Function In Preeclampsia Research Articles

Assessment of right heart function in preeclampsia by echocardiography.

Preeclampsia (PE) is a multisystemic disorder characterized by hypertension and proteinuria that is specific to pregnancy and associated with maternal and fetal morbidity-mortality. To assess right heart structure and function in PE by echocardiography using conventional and tissue Doppler techniques. In total, 67 women with untreated PE and 46 matched healthy pregnant women were included. PE was defined according to the ACOG (2002) criteria. Right and left heart functions were evaluated using transthoracic two-dimensional (2D) echocardiography with color Doppler and tissue Doppler imaging techniques. Right ventricular basal and outflow tract diameters and free wall thickness, right atrial end-systolic maximum diameter, and area were significantly higher in the PE group than the control group (p<0.05). Tricuspid annular plane systolic excursion, isovolumic acceleration time, tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), right ventricle fractional area change, and myocardial performance index (Tei) were significantly lower in the PE group than the controls (p<0.05). PE does not only affect the left side of the heart but also the right side. This finding may open new scenarios, because right ventricular dysfunction may also be responsible for PE-related morbidity.

Estimation of Thyroid Hormones in Pregnancy as an early predictor of Pre-eclampsia

Background: During normal pregnancy, changes in thyroid function is documented and these changes are physiological and have been considered as one of the pathophysiological causes of preeclampsia. The information regarding thyroid function in preeclampsia is scanty. Aim: To estimate the levels of thyroid hormones in preeclamptic pregnant women and to compare it with healthy normotensive pregnant women. Meterials and Methods: Thirty five pregnant women clinically diagnosed as preeclampsia were enrolled and an equal age matched, parity matched and gestation age matched healthy normotensive pregnant women were taken as controls for the study. This is a case-control hospital based study carried at Department of Biochemistry ,M.G.M. Medical College and associated M.Y. Hospital. Indore (M.P.) Blood samples collected were estimated for T3, T4 and TSH by a one step enzyme immunoassay sandwich method. Comparison between both the groups was done by Student’s t-test.Results: There were no significant differences between the two groups in age and BMI but significantly higher differences in gestational age, systolic and diastolic blood pressure was observed. No significant levels of T3 and T4 between healthy normotensive pregnant and preeclamptic pregnant women was observed. The study shows highly significant increase in the TSH levels in preeclampsia as compared to normal pregnancy. Conclusion: The study concluded that the thyroid disorder is one of the predisposing causes for preeclampsia. Hence thyroid hormonal assay can be considered as a screening test for early diagnosis and treatment of preeclampsia to prevent further complications of it. Key-words: Preeclampsia, Tri-iodothyronine(T3), Thyroxine (T4) , Thyroid stimulating hormone (TSH).

Placental (pro)renin receptor expression and plasma soluble (pro)renin receptor levels in preeclampsia

IntroductionThe prorenin receptor ((P)RR) contributes to the regulation of the tissue renin-angiotensin system (RAS) and the function of V-ATPase, which are essential for Wnt signaling. Thus, (P)RRs may be involved in the control both of feto-placental and maternal circulation during pregnancy. This study was conducted to clarify how placental (P)RR expression and plasma soluble (P)RR [s(P)RR] levels are associated with blood pressure elevations and renal function during pregnancy. MethodsWe conducted a cross-sectional study, conducted at Saitama medical center in 2010–2013. Preeclamptic women (n = 16) diagnosed according to the criteria of Japan Society of Obstetrics and Gynecology and normotensive pregnant women (n = 15) participated in the study. We measured the expression of (P)RR in the placenta, plasma s(P)RR levels, systolic blood pressure (SBP), and estimated glomerular filtration rate (eGFR). ResultsPlacental expression of (P)RR was significantly higher in preeclamptic women than in normotensive pregnant women. The plasma s(P)RR levels were significantly higher in preeclamptic women than in normotensive pregnant women. Systolic blood pressure (SBP) was positively correlated with placental (P)RR levels (P = 0.0001) and plasma s(P)RR levels (P = 0.005) in all pregnant women. In preeclamptic women, SBP was positively correlated with placental (P)RR levels (P = 0.004), but not with plasma s(P)RR levels (P = 0.15). The eGFR was negatively correlated with placental (P)RR levels (P = 0.02) and plasma s(P)RR levels (P = 0.0002) in all pregnant women. In preeclamptic women, eGFR was negatively correlated with plasma s(P)RR levels (P = 0.006), but not with placental (P)RR levels (P = 0.93). DiscussionPlacental (P)RR can be involved in blood pressure regulation via the tissue RAS. On the other hand, plasma s(P)RR may be involved in the pathogenesis of decreased renal function in preeclampsia.

The application of serum cystatin C in estimating the renal function in women with severe preeclamptic toxemia

Abstract Introduction Preeclampsia is a medical condition where hypertension arises in association with significant amount of proteinuria. It appears likely that there are substances from the placenta that can cause endothelial dysfunction in the maternal blood vessels of susceptible women. Preeclampsia usually develops from 20 weeks and it is the most common of the dangerous pregnancy complications; it may affect both the mother and the fetus so the ability to predict the appearance of preeclampsia later in pregnancy would be of great value, although the only known treatment for eclampsia or advancing preeclampsia is delivery. Early prediction of the complication will allow close monitoring and early intervention. Aim The present study aimed at evaluating the role of cystatin C in the evaluation of renal function in the severe preeclampsia. Subjects Twenty normal primigravidae with singleton pregnancy and another 40 with severe preeclampsia recruited from preeclamptic unit of El-Shatby Maternity University Hospital, Egypt in the third trimester of gestation with exclusion of any medical disease. Methods They are selected and subject to full history taking, complete clinical examination, laboratory investigation with special emphasis on serum uric acid, creatinine and serum cystatin C, obstetric abdominal ultrasound and Doppler. Results of the study were tabulated and statistically analyzed. Results The difference in the mean serum uric acid level (3.55 ± 0.58 versus 6.76 ± 1.06 mg/dl) was significantly higher in the preeclampsia (p = 0.001), the specificity was 100% and sensitivity of the test was 97.5%, the difference in the mean serum concentration of creatinine (1.55 ± 0.89 versus 0.66 ± 0.12) was significantly higher in preeclampsia (p = 0.001), the specificity of the test was 100% and the sensitivity was 60%. Serum cystatin C level has a mean (0.98 ± 0.29 versus 0.70 ± 0.06) which was significantly higher in preeclampsia (p = 0.001) with a specificity 100% and sensitivity 72.5%. We found a positive significant correlation between serum concentration of cystatin, and PI of umbilical artery Doppler (p = 0.05). Also, a significant correlation was found between serum concentration of cystatin and both PI and RI of middle cerebral artery Doppler (p = 0.05); this indicates the relation of serum cystatin C level with the severity of preeclampsia. Therefore, the past results demonstrate that the serum cystatin C and uric acid are having a good diagnostic accuracy for renal function of preeclampsia when compared to creatinine. Conclusion This indicates that cystatin C serum levels may have a significant role as a marker of preeclampsia and alternative marker of renal function in preeclampsia even more so when used in combination with uric acid levels which is still the most accurate predictor of preeclampsia and most accurate indicator of renal function of preeclampsia.

Persistence of Cardiovascular Risk Factors in Women With Previous Preeclampsia

BackgroundPreeclampsia is a cardiovascular (CV) disease risk factor, and lifestyle modifications are recommended. It was suggested that preeclampsia may increase the prevalence of various CV disease risk factors such as...

Hypertension Editors’ Picks

<i>Hypertension</i> Editors’ Picks

Maternal thyroid profile in pre-eclampsia

Background: During normal pregnancy, changes in thyroid function are well-documented, i.e., hypothyroidism is a common finding seen in pregnancy leading to various adverse maternal and fetal effects, but there is no adequate information about thyroid function in pre-eclampsia. Objective: To study maternal thyroid profile in normal pregnancy and pre-eclampsia. Materials and Methods: Blood sample of 30 normal pregnant woman and 30 pre-eclampsia was collected and thyroid hormone assay was done by radioimmunoassay (RIA). Descriptive statistics such as mean and SD were used. Comparison between pre-eclampsia group with normal group was done by unpaired t-test. A p-value less than 0.05 was considered as significant. Results: Thyroxine (T4 ) and tri-iodothyronine (T3) levels showed no difference between the normal pregnancy (9.03 ± 1.18, 1.21 ± 0.3) and pre-eclampsia patients (10.16 ± 1.13, 1.25 ± 0.11), but the thyroid-stimulating hormone (TSH) levels in pre-eclampsia patients were increased (7.22 ± 1.3) when compared to normal pregnancy (p = 0.0001). Conclusion: There was no significant difference in the thyroxine (T4 ) and tri-iodothyronine (T3) levels in two groups, but there was a significant increase in thyroid stimulating-hormone (TSH) levels in pre-eclampsia patients (7.22 ± 1.3) compared to normal pregnancy (2.48 ± 1.05) (p = 0.0001).

Editorial: New therapeutic targets for human placental angiogenesis disease.

Editorial: New therapeutic targets for human placental angiogenesis disease.

C0567: Cytokine Levels and Platelet Functions in Preeclampsia

C0567: Cytokine Levels and Platelet Functions in Preeclampsia

Prevention of ischemic vascular injury: targeting cellular stress in the endothelium with 5‐aminoimidazole‐4‐carboxamide 1‐β‐D‐ribofuranoside (1084.12)

A variety of stressors induce endothelial cells (ECs) to produce excessive oxygen radicals, triggering vascular inflammation, cellular stress and apoptotic activation which may have deleterious effects on vascular function and contribute to the pathophysiology of hypertension during preeclampsia. Although the benefits of AICAR on ischemic‐reperfusion (I/R) injury in the myocardium are well established, the role of AICAR on specifically on vascular ECs is much less clear. Thus, we hypothesized AICAR would promote cytoprotective pathways in ECs, reducing stress and attenuating apoptotic activity under hypoxic stress. To model vascular ischemia as might be found in the preeclamptic placenta, human umbilical vascular endothelial cells (HUVECs) were cultured at physiologic normoxic (8% O2) or hypoxic (1% O2) conditions and treated with AICAR (0.2, and 2mM). Cell protein and media were collected for further analysis. AICAR increased (p&lt;0.05) pAMPKα/AMPKα in hypoxic conditions, but not in normoxia. AICAR pretreatment (2mM, 1hr) and subsequent exposure to hypoxia (24hr) showed decreased (p&lt;0.05) BiP expression and cell‐adhesion molecule ICAM‐1 compared to normoxic control. AICAR reduced (p&lt;0.05) cellular metabolic activity measured by MTT assay in both 8 and 1% O2. Further, ET‐1 secretion was reduced (p&lt;0.05) following AICAR treatment (434 ±14 vs. *179 ±1pg/mL). Endothelial permeability was increased (p&lt;0.05) with AICAR at 12 (869%) and 24 hours (315%) compared to the control. HUVEC adhesion was reduced (p&lt;0.05) following AICAR treatment (‐91.57%), and CC blocked this effect. These data suggest by slowing cellular metabolic activity, reducing cell stress and apoptotic activity, AICAR could be a novel cytoprotective factor for improvement of vascular endothelial function in preeclampsia as well as other types of cardiovascular disease.Grant Funding Source: Supported by National Institute of Health RO1HL114096 and AHA 10SDG2600040

In Preeclampsia, Maternal Third Trimester Subcutaneous Adipocyte Lipolysis Is More Resistant to Suppression by Insulin Than in Healthy Pregnancy

Obesity increases preeclampsia risk, and maternal dyslipidemia may result from exaggerated adipocyte lipolysis. We compared adipocyte function in preeclampsia with healthy pregnancy to establish whether there is increased lipolysis. Subcutaneous and visceral adipose tissue biopsies were collected at caesarean section from healthy (n=31) and preeclampsia (n=13) mothers. Lipolysis in response to isoproterenol (200 nmol/L) and insulin (10 nmol/L) was assessed. In healthy pregnancy, subcutaneous adipocytes had higher diameter than visceral adipocytes (P<0.001). Subcutaneous and visceral adipocyte mean diameter in preeclampsia was similar to that in healthy pregnant controls, but cell distribution was shifted toward smaller cell diameter in preeclampsia. Total lipolysis rates under all conditions were lower in healthy visceral than subcutaneous adipocytes but did not differ after normalization for cell diameter. Visceral adipocyte insulin sensitivity was lower than subcutaneous in healthy pregnancy and inversely correlated with plasma triglyceride (r=-0.50; P=0.004). Visceral adipose tissue had lower ADRB3, LPL, and leptin and higher insulin receptor messenger RNA expression than subcutaneous adipose tissue. There was no difference in subcutaneous adipocyte lipolysis rates between preeclampsia and healthy controls, but subcutaneous adipocytes had lower sensitivity to insulin in preeclampsia, independent of cell diameter (P<0.05). In preeclampsia, visceral adipose tissue had higher LPL messenger RNA expression than subcutaneous. In conclusion, in healthy pregnancy, the larger total mass of subcutaneous adipose tissue may release more fatty acids into the circulation than visceral adipose tissue. Reduced insulin suppression of subcutaneous adipocyte lipolysis may increase the burden of plasma fatty acids that the mother has to process in preeclampsia.

Some Blood Cell Changes and Alteration in Renal and Hepatic Function in Pre-eclampsia: A Study in Owerri Nigeria

Aims: We studied some blood cell changes and alterations in renal and hepatic functions in pregnancy and pre-eclampsia and determined baselines for the population in owerri, south east Nigeria. Study Design: It was a cross sectional case control study conducted prospectively among antenatal women attending clinic at Holy Rosary, Federal Medical Centre and General Hospitals Owerri. The study included fifty non -pregnant, fifty preelampsia and fifty normotensivepregnant women of singleton gestation in their third trimester Place and Duration of Study:Sample: Antenatal unit ofHoly Rosary, Federal Medical Centre and General Hospitals Owerribetween May 2009 and June 2010. Methodology: The study included fifty (50) non

A Study of Oxidative Stress and Altered Endothelial Cell Function in Preeclampsia

Preeclampsia is a complex multisystem disorder characterized by hypertension and proteinuria. It is one of the most common and potentially fatal complications of pregnancy. A case control study was carried out to assess the levels of homocysteine, lipid peroxidation and antioxidant status in patients with preeclampsia. Fasting venous samples were collected during antepartum period and serum levels of homocysteine (Hcy), malondialdehyde (MDA), ascorbic acid (vitamin C) and uric acid were measured. In the preeclamptic group, Hcy and MDA levels were significantly raised while antioxidant ascorbic acid level was significantly reduced (p < 0.01) and uric acid concentration was increased significantly (p <0.01). These findings suggest that Hcy and lipid peroxidation are associated with preeclampsia. In preeclampsia, antioxidants are extensively utilized to counter act the cellular changes and endothelial dysfunction mediated by oxidative stress. Placental oxidative stress which results from the ischemic reperfusion injury is reported to be involved in the etiopathogenesis of preeclampsia.

259: CLA as a Src inhibitor: an innovative approach to rescue endothelial function in preeclampsia

259: CLA as a Src inhibitor: an innovative approach to rescue endothelial function in preeclampsia

Alteration of Liver Function in Preeclampsia and Eclampsia

Introduction: Abnormal liver function in patients with PET and eclampsia affect both maternal and fetal outcome negatively. This study was done to see change of liver function in comparison to normal pregnancy and normal reference value. Methods: Consecutive 47 patients of PET and eclampsia were taken as cases and 35 normal expectant mother were enrolled as controls. ALT, AST, alkaline phosphatase, serum bilirubin, serum creatinine and urine for albumin of patients andnormal pregnant women were tested and compared. Results: ALT, AST, S. Bilirubin, Alkaline phoshatase levels were elevated with more proteinuria among patients with PET and eclampsia, but ALT and alkaline phosphatase levels and level of proteinuria were significantly higher. Conclusions: Liver function impairment is very common in pre-eclampsia and eclampsia.Chattagram Maa-O-Shishu Hospital Medical College Journal Volume 12, Issue 3, September 2013: 9-10

Maternal Left Ventricular and Endothelial Functions in Preeclampsia

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Correlation of Thyroid Functions with Severity and Outcome of Pregnancy

Background:During normal pregnancy, changes in thyroid function are well documented; however, information regarding thyroid function in preeclampsia is scanty.Aim:The present study was planned to study thyroid hormones in mild and severe preeclamptic women and normotensive women and correlate them with outcome of pregnancy.Subject and Methods:Thyroid hormones were analyzed in mild (n = 50) and severe (n = 50) cases of preeclamptic women and normotensive women (n = 100).Results:Thyroid-stimulating hormone (TSH) and TT4 levels were higher in mild preeclampsia as compared with severe preeclampsia (P < 0.001 and P < 0.01, respectively). TT3 levels were lower in preeclampsia (more so in severe preeclamptics as compared with normotensive pregnant and non-pregnant women). Preeclamptic with raised TSH levels had significantly higher mean arterial blood pressure and low birth weight (BW). A negative correlation was observed between BW and TSH levels (r = 0.296, P < 0.001) and BW and TT4 levels. A positive correlation was observed between BW and TT3 levels.Conclusion:These findings indicate that there is a state of biochemical hypothyroidism that correlates with severity of preeclampsia and influences obstetric outcome in these women. Identification of thyroid hormone in pregnancy might be of help in predicting occurrence of preeclampsia.

A lesson for cancer research: placental microarray gene analysis in preeclampsia

Tumor progression and pregnancy share many common features, such as immune tolerance and invasion. The invasion of trophoblasts in the placenta into the uterine wall is essential for fetal development, and is thus precisely regulated. Its deregulation has been implicated in preeclampsia, a leading cause for maternal and perinatal mortality and morbidity. Pathogenesis of preeclampsia remains to be defined. Microarray-based gene profiling has been widely used for identifying genes responsible for preeclampsia. In this review, we have summarized the recent data from the microarray studies with preeclamptic placentas. Despite the complex of gene signatures, suggestive of the heterogeneity of preeclampsia, these studies identified a number of differentially expressed genes associated with preeclampsia. Interestingly, most of them have been reported to be tightly involved in tumor progression. We have discussed these interesting genes and analyzed their potential molecular functions in preeclampsia, compared with their roles in malignancy development. Further investigations are warranted to explore the involvement in molecular network of each identified gene, which may provide not only novel strategies for prevention and therapy for preeclampsia but also a better understanding of cancer cells. The trophoblastic cells, with their capacity for proliferation and differentiation, apoptosis and survival, migration, angiogenesis and immune modulation by exploiting similar molecular pathways, make them a compelling model for cancer research.

Maternal left ventricular and endothelial functions in preeclampsia

To compare maternal left ventricular and endothelial functions in preeclampsia and normal pregnancy, during pregnancy and after delivery. Observational study with follow-up. University hospital and midwife-led antenatal care center. Twenty untreated women with preeclampsia and 20 women with normal pregnancy, matched for gestational age and parity. The women were examined during pregnancy and three months after delivery. Left ventricular function was assessed by echocardiography, including tissue-Doppler imaging. Endothelial function was assessed by measuring flow-mediated dilation of the brachial artery. Early diastolic mitral annular tissue velocity, "e", peak systolic tissue velocity, "S", and flow-mediated dilation. The diastolic function was reduced in preeclampsia, with lower "e", and there was a higher ratio of early diastolic mitral inflow velocity and early diastolic mitral annular velocity, "E/e". Early diastolic mitral inflow deceleration time and isovolumetric relaxation time were similar between the groups, suggesting pseudonormalization and increased filling pressures in preeclampsia. "S" was lower in the preeclampsia group during pregnancy. Both diastolic and systolic left ventricular functions normalized postpartum. The flow-mediated dilation was impaired in the preeclampsia group both during pregnancy and three months after delivery. The maternal left ventricular function was impaired during preeclampsia but had normalized three months after delivery. The endothelial function, measured by flow-mediated dilation, was impaired in the preeclampsia group as compared with the normal pregnancy group both during pregnancy and three months after delivery.

L20. Differences in the hemodynamic profile between pre-eclampsia and other forms of hypertension in pregnancy

attenuated in normal pregnancy, but augmented in preeclampsia. There are consistent results demonstrating that preeclampsia leads to a state of increased arterial stiffness, generalised vasoconstriction and higher TVR. In contrast, there are contradictory results on hemodynamic, myocardial and cardiac chamber function in preeclampsia. There are numerous possible methodological, technical and analytic reasons for the conflicting conclusions of these studies. Studies using afterload-corrected indices, tissue Doppler derived deformation indices and validated algorithms for analysis have provided more reliable evaluation of the cardiovascular system in this disease state. These studies have demonstrated that both preterm and term preeclampsia exhibit global biventricular diastolic dysfunction, LV altered geometry and widespread myocardial impairment. However, only preterm preeclampsia is characterized by global biventricular systolic dysfunction and severe LV hypertrophy. The cardiovascular implications of preeclampsia also do not end with the birth of the baby and placenta. At one year postpartum, LV moderate-severe dysfunction, hypertrophy and stage B asymptomatic heart failure was present in the majority of women who had previously had preterm preeclampsia. The risk of developing essential hypertension within 2 years was 40% in these women. The cardiac assessment of women with preterm PE may be of relevance in identifying women at higher risk of developing cardiovascular morbidity and mortality in later life. Conventional risk factors for cardiovascular morbidity are linked to aging and only become apparent at advanced stages when intervention is less efficacious. A strategy of echocardiographic assessment to screen and treat those women at highest risk of subsequent cardiovascular morbidity needs to be evaluated in larger prospective interventional studies. Such targeted cardiac assessment may serve to reduce the gender discrepancy in outcomes of cardiovascular disease.