Mild Preeclamptic Patients Research Articles

Expression of urotensin II is\xa0associated with placental autophagy in patients with severe preeclampsia

The aims of this study are to explore the correlation between the expressions of urotensin II (UII) and autophagic markers (LC3 and P62) in patients with severe preeclampsia (SPE). A total of 64 pregnant subjects were recruited, including 29 healthy pregnancies and 35 preeclamptic patients (7 mild preeclamptic (MPE) patients and 28 SPE patients). UII and autophagic markers expression in placenta specimens was investigated by immunohistochemistry (IHC), RT-qPCR, and western blot. IHC analysis manifested that the expressions of UII and autophagic markers were mainly located in the placental cytotrophoblast and syncytiotrophoblast. Western blot and IHC analysis both indicated that the expression of UII was significantly correlated with autophagic marker LC3II (by western blot) or LC3 (by IHC) (r = 0.495, P = 0.010; r = 0.816, P = 0.007). Moreover, SPE group had higher expression of UII and LC3II, lower expression of P62 than that of normal controls. The expression of LC3II was positively related with systolic blood pressure (SBP) and urinary protein level (SBP (r = 0.501, P = 0.003) and urine protein quantitation (r = 0.509, P = 0.022)), whereas P62 had negative correlation with SBP. We first verify that UII has positive correlation with autophagic marker LC3 in placentas of preeclampsia patients; besides, autophagic levels are positively correlated with SBP and urine protein in patients with SPE.

MMP-8 C-799T and MMP-8 C+17G polymorphisms in mild and severe preeclampsia: Association between MMP-8 C-799T with susceptibility to severe preeclampsia

ABSTRACTObjective: The aim of present study was to determine the role of matrix metalloproteinase-8 (MMP-8) C-799T (rs11225395) and C+17 (rs2155052) polymorphisms in susceptibility to preeclampsia. Study design: In a case–control study, 256 pregnant women including 152 women with preeclampsia (86 women with mild preeclampsia and 66 women with severe preeclampsia) and 104 women with normal pregnancy from Western Iran with Kurdish ethnic background were investigated for MMP-8 C-799T and C + 17G polymorphisms using polymerase chain reaction-restriction fragment length polymorphism method. Results: Comparing the MMP-8 TT genotype with the combined genotype of CC+CT (recessive model) indicated a significantly higher frequency of the MMP-8 TT genotype (47%) in severe preeclamptic patients than that in healthy pregnant women (30.8%) that was associated with 1.99-fold increased risk of severe preeclampsia (95% CI = 1.05–3.77, p = 0.034). The frequency of MMP-8 G allele was 27.3% in all preeclamptic patients compared to 30.2% in controls (p = 0.56). Also, no significant difference was detected comparing the frequency of G allele in mild (26.6%, p = 0.46) and severe preeclamptic patients (28.4%, p = 0.75) with controls (30.2%). Conclusions: Our study demonstrated that the MMP-8 C-799T is associated with the risk of developing severe preeclampsia during pregnancy. However, the MMP-8 C + 17G polymorphism might not be a risk factor for susceptibility to preeclampsia.

Expressions of irisin and urotensin II and their relationships with blood pressure in patients with preeclampsia

ABSTRACTThe aims of this study are to observe irisin and urotensin II (UII) levels in serum and placenta in normal pregnant and preeclamptic women and investigate the relationship between expressions irisin and UII, and their association with blood pressure. A total of 67 pregnant subjects were recruited, including 31 healthy and 36 preeclamptic pregnant women. Serum irisin and UII concentrations were measured. Expressions of fibronectin type III domain-containing protein 5 (FNDC5) (irisin precursor) and UII in placenta specimens were performed. There was no significant difference of serum irisin levels between severe preeclamptic (SPE)) patients, mild preeclamptic (MPE) patients and normal controls, while serum UII was significantly higher in preeclamptic women than normal pregnancy. There was no relationship between serum UII and irisin levels. In patients with preeclampsia, serum irisin was negatively associated with systolic and diastolic blood pressure(r = −0.350, P = 0.004, r = −0.307, P = 0.011), while serum UII was positively associated with systolic blood pressure (r = 0.291, P = 0.031). Serum irisin, UII, urinary protein level, BMI and serum creatinine were the independent determinants of blood pressure in preeclampsia by multiple regression analysis. Protein expression of FNDC5 and UII was upregulated in placenta of patients with SPE and positively correlated with systolic blood pressure and urinary protein level. We firstly verify that serum irisin and placental irisin precursor expressions have differently correlated with blood pressure. Expressions of irisin and urotensin II have relationships with blood pressure in patients with preeclampsia

Is Magnesium Sulphate more Effective than Placebo in Prevention of Seizure in Mild Preeclampsia? A Randomized Placebo-Controlled Clinical Trial

Aim: To evaluate the comparison between magnesium sulfate (MgSO4) and placebo for prevention of seizures in mild pre-eclamptic patients. (Clinical trial code: 2016052111020). Methods and material: This double blind randomized clinical trial study was conducted on 500 patients with mild Pre-eclampsia admitted in Arash Hospital in during 2014-2016. The patients entered to equal two groups, 250 patients in group A, received MgSO4 and 250 patients in group Breceived Placebo. Primary outcome was occurrence of convulsion in mild pre-eclamptic patients. Secondary outcomes were 1 and 5 min Apgar scores in infants and number of caesarean section in each group. Results: Mild pre-eclamptic patients in group A did not experience any convulsion; however 3 patients (1.2%) had experienced convulsion in group B. There were no significant differences in convulsion rate (p=0.08), one-min (p=0.43) and five-min Apgar score (p=0.34) between two groups but there was significant differences in numbers of caesarean section, 123 in group A (49.2%) versus 92 in group B (36.8%) between two groups (P=0.005). Conclusion: Our results suggest that the magnesium sulfate and placebo groups are not statistically differ for prevention of seizure.

CXCR4, CXCR7, and CXCL12 are associated with trophoblastic cells apoptosis and linked to pathophysiology of severe preeclampsia

Preeclampsia is a pregnancy disorder with sudden onset of maternal hypertension and proteinuria, which is characterized by defective cytotrophoblast invasion, increased apoptosis in cytotrophoblast, and diminished syncytial differentiation. In this study, samples from 11 mild preeclamptic patients, 18 severe preeclamptic patients, and 21 normal pregnant women were collected. The expression level of CXCL12 and its two receptors (CXCR4 and CXCR7) in these samples and their relationship with apoptosis were investigated. Morphological change of trophoblast cells that was observed by scanning electron microscope (SEM) indicated a significant tendency of apoptosis in the preeclamptic placenta. Immunohistochemical staining showed that expression level of three proteins was significantly lower in severe preeclamptic placentas compared with normal placentas (P<0.05), whereas no significant difference was found between mild preeclamptic and normal placentas (P>0.05). Real time quantitative PCR (RT-qPCR) and Western blot showed that both mRNA and protein expression level of CXCR4, CXCR7, and CXCL12 of trophoblasts were lower in the severe preeclampsia group than that in the normal group (P<0.05 for mRNA, P<0.01 for protein). In conclusion, our data revealed that the roles of CXCR4, CXCR7, and CXCL12 are associated with trophoblastic cells apoptosis and may be linked to the occurrence and development of severe preeclampsia.

Concentraciones plasmáticas del factor de crecimiento vascular endotelial total en preeclampsia y eclampsia

ObjectiveTo compare plasma concentrations of total vascular endothelial growth factor in eclamptic, preeclamptic and normotensive pregnant women. Materials and methodWe included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (groupC). A control group with a similar age and body mass index to the study groups was selected, consisting of 30 healthy pregnant women (group D). Only nulliparous patients were selected. Plasma samples were collected in all patients before delivery and in the study groups immediately after diagnosis for plasma total vascular endothelial growth factor determination. ResultsValues of total vascular endothelial growth factor were higher in severe preeclamptic patients (141.5± 48.4ng/ml) and in patients with eclampsia patients (141.4±37.9ng/ml). Values were lower in mild preeclamptic patients (62.8±22.8ng/ml). Values of total vascular endothelial growth factor were higher in the study groups than in controls (22.1±3.99ng/ml; P<.05). Linear regression analysis showed that the factors significantly related to plasma total vascular endothelial growth factor concentrations were 24-hour proteinuria, uric acid, transaminases and creatinine (P<.05). ConclusionThe results of this study show that eclamptic and preeclamptic patients had higher plasma total vascular endothelial growth factor concentrations than normotensive pregnant women without these complications.

Clinical Comparative Study Comparing Efficacy of Intrathecal Fentanyl and Magnesium as an Adjuvant to Hyperbaric Bupivacaine in Mild Pre-Eclamptic Patients Undergoing Caesarean Section

Clinical Comparative Study Comparing Efficacy of Intrathecal Fentanyl and Magnesium as an Adjuvant to Hyperbaric Bupivacaine in Mild Pre-Eclamptic Patients Undergoing Caesarean Section

Does magnesium sulfate affect the oxytocin bolus requirement in pre-eclamptic patients undergoing cesarean section?

Objective The aim of this study was to determine whether the magnesium sulfate (MgSO 4 ) used for pre-eclamptic patients affects the oxytocin bolus dose requirement to maintain adequate uterine tone during cesarean section under spinal anesthesia. Materials and methods A total of 80 patients with mild pre-eclampsia were randomized to receive either intravenous MgSO 4 (group M, n = 40) or matched normal saline (group S, n = 40). After delivery of the baby, oxytocin was injected as an intravenous bolus of 3 IU. The uterine tone was assessed by the obstetrician to be either satisfactory or unsatisfactory at 2, 4, 6, 8, and 10 min. If the tone was assessed as unsatisfactory at any time less than 3 IU of oxytocin were injected as a 'rescue' bolus dose. A maximum of two 'rescue' doses of oxytocin were allowed at two separate recordings of inadequate uterine tone. If the uterine tone was still unsatisfactory after two rescue doses of oxytocin, then other uterotonic drugs were given. The primary endpoint was the number of patients who received rescue doses of oxytocin or other uterotonic medications. Secondary endpoints, including the change in the hematocrit value before surgery and within 30 min after cesarean section, the estimated amount of intraoperative blood loss, and any side effects associated with oxytocin, were recorded. Results The number of patients who required one rescue dose of oxytocin during the study was significantly higher in group M in comparison with group S ( P = 0.029). The total number of patients who received both additional oxytocin boluses and other uterotonic agents to achieve a satisfactory uterine tone was also statistically significant between both groups ( P = 0.034). Conclusion The use of MgSO 4 in mild pre-eclamptic patients leads to increased oxytocin requirements in order to maintain a satisfactory uterine tone during cesarean section under spinal anesthesia.

Does altered placental morphology and function explain increased incidence of poor pregnancy outcome in advanced maternal age

Does altered placental morphology and function explain increased incidence of poor pregnancy outcome in advanced maternal age

Índice aterogénico del plasma en pacientes con preeclampsia y embarazadas sanas

Background and objectiveTo compare the values of the atherogenic index of plasma between preeclamptic patients and healthy pregnant women. Patients and methodSeventy patients were selected. Twenty-three severe preeclamptic patients (group A), 12 mild preeclamptic patients (group B) and 35 healthy pregnant women with similar age and body mass index (group C). Blood samples for lipids and lipoproteins determination were taken and the atherogenic plasma index was calculated. ResultsWe did not find differences in group A and B with regard to maternal age, gestational age at the time of evaluation and body mass index compared with pregnant women in group C (P=ns). Plasma concentrations of triglycerides and low-density lipoproteins were significantly higher in patients of groups A and B compared with group C (P<.05). Normotensive patients presented higher concentrations of high-density lipoproteins than patients with severe and mild preeclampsia (P<.05). There were no differences between groups in plasma cholesterol concentrations (P=ns). Patients in groups A (1.14±0.44) and in group B (0.95±0.46) presented significantly higher values of the atherogenic index of plasma compared with pregnant women in group C (0.62±0.20; P<.05). ConclusionPatients with preeclampsia had higher values of the atherogenic index of plasma than healthy pregnant women.

Factor de crecimiento de hepatocitos plasmático en preeclampsia y eclampsia

ObjectiveTo compare plasma hepatocyte growth factor concentrations in eclamptic, preeclamptic and normotensive pregnant women. Materials and methodWe included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). A control group of 30 healthy pregnant women (group D) was selected with a similar age and body mass index to participants in the study groups. Only nulliparous patients were included. Blood samples were collected for plasma hepatocyte growth factor determination in all patients before delivery and in the study groups immediately after diagnosis. ResultsPlasma hepatocyte growth factor values were highest in eclamptic patients and in severe preeclamptic patients and were lowest in mild preeclamptic patients. Hepatocyte growth factor values were significantly higher in the study groups than in controls (P<.05). Linear regression analysis revealed that 24-hour proteinuria significantly affected plasma hepatocyte growth factor concentrations (P<.05). ConclusionThe findings of this research showed that plasma hepatocyte growth factor concentrations were higher in eclamptic and preeclamptic patients than in normotensive pregnant women.

Endostatina sérica en preeclampsia y eclampsia

ObjectiveTo compare serum endostatin concentrations in eclamptic, pre-eclamptic and normotensive pregnant women. Materials and methodThe study included 30 patients with mild preeclampsia (group A), 30 patients with severe pre-eclampsia (group B), and 30 patients with eclampsia (group C). A control group, consisting of 30 healthy pregnant women of similar age and body mass index to the studiy groups, was selected (group D). Only nuliparous patients were included. Blood samples were collected for serum endostatin determination from all patients before delivery, and from the study groups immediately after diagnosis. ResultsHigher values of endostatin were observed in eclamptic patients together with severe pre-eclamptic patients. Lower values were found in mild pre-eclamptic patients. The study groups had significantly higher values of endostatin compared with the control group (P<.05). Linear regression analysis, found that factors that significantly affected plasma endostatin concentrations were uric acid and 24-hour proteinuria. ConclusionThe findings of this study showed that eclamptic and pre-eclamptic patients had higher serum endostatin concentrations than normotensive pregnant women.

Chitotriosidase, interleukin-1 beta and tumor necrosis factor alpha levels in mild preeclampsia

Chitotriosidase (ChT) is an activated macrophage marker. Tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) are mainly produced macrophages. The aim of the present study was to evaluate the relationship between serum ChT activity, levels of TNF-α and IL-1β in patients with mild preeclampsia and normal pregnancy. An overall 64 cases, 32 healthy pregnant control women (control group) and 32 women with mild preeclamptic patients (study group), were enrolled in this study. At the beginning of the study, all study participants were matched for age and gestational age. Serum ChT activity was measured by fluorometer; TNF-α and IL-1β levels were measured by enzyme-linked immunosorbent assay. The mean age, gestational week, parity and gravida were similar in the two groups (p > 0.05). Serum ChT activity was significantly higher in the preeclampsia group compared to the control group (p < 0.05). Levels of TNF-α and IL-1β in patients with mild preeclampsia were similar compared to the control group (p > 0.05). In the PE group, serum ChT activity was not correlated with TNF-α and IL-1β. Mild preeclampsia is found associated with higher ChT activity. This result suggests that activated macrophages play a role in the pathogenesis of preeclampsia. This suggestion needs to be confirmed in future studies with larger populations.

Circulating levels of homocysteine in preeclamptic women

It has been hypothesized that maternal hyperhomocysteinemia to be associated with preeclampsia. The aims of the present study were to examine maternal serum levels of total homocysteine in preeclamptic women and its association with the severity of the disease. The study population consisted of 30 preeclamptic patients and 30 matched healthy pregnant women. Serum levels of total homocysteine were assessed using enzyme immunoassay method. Maternal serum levels of total homocysteine were significantly higher in preeclamptic group than in normal pregnant women. Women with severe preeclampsia had higher serum levels of total homocysteine than mild preeclamptic patients. Levels of total homocysteine correlated positively with systolic blood pressure values in preeclamptic women. In summary, maternal serum levels of total homocysteine were increased in preeclamptic women and hyperhomocysteinemia was associated with severity of preeclampsia.

Comparative expression profiles for KiSS-1 and REN genes in preeclamptic and healthy placental tissues

ObjectiveThe aim of the present work was to look at differences in the placental tissue expression of KiSS-1 and REN genes from preeclamptic and healthy pregnant women, that could account for a possible synergistic function for both genes in the pathogenesis of preeclampsia. Study designThis case–control study involved 27 preeclamptic women and 27 normoevolutive pregnant women. cDNA was obtained from placental tissue to carry out qPCR for both KiSS-1 and REN genes in order to compare mRNA expression levels in the studied groups. Statistical analysis showed expression differences that correlate with clinical and/or biochemical variables. ResultsHigher expression for KiSS-1 in PEE vs. control woman (p=0.001) was observed, whereas no difference was observed for REN expression (p=0.300) when all the subjects were included. However, REN expression was significant higher when the samples were stratified according to preeclampsia severity. For 18 mild preeclamptic patients the p-value was p=0.001 compared to their controls, while for the remaining nine with severe preeclampsia the expression became significant (p=0.001). ConclusionOur results suggest that the high KiSS-1 expression seen in preeclamptic patients is in accordance with its role as an inhibitor of trophoblast invasiveness and maintained until the end of gestation. On the other hand, aggressive therapeutic management and/or severity status of patients have a direct effect on placental REN expression levels, masking the natural high expression of this gene on preeclamptic placental tissue. Therefore it was not possible to establish a real concordant expression profile for KiSS-1 and REN genes.

Micropartículas endoteliales en preeclampsia y eclampsia

Objective To compare endothelial microparticles values in eclamptic, preeclamptic and normotensive pregnant women. Materials and methods Patients were selected among those who assisted to Obstetrics Emergency at Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. There were included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). A control group was selected for having similar age and body mass index to studied groups and consisted in 35 healthy pregnant women (group D). There were included only nuliparous patients. Blood samples were collected in all patients before delivery and in studied groups immediately after diagnosis for endothelial microparticles determination. Results There were statistically significant differences in gestational age between groups B and C compared with controls ( P < .05). Higher values of endothelial microparticles were observed in eclamptic patients together with severe preeclamptic patients. Lower values were found in mild preeclamptic patients. Studied groups presented significant higher values of endothelial microparticles compared with controls ( P < .05). When linear regression was performed, factors that significantly affected endothelial microparticles values were: uric acid, 24-hour proteinuria, transaminases and platelet count ( P < .05). Conclusions The findings of this research showed that eclamptic and preeclamptic patients had higher endothelial microparticles values than normotensive pregnant women.

Micropartículas plaquetarias en preeclampsia y eclampsia

Objective To compare platelet microparticle values in eclamptic, preeclamptic and normotensive pregnant women. Material and methods Patients attending the Dr. Urquinaona Central Hospital in Maracaibo, Venezuela, were selected. Thirty patients with mild preeclampsia (group A), 30 with severe preeclampsia (group B) and 30 with eclampsia (group C) were included. Thirty-five healthy women with a similar age and body mass index to those in the study groups were selected as controls (group D). Only nuliparous patients were included. Blood samples were collected before delivery from all patients and immediately after diagnosis for platelet microparticle determination in the study groups. Results Statistically significant differences were found in gestational age between groups B and C compared with the control group ( P < .05). Higher platelet microparticle values were found in eclamptic patients and severe preeclamptic patients. Lower values were found in mild preeclamptic patients. Significantly higher platelet microparticle values were found in the study groups than in controls ( P < .05). When linear regression was performed, the factors significantly affecting platelet microparticle values were 24-hour proteinuria, transaminase and uric acid levels and platelet count ( P < .05). Conclusions Our findings indicate that platelet microparticle values are higher in eclamptic and preeclamptic women than in normotensive pregnant women.

Hospitalized late preterm mild preeclamptic patients with mature lung testing: what are the risks of delivery?

To evaluate the risk of elective delivery of hospitalized patients with isolated mild preeclampsia with mature fetal lung profile compared with a cohort of patients who had preeclampsia with indicated delivery matched for gestational age. Patients with mild preeclampsia requiring hospitalization between 34 and 37 weeks estimated gestational age were offered amniocentesis for assessment of fetal lung maturity. If fetal lung maturity was documented, patients were offered delivery. These cases were then compared with indicated or spontaneously delivered controls with preeclampsia matched for gestational age. A total of 51 cases were identified and matched with 51 controls. Sixteen case neonates (31.4%) were admitted to neonatal intensive care unit compared with 21 controls (41.2%). Five cases (9.8%) in each group developed respiratory distress syndrome (RDS). Elective delivery of mild preeclampsia with mature lung profiles in the late preterm gestation is not without neonatal risks, including a 10% risk of RDS in this series.

Serum leptin and ghrelin concentrations of maternal serum, arterial and venous cord blood in healthy and preeclamptic pregnant women

Preeclampsia, a common complication of pregnancy, is associated with alteration in the concentration of leptin in maternal blood. The action of leptin is antagonistic to that of ghrelin. Here, we compared the levels of leptin and ghrelin in maternal serum and in arterial and venous cord blood between healthy pregnant women and those suffering from mild and severe preeclampsia. The levels of leptin in maternal and newborn's blood were elevated in both mild and severe preeclamptic patients (p < 0.05). Moreover, serum ghrelin levels were negatively correlated with blood pressure and leptin/ghrelin ratio was decreased in preeclampsia (p < 0.05). We concluded that increased production of ghrelin may represent a compensatory hypotensive mechanism in preeclamptic women.

471: Hospitalized late preterm mild preeclamptic (PE) patients with mature lung testing: What are the risks of delivery?

471: Hospitalized late preterm mild preeclamptic (PE) patients with mature lung testing: What are the risks of delivery?