venous side of the uteroplacental circulation in preeclamptic patients and healthy controls.Preeclamptic patients had higher arterial concentrations than controls of sFlt-1 (17,450 vs 5055 pg/ml, p = 0.003) and sEng (68.7 vs 28.7 ng/ml, p = 0.003).In the preclampsia group sFlt-1 was higher in the uterine vein than in the radial artery (22,450 vs 17,450 pg/ml, p = 0.005). We found no gradient for sEng.Our results support the hypothesis that excess sFlt-1 at least partly originates in placenta, while excess sEng appears to have a different origin.

L12. The role of heparin in the prevention of preeclampsia

is associated with a significant increase in the odds of developing preeclampsia. However, these sequential changes need to be large. Cross-sectional analysis of maternal sFlt1, sEng and PlGF showmodest significant differences of at least one of these factors during the third trimester in women who develop preeclampsia in all high-risk groups. Only sFlt1 was significantly higher 2–5 weeks before the clinical onset of preeclampsia in women with previous preeclampsia. However the concentration of these circulating angiogenic factors is unlikely to be useful in predicting preeclampsia in these high-risk populations. B-type natriuretic peptide (BNP) is a 32-amino acid polypeptide that is co-secreted with the inactive amino-terminal pro B-type natriuretic peptide (NTproBNP) from the left and right cardiac ventricle in response to ventricular volume expansion and pressure overload. NT-proBNP is used in the diagnosis and followup of patients with acute and chronic heart failure. Serum concentrations of NT-proBNP may be used to monitor cardiac function during pregnancy. Tihtonen et al. has already shown as serum concentrations of NT-proBNP concentrations are significantly higher in preeclamptic women compared to chronic hypertensive and normotensive pregnancies. The author concludes that high NT-proANP and NT-proBNP concentrations in preeclampsia reflect the strain on the heart caused by high afterload. Seong et al. confirm that in patients with mild and severe preeclampsia, NTproBNP levels are elevated; Our experience gives to NTproBNP a role in predicting preeclampsia in chronic hypertensive pregnancies: this may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia.

Study of serum homocysteine, folic Acid and vitamin b(12) in patients with preeclampsia.

The present study was carried out to evaluate the occurrence of association between homocysteine, folic acid and vitamin B(12) in patients with preeclampsia. Fifty preeclamptic patients from gynecology ward were studied for estimation of serum homocysteine, folic acid and vitamin B(12) over a period of October 2007 to June 2010. Serum homocysteine and folic acid, and vitamin B(12) were determined by means of Immulite 1000 analyzer. The statistical analysis of study group of preeclampsia compared with normotensive control group, showed significant alterations in serum homocysteine, folic acid and vitamin B(12) concentrations in preeclampsia. Inverse association between serum homocysteine and folic acid, and vitamin B(12) levels were observed in preeclampsia. The present study found hyperhomocysteinemia and deficiency of folic acid and vitamin B(12) along with increased blood pressure as a risk factor for cardiovascular disease (CVD) in preeclampsia.

Thiobarbituric acid reactive substances as marker of oxidative stress in pregnancies with pre-eclampsia

Pre-eclampsia is characterized by increased lipid peroxidation and diminished antioxidant capacity. The aim of the study was to establish concentration of thiobarbituric acid reactive substances as a marker of lipid peroxidation in normal pregnancies and in pregnancies complicated with pre-eclampsia, and to estimate the possibility of using thiobarbituric acid reactive substances as a screening method for development of pre-eclampsia. The study was conducted at the Department of Obstetrics and Gynaecology, Clinical Centre of Vojvodina. The study included 57 singleton pregnancies, gestation > or = 24 weeks, of which 29 were healthy pregnancies and 28 were with pre-eclampsia, defined as systolic arterial pressure of > or = 90 mmHg, diastolic of > or = 145 mmHg, and 24h proteinuria of > or = 300 mg. Thiobarbituric acid reactive substances concentrations evaluated by malondialdehyde equivalent standards (OxiSelect TBARS Assay Kit (malondialdehyde Quantitation), Cell Biolabs' OxiSelect) showed that oxidative stress was more evident in the group with pre-eclampsia, though not statistically significant (p = 0.107). There was no correlation ofthiobarbituric acid reactive substance levels with gestation in either group. The differences between the level of thiobarbituric acid reactive substance concentrations in pre-eclampsia and healthy pregnancies indicate the possibility of using thiobarbituric acid reactive substances as a screening tool for the development of pre-eclampsia. Further studies with larger numbers of patients are needed in order to come to final conclusions.

Association of omega-3 fatty acids and homocysteine concentrations in pre-eclampsia

The present study examines the associations of folic acid, vitamin B₁₂ and omega-3 fatty acids and increased homocysteine which are implicated in the pathology of pre-eclampsia. 49 Pre-eclamptic and 57 normotensive women were recruited at Bharati hospital, Pune, India. Plasma folate, vitamin B₁₂, homocysteine and erythrocyte omega-3 and omega-6 fatty acids were analyzed. Homocysteine concentrations were higher in pre-eclamptic than in normotensive women (14.28±7.31 vs. 11.03±4.38 μmol/l, p<0.01) despite similar levels of folic acid and vitamin B₁₂. In the pre-eclamptic group, plasma folate levels were positively associated with erythrocyte omega-6 fatty acids (p<0.05) while erythrocyte docosahexaenoic acid levels were negatively associated with plasma homocysteine levels (p<0.01). Our study provides evidence for the associations of altered omega-3 fatty acids especially docosahexaenoic acid and the resultant increased homocysteine concentrations in pre-eclampsia. Future studies need to examine if docosahexaenoic acid supplementation during pregnancy reduces homocysteine levels and ameliorates the risk of developing pre-eclampsia.