ADAMTS4 and Oxidative/Antioxidative Status in Preterm Premature Rupture of Membranes

AIM

To determine the function of a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS4), total oxidant status (TOS), total antioxidant status (TAS), and aryl esterase (ARES) in preterm premature rupture of membranes (PPROM) and to investigate the association with premature rupture of membranes (PROMs).

MATERIAL AND METHODS

58 pregnant women were included in this prospective study which comprised 29 PPROM patients as the study group and 29 patients, having healthy amniotic membranes, as the control group. ADAMTS4, TAS, TOS, and ARES levels were studied in the amniotic membrane homogenates of the patients.

RESULTS

ADAMTS4, TAS TOS, and ARES levels of amniotic membrane lysates were significantly different between PPROM and control groups (p < 0.001, p < 0.001, p = 0.008 and p = 0.002, respectively). Increased amniotic membrane ADAMTS4 (OR: 1.051 95% CI 1.006-1.098, p = 0.024) and TOS (OR: 12.777 95% CI 1.595-102.323, p = 0.016) were found to be significantly associated with the increased risk of PPROM.

CONCLUSION

ADAMTS4, TOS, and ARES levels were higher and TAS level was lower in PPROM patients than the normal healthy control group which had healthy amniotic membranes at term. As a result, ADAMTS4 may have a role in the pathogenesis by causing increased oxidative and inflammatory environment in PPROM.

Role of ADAMTS5 in Unexplained Fetal Growth Restriction (FGR)

AIM

We aim to determine the role of serum and placental A disintegrin and metalloproteinase with thrombospondin motif 5 (ADAMTS5) in fetal growth restriction (FGR).

MATERIAL AND METHODS

43 pregnancies suffering FGR and 45 healthy ones were homogenized for their body mass indices, ages, and gestational weeks. Expression of ADAMTS5 in placental samples was determined by immunohistochemical methods and concurrent maternal serum ADAMTS5 levels were determined with enzyme-linked immunosorbent assay.

RESULTS

Expression of ADAMTS5 was higher in FGR group than the healthy control in placenta. Both the cytoplasmic staining pattern of the syncytiotrophoblasts and staining of the decidual plate were shown in the FGR group; but not in the control group. A negative correlation between serum ADAMTS5 levels and birth weight in FGR group was observed.

CONCLUSION

Increased ADAMTS5 levels were observed in placental insufficiency cases. This study demonstrates that ADAMTS5 may be a sensitive indicator of placental insufficiency which has variable factors in etiology. Additional work is needed to delineate the mechanism of its involvement.

Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy?

AIM

Our aim was to investigate whether any hematological changes readily detectable by simple complete blood count (CBC), as well as fasting and postprandial total serum bile acid (SBA) levels, have diagnostic values for the prediction of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP).

METHODS

A prospective, case control study was carried out including 217 pregnant women (117 women with ICP and 100 healthy controls). The main outcome measures investigated were preterm delivery, APGAR scores, and neonatal unit admission. A multivariate logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes.

RESULTS

Compared with controls, women with ICP had significantly higher mean platelet volume (MPV) (mean 10.2±1.0 vs. 11.0±1.3; P<0.001) and platelet distribution width (PDW) (mean 13.1±2.3 vs. 14.7±2.8; P<0.001) values. Analysis with logistic regression revealed that the probability of preterm delivery did not increase until MPV levels exceeded 11.2 fL [odds ratio (OR)=2.68, 95% confidence interval (CI)=1.13-6.32, P=0.025], and total bilirubin levels exceeded 0.6 mg/dL (OR=3.13, 95% CI=1.21-8.09, P=0.019). Considering the low APGAR scores, only increased postprandial total SBA levels of ≥51 μmol/L were found to be predictive significantly (OR=3.02, 95% CI=1.07-8.53, P=0.037).

CONCLUSIONS

Our study suggests that increased MPV and total bilirubin levels are associated with preterm delivery, and increased postprandial total SBA levels are predictive for low APGAR in ICP patients.

An eight-year retrospective analysis of antenatal screening results for syphilis: is it still cost effective?

INTRODUCTION

This study aimed to document the prevalence of syphilis among pregnant women in Turkey.

METHODOLOGY

In this retrospective cohort study, a total of 63,276 sera obtained between January 2007 and June 2014 from women who were routinely screened for syphilis as a part of antenatal care at a tertiary referral hospital in Turkey were analyzed. Serological screening was done with the rapid plasma reagin (RPR) test on venous blood samples. Treponema pallidum hemagglutination assay (TPHA) was the confirmation test for the diagnosis of syphilis in patients who had positive results in the screening test.

RESULTS

Between 2007 and the first six months of 2014, 41 RPR+ and only five confirmed syphilis-positive patients were determined. The syphilis seroprevalence rate was 0.0648%. Within these years, there was no case of congenital syphilis detected in the hospital.

CONCLUSION

As there is evidence of effective screening of syphilis contributing to the effective treatment and prevention of adverse outcomes, routine antenatal screening of syphilis is recommended. The rationale depends on the consideration of the serious results of not treating the disease and the cost effectiveness of screening.

The role of interleukin-17 in intrahepatic cholestasis of pregnancy

OBJECTIVE

Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease, is characterized by pruritus, abnormal liver function and elevated serum bile acid levels. The main cause of ICP has not yet been identified. We aimed to provide a new perspective to the pathogenesis of by investigating the possible association of circulating interleukin-17 (IL-17) that is a recently discovered proinflammatory cytokine levels with ICP.

MATERIALS AND METHODS

In this controlled cross-sectional study, maternal venous blood samples were obtained from 33 consecutive pregnant women with ICP (15 with mild and 18 with severe forms of the disease) and 25 healthy women with uncomplicated pregnancies (as the control group) and IL-17 levels were compared among the groups.

RESULTS

Although serum IL-17 levels were significantly higher in the severe ICP group than in the control group (p = 0.022), there were no significant differences between the mild and severe ICP groups or between the control and mild ICP groups.

CONCLUSION

Explaining the mechanisms of hepatocyte injury might contribute to the existing therapeutic strategies for treating cholestatic diseases. Changes in IL-17 levels may shed light on the pathogenesis of ICP.

Alterations in lipid peroxidation and T-cell function in women with hyperemesis gravidarum

The objective of this study was to investigate serum adenosine deaminase (ADA) activity as a marker of T lymphocyte activation and parameters of oxidative stress and antioxidant defence in hyperemesis gravidarum (HG). Serum ADA activity, malondialdehyde (MDA), catalase (CAT) and glutathione peroxidase (GPx) levels were investigated in 40 pregnant women with the HG and 40 with healthy pregnancies, in a descriptive study. Although serum ADA and CAT were measured to be higher in HG group, the difference was not significant. Serum MDA and GPx levels were significantly elevated in women with HG when compared with those without HG. The significance of changes in lipid peroxidation and T-cell activation in the pathogenesis of HG and whether this is a cause or a compensatory reaction to HG requires further investigations with larger multicentre trials.

Placental ADAMTS-12 Levels in the Pathogenesis of Preeclampsia and Intrahepatic Cholestasis of Pregnancy

Our aim was to determine whether placental A Disintegrin-like Metalloproteinase with ThromboSpondin motif 12 (ADAMTS-12), arylesterase (ARES) levels, total oxidant status (TOS), and total antioxidant status (TAS) differ in preeclampsia, intrahepatic cholestasis of pregnancy (ICP), and uncomplicated pregnancies or not. A prospective case-control study was carried out including 84 pregnant women (26 with ICP, 28 preeclamptic patients, and 30 healthy controls). Levels of ADAMTS-12, TAS, TOS, and ARES were studied in the supernatants of placental tissue homogenates. Placental ADAMTS-12 levels were distributed as 240.9 pg/mg in ICP, 289.7 pg/mg in preeclampsia, and 310.8 pg/mg in control groups. Levels of ADAMTS-12 (odds ratio = 6.509, 95% confidence interval:1.070-39.592, P = .042) in the placenta of the ICP were significantly lower than those in preeclampsia and control groups (P = .004), but no statistical significant difference was determined between preeclampsia and control groups. Decreased levels of placental ADAMTS-12 were found to be associated with ICP, suggesting a possible role of inflammation in the pathogenesis.

First trimester interleukin-6 levels help to predict adverse pregnancy outcomes in both thyroid autoantibody positive and negative patients

AIM

The aim of the present study is to compare pregnancy outcomes among patients with and without thyroid antibodies and/or subclinical hypothyroidism and investigate whether there is an association between first trimester maternal plasma interleukin-6 (IL-6) levels and adverse pregnancy outcomes.

METHODS

A case-control study was carried out including 83 pregnant women (40 thyroid antibody positive and 43 healthy controls). The predictive value of first trimester maternal plasma IL-6 levels on adverse pregnancy outcomes were investigated. The optimal cut-off points of IL-6 for determining maternal and fetal outcomes were evaluated by receiver operating characteristic analyses.

RESULTS

Compared with the control, median IL-6 levels were significantly higher in thyroid antibody positive pregnancies (median 1.58 vs 1.63 pg/mL; P = 0.047). IL-6 levels were found to be significantly higher in women who had suffered a miscarriage (P = 0.002), preterm delivery (P < 0.001), intrauterine growth restriction (P = 0.047), preterm premature rupture of membranes (P = 0.043) and overall prenatal complications (P < 0.001). A statistically significant negative correlation between gestational week at birth and IL-6 levels was also determined among all participants involved in the study (r = -0.385, P < 0.001).

CONCLUSION

IL-6 levels are significantly increased in thyroid antibody positive patients and predictive for future adverse outcomes, irrespective of thyroid autoimmunity. Increased first trimester IL-6 levels independently predict adverse pregnancy outcomes, regardless of subclinical hypothyroidism.

Prediction of gestational diabetes mellitus by first trimester serum secreted frizzle-related protein-5 levels

OBJECTIVE

The main aim of this study was to investigate the first trimester maternal serum secreted frizzle-related protein-5 (Sfrp-5) levels and to evaluate the predictive value on the subsequently developed gestational diabetes mellitus (GDM).

METHODS

A total of 40 pregnant women who subsequently developed GDM and 44 age- and pre-pregnancy BMI-matched healthy pregnant women were enrolled in this prospective case-control study. First trimester serum Sfrp-5 levels were evaluated to determine if there is an association with the onset of GDM, by using logistic regression analysis.

RESULTS

Decreased first trimester serum Sfrp-5 levels (OR = 14.332, 95%CI: 4.166-49.301, p < 0.001) were found to be significantly associated with the increased risk of GDM. There were no statistically significant differences in serum Sfrp-5 levels between the diet- and insulin-treated GDM groups and also serum Sfrp-5 levels were not found to be predictive for adverse perinatal outcomes (p > 0.05).

CONCLUSIONS

Decreased first trimester serum Sfrp-5 levels are significantly associated with the increased risk of GDM.

The Value of Total antioxidant Status and Serum Tumor Necrosis Factor-α Levels at 24–28 Weeks of Gestation in the Prediction of Optimal Treatment Protocol in Gestational Diabetes Mellitus

Aim: The aim of this study was to investigate the serum oxidative stress markers, antioxidant enzyme and tumor necrosis factor-α (TNF-α) levels at 24–28 weeks of gestation and to evaluate the predictive value of them on the subsequent treatment protocol in gestational diabetes mellitus (GDM).

Methods: A total of 58 GDM patients (30 treated with only conventional healthy dietary recommendation (CHDR), 28 treated with insulin) and 30 healthy pregnant women at 24–28 weeks of gestation, were enrolled in this prospective case-control study. The oxidative status, antioxidant enzyme and TNF-α levels were evaluated to determine if there is an association with the need of insulin therapy for glycemic control by using multivariable logistic regression analysis.

Results: TNF-α (OR=11.976, 95%CI: 2.441–58.754, P=0.002) and total antioxidant status (TAS) (OR=12.769, 95%CI: 2.464–66.182, P=0.002) were found to be predictive for GDM at 24–28 weeks of gestation. Besides, further evaluation considering the treatment modality showed that increased TNF-α (OR=18.615, 95%CI: 2.338–148.240, P=0.006) and lower TAS levels (OR=99.471, 95%CI: 2.865–3 453.061, P=0.011) were independent predictors of the need for insulin treatment in GDM patients.

Conclusions: Increased TNF-α levels and low TAS are significantly associated with the increased risk of insulin requirement for achieving good glycemic control in GDM.

Maternal and fetal serum levels of caspase-cleaved fragments of cytokeratin-18 in intrahepatic cholestasis of pregnancy

OBJECTIVE

We aimed to investigate the relationship between intrahepatic cholestasis of pregnancy (ICP) and caspase-cleaved fragments of cytokeratin-18, also referred to as M30, a marker of apoptosis.

METHODS

In this case-control study, maternal and umbilical cord blood venous samples were obtained from 21 pregnant women with ICP and 22 healthy pregnant women as a control group. M30 levels were compared among the groups.

RESULTS

Maternal serum M30 levels were significantly higher in the severe ICP group than in the control (p < 0.001) and mild ICP groups (p = 0.006). The values were comparable between the mild ICP and the control groups. The umbilical cord serum M30 levels were also significantly greater in the severe ICP group than in the control group (p = 0.001).

CONCLUSIONS

Changes in M30 levels, as an apoptosis marker, may shed light on the pathogenesis of ICP. Explaining the mechanisms of bile acid (BA)-induced hepatocyte injury may contribute further therapeutic strategies for the treatment of human cholestatic diseases.

Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion

We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.

Prediction of cardiovascular risk by electrocardiographic changes in women with intrahepatic cholestasis of pregnancy

OBJECTIVE

We aimed to investigate P wave characteristics in pregnant women with and without intrahepatic cholestasis of pregnancy (ICP).

METHODS

In this case-control study, including 59 pregnant women with intrahepatic cholestasis and 28 with healthy uncomplicated pregnancies, electrocardiographic maximum (Pmax) and minimum (Pmin) P-wave durations and P-wave dispersion (Pd) parameters were investigated.

RESULTS

While Pmin and Pd values were significantly lower in women both with mild and severe ICP when compared to healthy pregnant women (p < 0.001), there was no significant difference between mild and severe disease groups.

CONCLUSION

Intrahepatic cholestasis predisposes to cardiovascular complications. P-wave durations and Pd constitute a recent contribution to the field of noninvasive electrocardiology. Our data clearly demonstrated that these parameters were significantly altered in pregnant women with ICP when compared to the normal ones. This important association can be used to screen for women with an increased risk to better target counseling on lifestyle modifications and to closer follow-up and management of women with a history of ICP.

Birth weight for gestational age: a reference study in a tertiary referral hospital in the middle region of Turkey

BACKGROUND

The purpose of this study was to establish a fetal birth weight curve for gestational age for patients who presented to our tertiary referral hospital. The curve can be used for epidemiological analysis and also to develop Turkey's first national nomogram.

METHODS

A total of 68,255 live singleton pregnancies delivered during the study period in a tertiary referral hospital were initially reviewed in this study. The data were carefully collected from hospital records and patients' files. Gestational age (weeks) was assessed by either ultrasound examination or according to the patient's last menstrual period, or both. Sex-specific reference tables for fetal birth weight by gestational age were created, and statistical analyses were carried out for descriptive variables using SPSS 15.0 for Windows.

RESULTS

Most newborns weighed between 3000 g and 4000 g. The percentile fetal birth weight curves for gestational age showed that fetal birth weight increased with the increase in gestational age. Typically, male infants were noted to have higher birth weights than female infants. When our results were compared with those of previous studies, it was demonstrated that values for the 10(th) percentile were higher in our study, whereas values for the 90(th) percentile were similar to those of previous studies.

CONCLUSION

To the best of our knowledge, this is the first study evaluating the correlation between gestational age and fetal birth weight with such a large sample size in Turkey. Therefore, the results of this reference study can be helpful in defining normal and abnormal fetal growth in Turkish newborns.

P-wave duration changes and dispersion in preeclampsia

OBJECTIVE

The purpose of this research was to study P wave parameters to determine the association between preeclampsia and future cardiovascular risk and to study the possible correlation between P waves and severity of preeclampsia.

STUDY DESIGN

In this case-control study 58 pregnant women with preeclampsia and 30 normal pregnant women were compared by measuring maximum and minimum P-wave durations and P-wave dispersion (Pd) in the late third trimester.

RESULTS

Minimum P wave values were lower and Pd values were higher, both significantly, in the preeclampsia groups than in the control group. In addition, the Pd values of the severe preeclampsia group were higher compared to that of the mild preeclampsia group.

CONCLUSION

Preeclampsia predisposes the patient to future cardiovascular complications including atrial or ventricular arrhythmias, but validated tools to assess the risks are yet not available. P-wave duration and Pd constitute a recent contribution to the field of noninvasive electrocardiology. Our data clearly demonstrated that minimum P wave and Pd values were significantly altered in preeclamptic pregnant women when compared to the controls. This important association can be used to screen women for increased risk in order to better target counseling regardinglifestyle modifications and to follow up and manage women with a history of preeclampsia more closely.

Disturbed release of cholecystokinin in pregnant women with hyperemesis gravidarum

AIMS

We aimed to investigate cholecystokinin (CCK) release in pregnant women with and without hyperemesis gravidarum (HG).

MATERIAL AND METHODS

In this case-control study including 40 pregnant women with HG and 40 women with healthy uncomplicated pregnancies, serum CCK levels in addition to hematological, biochemical and hormonal parameters were investigated.

RESULTS

Serum CCK values were found to be significantly lower in pregnant women with HG (P < 0.001). Additionally, while serum blood urea nitrogen and free thyroxine levels were significantly higher, sodium, potassium, and thyroid stimulating hormone levels were significantly lower in women with HG than in control women. No correlation was detected between CCK and other parameters like ketonuria and thyroid function tests.

CONCLUSIONS

CCK release has been found to be halved in pregnant women with HG, which supports the hypothesis that gastrointestinal motility is increased in pregnant women with HG. A causal effect remains to be confirmed.