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Preeclampsia

Distribution by Scientific Domains

Medical Sciences	57%
Life Sciences	41%

Distribution within Medical Sciences

Obstetrics & Gynecology	10%
Nursing General	7%
Transplantation	5%
General & Introductory Medical Science	3%
17 Other Subdomains	69%

Kinds of Preeclampsia

severe preeclampsia

Selected Abstracts

Pregnancy-induced sympathetic overactivity: a precursor of preeclampsia,

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 6 2004
T. Fischer
Abstract Background, Preeclampsia has been shown to constitute a state of sympathetic overactivity. However, it remains unclear if the sympathetic activity precedes preeclampsia or represents only a secondary phenomenon. To further investigate this issue, we performed a prospective study in pregnant women considered to be at increased risk for preeclampsia owing to preeclampsia during a preceding pregnancy. Materials and methods, Twenty-two women with a history of preeclampsia were longitudinally studied on three occasions: twice during pregnancy (M1: 22 ± 4, M2: 33 ± 5 weeks) and once postpartum (M3: 26 ± 6 weeks postpartum). We measured muscle sympathetic nerve activity (MSNA), forearm blood flow, and blood pressure at rest and during reactive hyperaemia after forearm occlusion. Results, At M1 and M2, none of the subjects was hypertensive, however, muscle sympathetic nerve activity levels were significantly augmented, compared with their postpartum values (M1: 21 ± 9, M2: 29 ± 14, M3: 9 ± 5 bursts min,1; P < 0·05). Forearm vascular resistance did not significantly change from M1 through M3 (M1: 16 ± 9, M2: 15 ± 7, M3: 16 ± 7 U; P = NS). Gestational muscle sympathetic nerve activity values did not differ significantly among the subjects with subsequent preeclampsia compared with those who remained normotensive [with preeclampsia (n = 6): M1: 21 ± 5, M2: 27 ± 6, M3: 7 ± 4 bursts min,1; without preeclampsia (n = 16): M1: 21 ± 11, M2: 30 ± 16, M3: 9 ± 6 bursts min,1; P = NS]. Conclusion, Invariably, all women at risk for preeclampisa showed a pregnancy-induced increase in MSNA (pregnancy-induced sympathetic overactivity, PISO), which normalized after delivery. Most importantly, PISO is not necessarily associated with peripheral vasoconstriction and hypertension. Furthermore, only a subset of patients developed preeclampsia later on. Therefore, we hypothesize that PISO constitutes a precursor of preeclampsia which is physiologically compensated for by vasodilating mechanisms, leading to preeclampsia only when they fail. [source]

Lipid compounds of human Wharton's jelly and their alterations in preeclampsia

INTERNATIONAL JOURNAL OF EXPERIMENTAL PATHOLOGY, Issue 1 2010
Lech Romanowicz
Summary Wharton's jelly is a myxomatous substance which surrounds the umbilical cord vessels protecting them against extension, bending, twisting and compression. Very low number of cells in this tissue produce high amounts of extracellular matrix; collagen, hyaluronate and proteoglycans which bind large quantities of peptide growth factors (PGFs). Preeclampsia (the most common pregnancy-associated syndrome) is accompanied by a significant reduction in hyaluronate and a concomitant increase in sulphated glycosaminoglycans/proteoglycans content in Wharton's jelly. Such a phenomenon corresponds to an ,early ageing' of this tissue. We have evaluated the lipid composition of Wharton's jelly and its alteration in preeclampsia. Thin layer chromatography and high-performance liquid chromatography were employed. It was found that Wharton's jelly contains free fatty acids (FFA), mono-, di- and triacylglycerols, free cholesterol and its esters. The characteristic feature is the presence of relatively high amounts of unsaturated fatty acids, including those (C18:2 and C18:3) which are nutritionally essential. Preeclampsia is associated with a slight increase in the total fatty acid content in Wharton's jelly and with marked changes in the proportional relationships between various lipids. A distinct decrease in the amounts of FFA was observed with a concomitant increase in monoacylglycerols and cholesterol esters. At least in some cases the effects exerted by PGFs are mediated by the lipid second messengers. Thus it is possible that alterations in lipid compounds of Wharton's jelly may participate in the deregulation of various cell functions, including overproduction of sulphated glycosaminoglycans or down-regulation of enzymes which participate in their degradation. [source]

Prenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing Preeclampsia

JOURNAL OF NURSING SCHOLARSHIP, Issue 2 2010
SeonAe Yeo RNC
Abstract Purpose: Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia. Design: Secondary data analysis. Methods: Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study. Findings: Heart rates in the stretching group were consistently lower than those in the walking group. Conclusions: Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed. Clinical Relevance: If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care. [source]

Preeclampsia: Exposing Future Cardiovascular Risk in Mothers and Their Children

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2007
Cindy M. Anderson
There is an increased risk for future cardiovascular disease in women who have had preeclampsia. In infants born to mothers with preeclampsia, there is growing evidence of increased risk for both cardiovascular disease and preeclampsia. Epidemiologic and experimental data provide a strong link between intrauterine exposure to preeclampsia and subsequent risk for the development of cardiovascular disease in women. JOGNN, 36, 3-8; 2007. DOI: 10.1111/J.1552-6909.2006.00115.x [source]

Maternal Mortality Associated with Eclampsia and Severe Preeclampsia of Pregnancy

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2000
Dr. H. Sawhney
Abstract Objective: To analyse factors associated with maternal mortality in eclampsia and preeclampsia. Method: Retrospective analysis of 69 maternal deaths due to (eclampsia-61; severe preeclampsia-8) was carried out during a period of 17 years (1982,1998). Maternal condition on admission, associated complications and principal cause of death was analysed in each case. Results: Mean time interval between hospitalization and maternal death was 49.56 + 62.01 hrs (1,240 hrs). Twenty (28.9%) women died undelivered. Twenty-three (37.7%) women were in grade IV coma and 52.4% of eclampsia patients had recurrent convulsions (> 10) prior to admission. Associated complications in form of hemorrhage, cerebrovascular accidents, acute renal failure, jaundice, aspiration pneumonia and pulmonary oedema were 30.4, 31.8, 34.8, 18.8, 17.8, and 5.8%, respectively. Maternal mortality in eclampsia was significantly low in time period B (4.1%) when magnesium sulphate was used as an anticonvulsant. Conclusions: Maternal condition on admission and associated complications are the major determinant of maternal outcome. Use of magnesium sulphate is associated with significant reduction of maternal mortality. [source]

Preeclampsia and its interaction with common variants in thrombophilia genes

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 9 2004
M. P. M. De Maat
Summary., Recently, it has been proposed that abnormalities in coagulation and fibrinolysis contribute to the development of preeclampsia by increasing the thrombotic tendency. This hypothesis was tested in women who have had preeclampsia (cases) compared with matched controls. Polymorphisms in the thrombophilia genes {plasminogen activator inhibitor type 1 [PAI-1 ,675(4G/5G)], thrombin activatable fibrinolysis inhibitor (TAFI ,438G/A and 1040C/T), methylenetetrahydrofolate reductase (MTHFR 677C/T), factor V (FV Leiden R/Q506), prothrombin (FII 20210G/A) and factor XIIIA (FXIIIA V/L34)} were determined in 157 women with preeclampsia and 157 women with uncomplicated pregnancy. The associated risk of preeclampsia was analyzed using logistic regression methods. The frequency distributions of the genotypes of these six polymorphisms in thrombophilia genes were similar in the case and control groups. We found no differences in the prevalence of genetic risk factors of thrombosis in women with preeclampsia compared with controls, which makes it unlikely that these polymorphisms are risk factors for preeclampsia. [source]

Impaired cytotrophoblast cell,cell fusion is associated with reduced Syncytin and increased apoptosis in patients with placental dysfunction

MOLECULAR REPRODUCTION & DEVELOPMENT, Issue 1 2008
Manuela Langbein
Abstract Preeclampsia (PE), Hemolysis Elevated Liver Enzymes and Low Platelets (HELLP)-syndrome, and intrauterine growth restriction (IUGR) are associated with abnormal placentation. In early pregnancy, placental cytotrophoblasts fuse and form multinuclear syncytiotrophoblasts. The envelope gene of the human endogenous retrovirus-W, Syncytin, is a key factor for mediating cell,cell fusion of cytotrophoblasts. This study investigated clinical parameters of PE and HELLP-associated IUGR and analyzed the cell,cell fusion index and ,-human chorionic gonadotropin (,-hCG) secretion of cytotrophoblasts isolated and cultured from placentas of these patients. In addition, we performed absolute quantitation of Syncytin and determined the apoptosis rate in both cultured cytotrophoblasts and placental tissues. Cultured cytotrophoblasts from PE and HELLP-associated IUGR correlated with a pronounced lower cell,cell fusion index, 1.8- and 3.6-fold; less nuclei per syncytiotrophoblast, 1.4- and 2.0-fold; a significantly decreased ,-hCG secretion, 4.3- and 17.2-fold and a reduction of Syncytin gene expression, 8.1 (P,=,0.019) and 222.7-fold (P,=,0.011) compared with controls, respectively. In contrast, a significantly 2.3-fold higher apoptosis rate was observed in cultured PE/IUGR cytotrophoblasts (P,=,0.043). Importantly, Syncytin gene expression in primary placental tissues of PE/IUGR was 5.4-fold lower (P,=,0.047) and in HELLP/IUGR 10.6-fold lower (P,=,0.019) along with a 1.8- and 1.9-fold significant increase in the apoptosis rate compared with controls, respectively. Low Syncytin expression in both cultured cytotrophoblasts and primary tissues from pathological placentas supports an intrinsic placenta-specific deregulation of cell,cell fusion in the formation of syncytiotrophoblasts leading to increased apoptosis. These processes could contribute to the development and severity of PE and HELLP-associated IUGR. Mol. Reprod. Dev. 75: 175,183, 2008. © 2007 Wiley-Liss, Inc. [source]

First-trimester assessment of placenta function and the prediction of preeclampsia and intrauterine growth restriction

PRENATAL DIAGNOSIS, Issue 4 2010
Yan Zhong
Abstract Preeclampsia and intrauterine growth restriction (IUGR) are major contributors to perinatal mortality and morbidity worldwide. Both are characterized by impaired trophoblastic invasion of the maternal spiral arteries and their conversion from narrow muscular vessels to wide non-muscular channels. Despite improvement in the understanding of the pathophysiology of these conditions, ability to accurately identify pregnant woman who will develop them is limited. This greatly impairs the development and testing of preventive interventions. While different measures of placental dysfunction have been associated with increased risk for adverse pregnancy outcomes, the ability of any single one to accurately predict these outcomes is poor. Developing predictive tests is further challenged by difficulty in the timing of the measurements, as both the structural and biochemical characteristics of the placenta change with increasing gestational age. The ideal screening test would accurately predict the development of adverse pregnancy outcomes early enough to provide a window for preventive interventions. Improvement in ultrasound technology provides potentially useful novel tools for evaluating placental structure, but measuresments need to be standardized in order to be useful. Maternal serum analyte screening is a noninvasive test of placental biochemical function, but present serum marker alone is not sufficiently accurate to suggest its routine use in clinical practice. The use of first trimester biochemical markers in combination with uterine artery Doppler screening is promising as a potential screening tool. Prospective longitudinal studies using standardized methodology are necessary to further evaluate the choice of parameters and strategies of combination to achieve the best predictive models. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Early onset preeclampsia and second trimester serum markers

PRENATAL DIAGNOSIS, Issue 12 2009
Geralyn M. Lambert-Messerlian
Abstract Objective To examine serum markers measured in the second trimester to identify women who subsequently develop preeclampsia. Methods Clinically defined preeclampsia was confirmed in 45 women who had provided a serum sample as part of Down syndrome screening. Preeclampsia was categorized as mild or severe, as well as early (<32 weeks) or late onset. Each case was matched with five controls based on gestational age and date of serum collection. Stored sera were retrieved and tested for inhibin A, soluble vascular endothelial growth factor receptor 1 (sVEGF R1), placental growth factor (PlGF), and endoglin. Results were converted to multiples of the median (MoM) and compared in case and control pregnancies. Univariate analysis was used to identify the strongest markers, which were then used in a multivariate model. Results Inhibin A, PlGF, and endoglin were consistently associated with preeclampsia, especially for early onset disease. A multivariate model using the three markers could identify 50% of the pregnancies with early onset preeclampsia with a 2% false positive rate. Conclusion The levels of inhibin A, PlGF, and endoglin in the second trimester can be combined using a predictive model to provide individualized risk estimates for early onset preeclampsia. Copyright © 2009 John Wiley & Sons, Ltd. [source]

ORIGINAL ARTICLE: Women with Pre-Eclampsia Have an Altered NKG2A and NKG2C Receptor Expression on Peripheral Blood Natural Killer Cells

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 3 2009
Nora Bachmayer
Problem, Preeclampsia, a pregnancy disorder, is associated with exaggerated inflammation and increased serum monokines. Uterine natural killer (NK) cells are implicated in preeclampsia pathology, but little is known regarding peripheral NK cells in the disease. Method of Study, We examined blood NK cells at delivery in women with preeclampsia, in healthy pregnant women and in healthy non-pregnant blood donors as a reference. Results, Although the percentages of both NKG2A- and NKG2C-positive NK cells were normal in preeclamptic women, the levels of NKG2A and NKG2C on NK cells were significantly up-regulated in these women. In vitro stimulation of PBMCs from healthy pregnant women and blood donors with monokines resulted in increased percentage of NKG2A+ NK cells and increased NKG2A levels, while levels of NKG2C were decreased. Conclusions, Our results suggest that the peripheral NK-cell pool is skewed in preeclampsia and possibly under the influence of monokines like interleukin (IL)-15 and IL-12. [source]

ORIGINAL ARTICLE: Leukocyte Activation and Circulating Leukocyte-Derived Microparticles in Preeclampsia

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 5 2009
Christianne A.R. Lok
Problem, Preeclampsia shows characteristics of an inflammatory disease including leukocyte activation. Analyses of leukocyte-derived microparticles (MP) and mRNA expression of inflammation-related genes in leukocytes may establish which subgroups of leukocytes contribute to the development of preeclampsia. Method of Study, Blood samples were obtained from preeclamptic patients, normotensive pregnant and non-pregnant controls. sL-selectin and elastase were measured by ELISA. mRNA was isolated from leukocytes and gene expression was determined by multiplex ligation-dependent probe amplification (MLPA). MP were characterized by flow cytometry. Results, Altered concentrations of sL-selectin and elastase confirmed leukocyte activation in preeclampsia. These leukocytes showed up-regulation of Nuclear Factor of Kappa light chain gene enhancer in B Cells inhibitor (NF,B-1A) and cyclin-dependent kinase inhibitor (CDKN)-1A compared with normotensive pregnant women. interleukin-1 Receptor Antagonist (IL-1RA) and tumor necrosis factor (TNF)-R1 were increased compared with those in non-pregnant controls. Monocyte-derived MP were elevated in preeclamptic patients compared with pregnant women. The numbers of cytotoxic T-cell-derived and granulocyte-derived MP were elevated compared with those of non-pregnant women. Conclusion, Leukocytes are activated in preeclampsia. A pro-inflammatory gene expression profile is not prominent, although differences in mRNA expression can be detected. Increased levels of particular subsets of leukocyte-derived MP reflect activation of their parental cells in preeclampsia. [source]

Cytokine profile in women with preeclampsia

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 3 2002
Yvonne Jonsson
Preeclampsia is a severe complication engaging 5,10% of all pregnancies. Immune mechanisms have been suggested in the etiology of this disease. AIM:, To study the systemic spontaneous and fetus-specific cytokine production by peripheral blood mononuclear cells (PBMCs) in women with preeclampsia and normal pregnancies. METHODS:, PBMCs from nine women with preeclampsia and five women with normal pregnancies were stimulated in mixed leukocyte cultures with paternal cells (representing the fetus) and autologous blood lymphocytes. The stimulated and spontaneous production of IL-4, IL-10 and IFN-, were analysed by ELISPOT and IL-12 and IL-13 in cell-culture supernatants by ELISA. Cell-culture supernatants were collected for 2,7 days of incubation. RESULT:, The results are preliminary since analysis of data is going on. We found a trend of decreased IL-10 production in response to paternal cells in preeclamptic women. Data for the other cytokines did not show any differences between groups. CONCLUSION:, The material studied so far is limited and further studies are needed to draw any safe conclusions. [source]

Evidence for Superantigen Involvement in Preeclampsia

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 4 2000
PATRIZIA LUPPI
PROBLEM: Preeclampsia is the leading cause of maternal morbidity and premature fetal delivery in the United States, most likely involving the immune system in disease genesis. In this report, we tested the hypothesis that a superantigen phenomenon is an important factor in the pathogenesis of the disease. METHOD OF STUDY: A semi-quantitative polymerase chain reaction (PCR) was used to assess T-cell receptor (TCR) , chain variable (V,) regions as an indicator of T-cell expansion in both peripheral blood and basal plate of preeclamptic patients. All the subjects were also molecularly typed to identify their HLA-class II alleles. RESULTS: In peripheral blood of the majority of the patients, there was a high abundance of the V,4 gene family, which was not observed in the control group. Polyclonality of this V, gene family was confirmed by analysis of the V, chain and the complementary determining region 3 (CDR3). The majority of patients carried the Human Leukocyte Antigens (HLA)-DRB1*13 allele. CONCLUSION: We present evidence for the existence of a superantigen-like effect in at least a subset of patients with preeclampsia. [source]

Effects of Oral L-Arginine on the Foetal Condition and Neonatal Outcome in Preeclampsia: A Preliminary Report

BASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 2 2006
Krzysztof Rytlewski
Randomized, placebo-controlled, double-blind, clinical trial. Oral therapy with 3 g of L-arginine daily or placebo as a supplement to standard therapy. Eighty-three preeclamptic women, randomly assigned to the L-arginine (n=42) or placebo (n=41) groups; [n=30 (L-arginine) and n=31 (placebo) ended the study, respectively]. Foetal gain chances due to ultrasound biometry, biophysical profile, Doppler velocimetry of pulsatility indices of umbilical and middle cerebral arteries, cerebro-placental ratio, as well as differences in duration of pregnancy and clinical data of newborn. L-arginine treatment transitory accelerated foetal gain and improved biophysical profile. Starting from 3rd week of therapy, the umbilical artery pulsatility indices values were significantly lower in L-arginine than in placebo group. Moreover, treatment with L-arginine caused significant increase of middle cerebral artery pulsatility indices and cerbro-placental ratio values. Latency was longer in L-arginine group. Neonates delivered in the L-arginine group revealed higher Apgar score. Supplementary treatment with oral L-arginine seems to be promising in improving foetal well-being and neonatal outcome as well as in prolonging pregnancy complicated with preeclampsia. However, these benefits require confirmation in more-powered, larger studies. [source]

Aspirin (100 mg) used for prevention of pre-eclampsia in nulliparous women: the Essai Régional Aspirine Mère,Enfant study (Part 1)

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2003
Damien Subtil
Objective To reduce the incidence of pre-eclampsia in nulliparous women, in accordance with the suggestion of a recent meta-analysis that low dose aspirin might decrease this incidence by more than half if used early enough in and at a sufficient dose during pregnancy (more than 75 mg). Design Multicentre randomised double-blinded placebo-controlled trial. Setting Twenty eight centres in Northern of France and one in Belgium. Population Three thousand and two hundred ninety-four nulliparous women recruited between 14 and 20 weeks. Methods Randomisation to either 100 mg aspirin or placebo daily from inclusion through 34 weeks. Main outcome measures Preeclampsia was defined as hypertension (,140 and or 90 mmHg) associated with proteinuria (,0.5 g/L). Results The aspirin (n= 1644) and placebo (n= 1650) groups did not differ significantly in the mothers' incidence of pre-eclampsia (28 of 1632 [1.7%] vs 26 of 1637 [1.6%]; relative risk, RR, 1.08, 95% CI 0.64,1.83), hypertension, HELLP syndrome or placental abruption, or in the children's incidence of perinatal deaths or birthweight below the 10th centile. The incidence of babies with birthweight below the third centile was significantly higher in the aspirin group, with no explanation. The incidence of maternal side effects was higher in the aspirin group, principally because of a significantly higher rate of haemorrhage. Conclusions Aspirin at a dose of 100 mg does not reduce the incidence of pre-eclampsia in nulliparous women. Aspirin (100 mg) is associated with an increase in bleeding complications. [source]

Effects of oral L -arginine supplementation on blood pressure and asymmetric dimethylarginine in stress-induced preeclamptic rats

CELL BIOCHEMISTRY AND FUNCTION, Issue 5 2008
Zekiye Sultan Altun
Abstract This study was carried out to elucidate the role of asymmetric dimethylarginine (ADMA) and nitric oxide (NO) in preeclampsia development, and to investigate the effect of L -arginine supplementation in rats. Preeclampsia was induced in pregnant rats using a stress model. L -arginine was administered orally and ADMA, urinary nitrate, and protein levels were measured on the 20th day of pregnancy. Compared with the group of rats that are normally pregnant, the levels of blood pressure (BP), protein excretion, and ADMA were significantly increased in preeclampsia which returned to normal levels following the supplementation of L -arginine. Both group of rats had similar urine nitrate levels. Arginine,ADMA,NO pathway is affected in preeclampsia. L -arginine supplementation decreased hypertension (HT), proteinuria, and ADMA levels indicating that taking L -arginine may be beneficial in preeclampsia treatment. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Maternal antecedents for cerebral palsy in extremely preterm babies: a case-control study

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2001
Peter H Gray MD FRCPI FRACP FRCPCH
The study aimed to identify significant antenatal risk factors for cerebral palsy (CP) among extremely preterm infants with a matched case-control design. Infants born between 1989 and 1996 at 24 to 27 weeks'gestation who survived to hospital discharge were evaluated: 30 with a proven diagnosis of CP at 2 years corrected for prematurity and 120 control children matched for gestational age without CP. Information on maternal obstetric risk factors and medication was obtained. Matched analyses were performed and odds ratios (OR) and 95% confidence intervals (CI) were calculated. An antenatal diagnosis of intrauterine growth restriction was associated with an increased risk of CP (OR 6.6; 95% CI 1.8 to 25.2), while maternal administration of corticosteroids was associated with a reduced risk of CP (OR 0.4; 95% CI 0.1 to 0.98). A high rate of placental histopathology was achieved but no relation between clinical or histological chorioamnionitis or funisitis and CP was demonstrated. Maternal preeclampsia was not associated with a statistically significant reduction in the risk of CP. It is concluded that a reduced risk of CP in extremely preterm infants is associated with the antenatal use of corticosteroids. [source]

Community-based, Prospective, Controlled Study of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with Epilepsy

EPILEPSIA, Issue 1 2006
Katriina Viinikainen
Summary:,Purpose: This study evaluated obstetric and neonatal outcome in a community-based cohort of women with active epilepsy (WWAE) compared with the general pregnant population receiving modern obstetric care. Methods: We reviewed the total population who gave birth between January 1989 and October 2000 at Kuopio University Hospital. Obstetric, demographic, and epilepsy data were collected prospectively from 179 singleton pregnancies of women with epilepsy and from 24,778 singleton pregnancies of unaffected controls. The obstetric data from the pregnancy register was supplemented with detailed neurologic data retrieved from the medical records. The data retrieved were comprehensive because of a follow-up strategy according to a predecided protocol. Results: During pregnancy, the seizure frequency was unchanged, or the change was for the better in the majority (83%) of the patients. We found no significant differences between WWAE and controls in the incidence of preeclampsia, preterm labor, or in the rates of caesarean sections, perinatal mortality, or low birth weight. However, the rate of small-for-gestational-age infants was significantly higher, and the head circumference was significantly smaller in WWAE. Apgar score at 1 min was lower in children of WWAE, and the need for care in the neonatal ward and neonatal intensive care were increased as compared with controls. The frequency of major malformations was 4.8% (,0.6,10.2%; 95% confidence interval) in the 127 children of WWAE. Conclusions: Pregnancy course is uncomplicated and neonatal outcome is good in the majority of cases when a predecided protocol is used for the follow-up of WWAE in antenatal and neurologic care. Long-term follow-up of the neurologic and cognitive development of the children of WWAE is still needed. [source]

Pregnancy-induced sympathetic overactivity: a precursor of preeclampsia,

Clinical pharmacology and therapeutic use of antioxidant vitamins

FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2007
Ramón Rodrigo
Abstract The clinical use of antioxidants has gained considerable interest during the last decade. It was suggested from epidemiological studies that diets high in fruits and vegetables might help decrease the risk of cardiovascular disease. Therefore, supplements of vitamins C and E were applied through protocols aimed to prevent diseases such as atherosclerosis, preeclampsia or hypertension, thought to be mediated by oxidative stress. Despite the biological properties of these vitamins could account for an effective protection, as shown by several clinical and experimental studies, their efficacy remains controversial in the light of some recent clinical trials and meta-analyses. However, the methodology of these studies, criteria for selection of patients, the uncertain extent of progression of the disease when initiating supplementation, the lack of mechanistic studies containing basic scientific aspects, such as the bioavailability, pharmacokinetic properties, and the nature of the antioxidant sources of vitamins, could account for the inconsistency of the various clinical trials and meta-analyses assessing the efficacy of these vitamins to prevent human diseases. This review presents a survey of the clinical use of antioxidant vitamins E and C, proposing study models based on the biological effects of these compounds likely to counteract the pathophysiological mechanisms able to explain the structural and functional organ damage. [source]

Role of a fetal defence mechanism against oxidative stress in the aetiology of preeclampsia

HISTOPATHOLOGY, Issue 1 2009
Christoph Jan Wruck
Aims:, Increasing evidence suggests that oxidative stress may play a key role in the aetiology of preeclampsia (PE). The aim of this study was to elucidate the placental defence mechanisms employed against oxidative stress and, in particular, the specific role of nuclear factor erythroid 2-related factor 2 (Nrf2). Methods and results:, Expression of Nrf2 in third-trimester placental tissue was compared in preeclamptic and normal gestation-matched controls. PE was associated with increased Nrf2 activity within cytotrophoblastic nuclei. Nrf2 expression was restricted to proliferative and early post-proliferative cytotrophoblast only. Syncytiotrophoblast was immunonegative for Nrf2 in both controls and preeclamptic placentas. Conclusions:, Nrf2 is exclusively active within cytotrophoblast, strongly suggesting that these cells are the origin of Nrf2-dependent gene products. Syncytiotrophoblast is transcriptionally inactive; therefore in times of oxidative stress essential cytoprotective enzymes must be derived from the cytotrophoblast. Excessive cytotrophoblastic turnover causes disproportionate release of toxic placental factors, manifesting as PE and endangering maternal health. Increased cytotrophoblastic proliferation/fusion could thus be interpreted as a fetal defence mechanism, initiated in response to the requirements of vulnerable syncytiotrophoblast. We therefore propose a direct relationship between fetal defence against oxidative stress and consequent placental toxicity as part of the aetiology of this complex maternal disease. [source]

Lipid compounds of human Wharton's jelly and their alterations in preeclampsia

Antithrombin plasma levels decrease is associated with preeclampsia worsening

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 2 2009
M. MARIETTA
Summary Antithrombin plasma levels (AT) have been found decreased in women with preeclampsia (PE), but little is known about the trend of AT during the course of this disease. We prospectively investigated AT in consecutive women admitted to our hospital with a diagnosis of PE, to assess if AT fluctuations could be associated with the evolution of the disease. AT, platelet count and d -dimer levels were determined every other day. In the 73 patients studied, AT, platelet count and fibrinogen progressively reduced during the observational period, reaching a nadir on the day of delivery, whereas d -dimer progressively increased over time. Statistical analysis was restricted to the 39 women that had an AT measurement performed on each of days ,1, 0 and +1, with respect to the day of delivery. These subjects showed a significant decrease in AT on the day of delivery compared to the day just before (77.8 ± 15.1%vs. 85.4 ± 14.2%, P = 0.027), followed by a recovery on the first day after delivery (87.6 ± 21.3% from 77.8 ± 15.1%, P = 0.005). Our study demonstrates that a significant drop in AT levels is associated with the clinical worsening of PE, regardless of its severity. [source]

Evaluation of metalloproteinases 2 and 9 and their inhibitors in physiologic and pre-eclamptic pregnancy

JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 2 2009
Martina Montagnana
Abstract Matrix metalloproteinases (MMPs) are a family of zinc and calcium-dependent endopeptidases involved in remodeling and physiological homeostasis of extracellular matrix (ECM). The metalloproteinases activity is predominantly modulated by specific tissue inhibitors of matrix metalloproteinases (TIMPs). The balance between MMPs and TIMPs is likely to play an important role in remodeling uterine arteries in pregnancy, and it may represent means by which vasodilatation is maintained in later pregnancy. Moreover, increased levels of MMPs and in particular MMP-2 play a role in the vascular alterations induced by hypertension. The aim of this study was the evaluation of MMP-2 and -9, along with their inhibitors TIMP-1 and -2, in pre-eclamptic women compared with normotensive pregnancy and non-pregnant women. Fourteen pre-eclamptic women were compared with 37 normotensive women in different gestational age and 21 non-pregnant women. Multiplexed sandwich enzyme-linked immunosorbent assay was used to measure MMPs and TIMPs simultaneously. MMP-2 levels were significantly higher in pre-eclamptic women vs. both non-pregnant and physiologic pregnant women. MMP-9 concentrations were significantly higher in physiologic pregnant vs. non-pregnant women. The serum levels of TIMP-1 were significantly higher in pre-eclamptic vs. both non-pregnant and physiologic pregnant women. TIMP-2 values were higher in physiologic pregnant women and pre-eclamptic women vs. non-pregnant women. A positive correlation between MMP-9 values and gestational age was observed in normal pregnant women. Results of the present investigation confirm that MMP-2 and TIMP-1 values are significantly higher in preeclampsia. We confirm that the modification of the fine balance between MMPs and their inhibitors plays a greater role in the structural and functional vascular changes of women with complicated pregnancies. J. Clin. Lab. Anal. 23:88,92, 2009. © 2009 Wiley-Liss, Inc. [source]

Prenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing Preeclampsia

Effects of Obesity on Pregnancy

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2008
Shelia A. Smith
ABSTRACT Objectives:, To examine physiologic and psychological outcomes associated with maternal obesity in pregnancy and patterns of pregnancy weight gain. To identify effective interventions for maternal obesity. Data sources and study selection:, Search of obesity and pregnancy research conducted over the past 10 years using CIHAHL, Medline ERIC, and PyscInfo databases. Studies including the following keywords were included in the review: obesity, weight gain, body image, pregnancy weight gain, pregnancy obesity complications, preeclampsia and gestational diabetes. Articles were included based on scientific merit and research outcomes. Data synthesis and conclusions:, Maternal obesity is a serious condition that significantly impacts not only mothers' health but also the health and future of their children. It is paramount that all levels of health care providers be aware of consequences of obesity and be knowledgeable of effective interventions. No effective long-term interventions have been demonstrated to prevent or control obesity during pregnancy. The paucity of published results of pregnancy and postpartum interventions to address weight gain in pregnancy suggests the need for more community and individualized based intervention studies, especially focusing on long-term effects. [source]

Preeclampsia: Exposing Future Cardiovascular Risk in Mothers and Their Children

Double inherited thrombophilias and adverse pregnancy outcomes: Fashion or science?

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2010
Giovanni Larciprete
Abstract Aim:, To determine to what extent double inherited thrombophilias are associated with adverse obstetric complications correlated with fetoplacental insufficiency, such as preeclampsia, hemolytic anemia elevated liver enzymes and low platelet count (HELLP) syndrome, gestational hypertension, fetal growth restriction (FGR), intrauterine death (ID), abruptio placentae and disseminated intravascular coagulopathy. Methods:, Pregnant women coming to delivery were retrospectively divided into two groups: group A (controls) and group B (cases). Patients belonging to group B had one of the following: severe preeclampsia, HELLP syndrome, gestational hypertension, FGR, intrauterine death, abruptio placentae of disseminated intravascular coagulopathy. We detected methylenetetrahydrofolate reductase (MTHFR) A1298C, MTHFR C677T, factor V Leiden, PAI-1, mutant prothrombin G20210A, plasma homocysteine, antithrombin III, protein S and activated protein C resistance. Normal pregnant women or pregnant women with double defects were enrolled in this study. Results:, The combination of MTHFR C677T mutation with PAI-1 (5G/5G) mutation was significantly linked with the occurrence of ID. HELLP syndrome was significantly related to the simultaneous presence of factor VIII and X mutations. The combination of MTHFR C677T with factor VIII mutation and the combination of factor II and V mutations were significantly related to the occurrence of abruptio placentae. We found an association between double isoforms MTHFR mutation and FGR. Conclusion:, It seems that some thrombophilias and a combination of thrombophilic factors carry a greater risk than others for a given adverse outcome. Further studies are needed to check the link between thrombophilic gene mutations and adverse pregnancy outcomes, such as recurrent miscarriages and deep venous thrombosis. [source]

Neutrophil apoptosis in preeclampsia, do steroids confound the relationship?

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2004
Akiko Fuchisawa
Abstract Aim:, To investigate the influence of maternal corticosteroid administration on neutrophil apoptosis in early onset preeclampsia. Methods:, We investigated five groups: early onset preeclampsia (EOPET, <34 weeks, n = 10); late-onset preeclampsia (LOPET, ,34 weeks, n = 7); normotensive intrauterine growth restriction (nIUGR, n = 11); normal pregnancy (NPC, n = 22); and non-pregnancy (n = 10). We examined, by flow cytometry, spontaneous neutrophil apoptosis after 18 h culture (hypodiploid DNA, Annexin V binding, propidium iodide [PI] permeability). Results:, For the 10 women with EOPET exposed to betamethasone in the previous 48 h, we found that neutrophil apoptosis was not inappropriately inhibited, in contrast to our previous findings in women not thus exposed. Neither LOPET nor nIUGR differed from normal pregnancy. Conclusion:, Betamethasone alters the rate of spontaneous neutrophil apoptosis in EOPET. The anti-inflammatory influence of betamethasone may explain some of the differences between our previous and present findings with respect to neutrophil apoptosis in EOPET. Corticosteroids ameliorate the course of antenatal and postnatal preeclampsia. These results may reflect the mechanisms that underlie the transient improvements seen with antenatal dexamethasone use. [source]