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Muacevic A, Adler JR. Is Maternal Serum Homocysteine a Novel Diagnostic Biomarker for Predicting Placenta-Mediated Disorders? Cureus 2023; 15:e33768. [PMID: 36793824 PMCID: PMC9924433 DOI: 10.7759/cureus.33768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/15/2023] Open
Abstract
Background Uteroplacental insufficiency and related disorders, though a significant cause of undesirable maternal and fetal outcomes, are complex and poorly understood. The newer screening modalities are expensive and difficult to procure for day-to-day use in developing countries. This study aimed to examine the association of mid-trimester maternal serum homocysteine levels with maternal and neonatal outcomes. Methodology This was a prospective cohort study involving 100 participants between 18 and 28 weeks of gestation. The study was conducted at a tertiary care center in south India from July 2019 to September 2020. Maternal blood samples were analyzed for serum homocysteine levels and correlated with the third-trimester pregnancy outcomes. Statistical analysis was done, and diagnostic measures were computed. Results The mean age was found to be 26.8 ± 4.8 years. Of the participants, 15% (n = 15) were diagnosed with hypertensive disorders during pregnancy, while 7% (n = 7) had fetal growth restriction (FGR) and 7% (n = 7) were complicated by preterm birth. An elevated maternal serum homocysteine level was positively associated with adverse pregnancy outcome measures such as hypertensive disorders (p = 0.001), with sensitivity and specificity of 27% and 99%, respectively, and FGR (p = 0.03) with sensitivity and specificity of 28.6% and 98.6%, respectively. Moreover, a statistically significant outcome was noted with preterm birth before 37 weeks (p = 0.001) and a low Apgar score (p = 0.02). No association was established with spontaneous preterm labor (p = 1.00), neonatal birth weight (p = 0.42), and special care unit admission (p = 1.00). Conclusions Such a simple and affordable investigation has the potential to go a long way in the early diagnosis and management of placenta-mediated disorders in pregnancy during the antenatal period, especially in low-resource settings.
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Association of combined second trimester maternal serum Homocysteine and Uterine Artery Doppler to predict adverse pregnancy outcome. J Obstet Gynaecol India 2022; 72:307-313. [PMID: 35923515 PMCID: PMC9339433 DOI: 10.1007/s13224-021-01451-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/19/2021] [Indexed: 10/20/2022] Open
Abstract
Introduction Disturbances in placentation increase the risk of maternal and fetal complications. Several biochemical and imaging modalities have been studied, but the hunt for a single effective screening test never became a reality as the causes of this complex condition are multifactorial and polygenetic, many of which we are only beginning to discover. Not many studies have been conducted in the developing countries like India and other low resource settings to consider whether it would be worthwhile to combine inexpensive and effective markers together for better prediction of adverse pregnancy outcome.This study primarily aims to investigate the predictability of combined screening with maternal serum homocysteine and second trimester uterine artery Doppler in diagnosis of adverse pregnancy outcome. Methodology A prospective cohort study which involved 100 women with singleton gestation, meeting the inclusion criteria, attending the inpatient or outpatient of Obstetrics and Gynaecology in Amrita Institute of Medical Sciences, Kerala, a tertiary care centre in Southern India from July 2016 and September 2018 was conducted. Serum Homocysteine estimation (tHcy) was done between 18 and 28 weeks of gestation with informed consent, and uterine artery (UA) Doppler PI which is a non-invasive routine study was done along with targeted second trimester anomaly scan (18-24 weeks) in Fetal Medicine Department. Cutoff values of tHcy and UA PI were computed at 95th (> / = 9.7 mmol/l) and 90th percentile, respectively as reported by Onalan et al. [9] and Nicholaides et al. [4]. Statistical analysis was performed using IBM SPSS version 20.0 software. Chi-square test and diagnostic measures were also used. Results Of the 100 patients, 15% (n = 15) developed hypertensive disorder. 7% (n = 7) had FGR and 7%(n = 7) had spontaneous preterm birth. 6% (n = 6) neonates had an APGAR score < 7 and 8% neonates (n = 8) required immediate NICU admission. Statistically significant association was found when tHcy and UA PI were used together for the prediction of FGR (p = 0.003), preterm birth (p = 0.002) and low APGAR score at birth (p = 0.009) with a specificity of 83.4%. With regard to PIH, both parameters were found to be statistically significant only when used independently (p = 0.001) but not when used in combination (p = 0.17). Both elevated tHcy and abnormal UA PI used in combination predicted adverse pregnancy outcome like FGR but with a low sensitivity of 14.3% and high specificity of 98.9%. However, when used independently these markers predicted FGR with a better sensitivity (tHcy- 28.6% and UA PI- 44.4%). Conclusion Findings from this study have been promising with potential clinical implications for the diagnosis and management of high-risk pregnancies. Though the independent role of the two markers in screening various adverse pregnancy outcomes could be proved, their combined use to improve predictivity of more complications warrants further studies on a larger population with appropriate randomisation.
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Mardali F, Fatahi S, Alinaghizadeh M, Kord Varkaneh H, Sohouli MH, Shidfar F, Găman MA. Association between abnormal maternal serum levels of vitamin B12 and preeclampsia: a systematic review and meta-analysis. Nutr Rev 2021; 79:518-528. [PMID: 33001182 DOI: 10.1093/nutrit/nuaa096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Some evidence has shown an association between maternal vitamin B12 levels and the development of preeclampsia in pregnant women, but the relationship between preeclampsia and vitamin B12 is not clear. OBJECTIVE The aim of this systematic review was to compare serum vitamin B12 levels in women with preeclampsia with those in normotensive pregnant women. DATA SOURCES The PubMed/MEDLINE, Scopus, and Web of Science databases were searched up to August 2019, along with the reference lists of included articles. STUDY SELECTION The literature was searched for observational studies that investigated vitamin B12 levels in women with preeclampsia. DATA EXTRACTION Data were extracted independently by 2 authors. Data were pooled using a random-effects model. RESULTS Vitamin B12 levels in women with preeclampsia were significantly lower than those in healthy women (mean, -15.24 pg/mL; 95%CI, -27.52 to -2.954; P < 0.015), but heterogeneity between studies was high (I2 = 97.8%; P = 0.0103). Subgroup analyses based on folic acid supplementation, homocysteine concentrations, and gestational age at the time of sampling for vitamin B12 assessment did not identify the sources of heterogeneity. CONCLUSIONS Women with preeclampsia had significantly lower vitamin B12 concentrations than normotensive pregnant women.
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Affiliation(s)
- Farzaneh Mardali
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Somaye Fatahi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Alinaghizadeh
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Kord Varkaneh
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mihnea-Alexandru Găman
- Department of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Cavallé-Busquets P, Inglès-Puig M, Fernandez-Ballart JD, Haro-Barceló J, Rojas-Gómez A, Ramos-Rodriguez C, Ballesteros M, Meyer K, Ueland PM, Murphy MM. Moderately elevated first trimester fasting plasma total homocysteine is associated with increased probability of miscarriage. The Reus-Tarragona Birth Cohort Study. Biochimie 2020; 173:62-67. [DOI: 10.1016/j.biochi.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/15/2020] [Indexed: 11/26/2022]
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The determinants of maternal homocysteine in pregnancy: findings from the Ottawa and Kingston Birth Cohort. Public Health Nutr 2020; 23:3170-3180. [PMID: 32188521 DOI: 10.1017/s1368980019004002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Observational studies have linked elevated homocysteine to vascular conditions. Folate intake has been associated with lower homocysteine concentration, although randomised controlled trials of folic acid supplementation to decrease the incidence of vascular conditions have been inconclusive. We investigated determinants of maternal homocysteine during pregnancy, particularly in a folic acid-fortified population. DESIGN Data were from the Ottawa and Kingston Birth Cohort of 8085 participants. We used multivariable regression analyses to identify factors associated with maternal homocysteine, adjusted for gestational age at bloodwork. Continuous factors were modelled using restricted cubic splines. A subgroup analysis examined the modifying effect of MTHFR 677C>T genotype on folate, in determining homocysteine concentration. SETTING Participants were recruited in Ottawa and Kingston, Canada, from 2002 to 2009. PARTICIPANTS Women were recruited when presenting for prenatal care in the early second trimester. RESULTS In 7587 participants, factors significantly associated with higher homocysteine concentration were nulliparous, smoking and chronic hypertension, while factors significantly associated with lower homocysteine concentration were non-Caucasian race, history of a placenta-mediated complication and folic acid supplementation. Maternal age and BMI demonstrated U-shaped associations. Folic acid supplementation of >1 mg/d during pregnancy did not substantially increase folate concentration. In the subgroup analysis, MTHFR 677C>T modified the effect of folate status on homocysteine concentration. CONCLUSIONS We identified determinants of maternal homocysteine relevant to the lowering of homocysteine in the post-folic acid fortification era, characterised by folate-replete populations. A focus on periconceptional folic acid supplementation and improving health status may form an effective approach to lower homocysteine.
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Chaudhry SH, Taljaard M, MacFarlane AJ, Gaudet LM, Smith GN, Rodger M, Rennicks White R, Walker MC, Wen SW. The role of maternal homocysteine concentration in placenta-mediated complications: findings from the Ottawa and Kingston birth cohort. BMC Pregnancy Childbirth 2019; 19:75. [PMID: 30782144 PMCID: PMC6381683 DOI: 10.1186/s12884-019-2219-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 02/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background Homocysteine is an intermediate metabolite implicated in the risk of placenta-mediated complications, including preeclampsia, placental abruption, fetal growth restriction, and pregnancy loss. Large cohort and case-control studies have reported inconsistent associations between homocysteine and these complications. The purpose of this study was to investigate whether elevated maternal plasma homocysteine concentration in the early to mid-second trimester is associated with an increased risk of placenta-mediated complications. We examined the following potential moderating factors that may explain discrepancies among previous studies: high-risk pregnancy and the MTHFR 677C>T polymorphism. Methods We analyzed data from participants recruited to the Ottawa and Kingston (OaK) Birth Cohort from 2002 to 2009 in Ottawa and Kingston, Canada. The primary outcome was a composite of any placenta-mediated complication, defined as a composite of small for gestational age (SGA) infant, preeclampsia, placental abruption, and pregnancy loss. Secondary outcomes were, individually: SGA infant, preeclampsia, placental abruption, and pregnancy loss. We conducted multivariable logistic regression analyses with homocysteine as the primary continuous exposure, adjusting for gestational age at the time of bloodwork and explanatory maternal characteristics. The functional form, i.e., the shape of the homocysteine association with the outcome was examined using restricted cubic splines and information criteria (Akaike’s/Bayesian Information Criterion statistics). Missing data were handled with multiple imputation. Results 7587 cohort participants were included in the study. Maternal plasma homocysteine concentration was significantly associated (linearly) with an increased risk of both the composite outcome of any placenta-mediated complication (p = 0.0007), SGA (p = 0.0010), severe SGA, and marginally with severe preeclampsia, but not preeclampsia, placental abruption and pregnancy loss. An increase in homocysteine concentration significantly increased the odds of any placenta-mediated complication (odds ratio (OR) for a 5 μmol/L increase: 1.63, 95% Confidence Interval (CI) 1.23–2.16) and SGA (OR 1.76, 95% CI 1.25–2.46). Subgroup analyses indicated some potential for modifying effects of the MTHFR 677C>T genotype and high-risk pregnancy, although the interaction was not statistically significant (high-risk subgroup OR 2.37, 95% CI 1.24–4.53, p-value for interaction =0.14). Conclusions Our results suggest an independent effect of early to mid-pregnancy elevated maternal homocysteine on placenta-mediated pregnancy complications. Electronic supplementary material The online version of this article (10.1186/s12884-019-2219-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shazia H Chaudhry
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda J MacFarlane
- Nutrition Research Division, Health Canada, Ottawa, Ontario, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Laura M Gaudet
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics & Gynaecology, Division of Maternal-Fetal Medicine, Queen's University, Kington, Ontario, Canada.,Kingston General Hospital Research Institute, Kington, Ontario, Canada
| | - Marc Rodger
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Mark C Walker
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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Maged AM, Saad H, Meshaal H, Salah E, Abdelaziz S, Omran E, Deeb WS, Katta M. Maternal serum homocysteine and uterine artery Doppler as predictors of preeclampsia and poor placentation. Arch Gynecol Obstet 2017; 296:475-482. [PMID: 28689278 DOI: 10.1007/s00404-017-4457-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the role of maternal serum total Homocysteine (tHcy) and uterine artery (Ut-A) Doppler as predictors of preeclampsia (PE), intrauterine growth restriction (IUGR), and other complications related to poor placentation. PATIENTS AND METHODS A prospective cohort study was conducted on 500 women with spontaneous pregnancies. tHcy was measured at 15-19 weeks, and then, Ut-A Doppler was performed at 18-22 weeks of pregnancy. RESULTS 453 pregnant women completed the follow-up of the study. The tHcy and Ut-A resistance index were significantly higher in women who developed PE, IUGR, and other complications when compared to controls (tHcy: 7.033 ± 2.744, 6.321 ± 3.645, and 6.602 ± 2.469 vs 4.701 ± 2.082 μmol/L, respectively, p value <0.001 and Ut-A resistance index: 0.587 ± 0.072, 0.587 ± 0.053, and 0.597 ± 0.069 vs 0.524 ± 0.025, respectively, p value <0.001). The use of both tHcy assessment and Ut-A Doppler improved the sensitivity of prediction of PE relative to the use of each one alone (85.2 relative to 73.33 and 60%, respectively). CONCLUSION The use of elevated homocysteine and uterine artery Doppler screening are valuable in prediction of preeclampsia, IUGR, and poor placentation disorders. CLINCALTRIAL. GOV ID NCT02854501.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt.
| | - Hany Saad
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Hadeer Meshaal
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Emad Salah
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Suzy Abdelaziz
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Eman Omran
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Wesam S Deeb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Maha Katta
- Department of Obstetrics and Gynecology, Faculty of Medicine, BeniSuef University, Beni Suef, Egypt
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Shahraki AD, Dehkordi NZ, Lotfizadeh M. Comparison of high dose and low dose folic acid supplementation on prevalence, onset and severity of preeclampsia. Adv Biomed Res 2016; 5:192. [PMID: 28217630 PMCID: PMC5221122 DOI: 10.4103/2277-9175.190944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Folic acid supplementation had previously mentioned as a protective factor against the onset of preeclampsia (PE). In this study, we aimed to compare the effect of high dose (5 mg daily) and low dose (1 mg daily) of folic acid supplementation on prevalence, onset and severity of PE. MATERIALS AND METHODS Pregnant women who were in the first trimester and referred to prenatal care university hospitals of Isfahan, Iran during October 2013-May 2015 were included in this study, then they were randomly divided into two groups of 5 mg and 1 mg (treated with daily 5 mg and 1 mg of folic acid, respectively), both groups received folic acid from the first trimester of pregnancy to 42 days after termination. Blood pressure, body mass index (BMI), and some urine and blood biochemistry parameters were measured. SPSS-22 used for statistical analysis. RESULTS A total of 943 pregnant women participated in the study (450 women in 1 mg group and 450 women in 5 mg group). Incidence rate of PE was 3.8% in 1 mg group and 2.4% in 5 mg group. In a comparison of preeclamptic patients in 1 mg and 5 mg group, no significant differences were seen regarding age, BMI, laboratory data, the severity of the disease, and onset (early or late) (P > 0.05). CONCLUSION Although our findings support that administration of high dose folic acid may decrease the prevalence of PE, there is not enough data to support that higher amount of folic acid administration can reduce the severity of presentation's signs or ameliorate the laboratory data and the onset of PE.
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Affiliation(s)
- Azar Danesh Shahraki
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, I.R., Iran
| | - Nastaran Zamani Dehkordi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, I.R., Iran
| | - Masoud Lotfizadeh
- Department of Community Health, Social Health Determinants Research Center, Shahrekord University of Medical Sciences, Shahrekord, I.R., Iran
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Gelaye B, Sumner SJ, McRitchie S, Carlson JE, Ananth CV, Enquobahrie DA, Qiu C, Sorensen TK, Williams MA. Maternal Early Pregnancy Serum Metabolomics Profile and Abnormal Vaginal Bleeding as Predictors of Placental Abruption: A Prospective Study. PLoS One 2016; 11:e0156755. [PMID: 27300725 PMCID: PMC4907440 DOI: 10.1371/journal.pone.0156755] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/19/2016] [Indexed: 01/22/2023] Open
Abstract
Background & Objective Placental abruption, an ischemic placental disorder, complicates about 1 in 100 pregnancies, and is an important cause of maternal and perinatal morbidity and mortality worldwide. Metabolomics holds promise for improving the phenotyping, prediction and understanding of pathophysiologic mechanisms of complex clinical disorders including abruption. We sought to evaluate maternal early pregnancy pre-diagnostic serum metabolic profiles and abnormal vaginal bleeding as predictors of abruption later in pregnancy. Methods Maternal serum was collected in early pregnancy (mean 16 weeks, range 15 to 22 weeks) from 51 abruption cases and 51 controls. Quantitative targeted metabolic profiles of serum were acquired using electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and the Absolute IDQ® p180 kit. Maternal sociodemographic characteristics and reproductive history were abstracted from medical records. Stepwise logistic regression models were developed to evaluate the extent to which metabolites aid in the prediction of abruption. We evaluated the predictive performance of the set of selected metabolites using a receiver operating characteristics (ROC) curve analysis and area under the curve (AUC). Results Early pregnancy vaginal bleeding, dodecanoylcarnitine/dodecenoylcarnitine (C12 / C12:1), and phosphatidylcholine acyl-alkyl C 38:1 (PC ae C38:1) strongly predict abruption risk. The AUC for these metabolites alone was 0.68, for early pregnancy vaginal bleeding alone was 0.65, and combined the AUC improved to 0.75 with the addition of quantitative metabolite data (P = 0.003). Conclusion Metabolomic profiles of early pregnancy maternal serum samples in addition to the clinical symptom, vaginal bleeding, may serve as important markers for the prediction of abruption. Larger studies are necessary to corroborate and validate these findings in other cohorts.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Susan J. Sumner
- Discovery Sciences, RTI International, Research Triangle Park, NC, United States of America
| | - Susan McRitchie
- Discovery Sciences, RTI International, Research Triangle Park, NC, United States of America
| | - James E. Carlson
- Discovery Sciences, RTI International, Research Triangle Park, NC, United States of America
| | - Cande V. Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, United States of America
| | - Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, United States of America
| | - Tanya K. Sorensen
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, United States of America
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Haas DM, Parker CB, Wing DA, Parry S, Grobman WA, Mercer BM, Simhan HN, Hoffman MK, Silver RM, Wadhwa P, Iams JD, Koch MA, Caritis SN, Wapner RJ, Esplin MS, Elovitz MA, Foroud T, Peaceman AM, Saade GR, Willinger M, Reddy UM. A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b). Am J Obstet Gynecol 2015; 212:539.e1-539.e24. [PMID: 25648779 DOI: 10.1016/j.ajog.2015.01.019] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/01/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The primary aim of the "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" is to determine maternal characteristics, which include genetic, physiologic response to pregnancy, and environmental factors that predict adverse pregnancy outcomes. STUDY DESIGN Nulliparous women in the first trimester of pregnancy were recruited into an observational cohort study. Participants were seen at 3 study visits during pregnancy and again at delivery. We collected data from in-clinic interviews, take-home surveys, clinical measurements, ultrasound studies, and chart abstractions. Maternal biospecimens (serum, plasma, urine, cervicovaginal fluid) at antepartum study visits and delivery specimens (placenta, umbilical cord, cord blood) were collected, processed, and stored. The primary outcome of the study was defined as pregnancy ending at <37+0 weeks' gestation. Key study hypotheses involve adverse pregnancy outcomes of spontaneous preterm birth, preeclampsia, and fetal growth restriction. RESULTS We recruited 10,037 women to the study. Basic characteristics of the cohort at screening are reported. CONCLUSION The "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" cohort study methods and procedures can help investigators when they plan future projects.
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McNulty B, McNulty H, Marshall B, Ward M, Molloy AM, Scott JM, Dornan J, Pentieva K. Impact of continuing folic acid after the first trimester of pregnancy: findings of a randomized trial of Folic Acid Supplementation in the Second and Third Trimesters. Am J Clin Nutr 2013; 98:92-8. [PMID: 23719554 DOI: 10.3945/ajcn.112.057489] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Supplementation with folic acid (FA) is recommended worldwide before and during early pregnancy because of its proven effect in preventing neural tube defects, but the role of FA after the 12th gestational week (GW) is much less clear. OBJECTIVE We investigated maternal folate and homocysteine responses and related effects in the newborn that resulted from continued FA supplementation after the first trimester of pregnancy. DESIGN Pregnant women, aged 18-35 y, who were attending an antenatal clinic in Northern Ireland with singleton uncomplicated pregnancies and reported taking FA supplements in the first trimester, were randomly assigned at the start of trimester 2 to receive 400 μg FA/d or a placebo capsule. RESULTS A total of 119 women (60 women in the placebo group; 59 women in the treatment group) completed the trial. From GWs 14-36, mean (±SD) serum folate decreased (from 45.7 ± 21.3 to 19.5 ± 16.5 nmol/L; P < 0.001) in unsupplemented women, whereas plasma homocysteine increased (6.6 ± 2.3 to 7.6 ± 2.3 μmol/L; P < 0.001). However, FA supplementation prevented these changes and resulted in a significant increase in red blood cell folate concentrations from 1203 ± 639 to 1746 ± 683 nmol/L (P < 0.001; GWs 14-36). Cord blood folate was significantly higher in the FA group than in the placebo group (red blood cell concentrations of 1993 ± 862 and 1418 ± 557 nmol/L, respectively; P = 0.001). CONCLUSIONS Continued supplementation with 400 μg FA/d in trimesters 2 and 3 of pregnancy can increase maternal and cord blood folate status and prevent the increase in homocysteine concentration that otherwise occurs in late pregnancy. Whether these effects have benefits for pregnancy outcomes or early childhood requires additional study.
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Affiliation(s)
- Breige McNulty
- Northern Ireland Centre for Food & Health, School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom
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Laskowska M, Laskowska K, Oleszczuk J. Elevated maternal serum sP-selectin levels in preeclamptic pregnancies with and without intrauterine fetal growth restriction, but not in normotensive pregnancies complicated by isolated IUGR. Med Sci Monit 2013; 19:118-24. [PMID: 23416763 PMCID: PMC3628855 DOI: 10.12659/msm.883780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background The aim of this study was to show differences of maternal serum sP-selectin levels in pregnancies complicated by intrauterine fetal growth restriction (IUGR) in the course of preeclampsia and to compare the results with normotensive pregnant women with isolated IUGR. These studies were also conducted on preeclamptic pregnancies with appropriate-for-gestational-age weight infants and on the control normotensive pregnant women. Material/Methods The study was carried out on 55 patients with pregnancy complicated by fetal growth restriction in the course of preeclampsia, 70 normotensive patients with pregnancies complicated by isolated IUGR, 39 preeclamptic patients with appropriate-for-gestational-age weight fetuses and 54 healthy normotensive pregnant patients with normal fetal growth. Maternal serum levels of sP-selectin were determined using the enzyme-linked immunosorbent assay. Results Levels of sP-selectin were higher in women with pregnancy complicated by preeclampsia with and without IUGR; whereas, in the group of normotensive pregnant women with isolated fetal growth restriction, serum sP-selectin levels tended to be lower than in the control subjects, but this difference was not statistically significant. The mean values were 192.05±70.96 ng/mL in the IUGR group, 293.18±222.92 ng/mL in the PI group, 379.78±353.13 ng/mL in the P group and 227.96±134.04 ng/mL in the healthy controls (p<0.001*). Conclusions Our findings may suggest that the elevated level of the soluble P-selectin is associated with preeclampsia, and that it may confirm the presence of platelet and endothelial activation, the presence of the hypercoagulant state and may be due to the systemic inflammatory response in this serious pregnancy disorder.
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Affiliation(s)
- Marzena Laskowska
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland.
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Conde-Agudelo A, Papageorghiou AT, Kennedy SH, Villar J. Novel biomarkers for predicting intrauterine growth restriction: a systematic review and meta-analysis. BJOG 2013; 120:681-94. [PMID: 23398929 DOI: 10.1111/1471-0528.12172] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several biomarkers for predicting intrauterine growth restriction (IUGR) have been proposed in recent years. However, the predictive performance of these biomarkers has not been systematically evaluated. OBJECTIVE To determine the predictive accuracy of novel biomarkers for IUGR in women with singleton gestations. SEARCH STRATEGY Electronic databases, reference list checking and conference proceedings. SELECTION CRITERIA Observational studies that evaluated the accuracy of novel biomarkers proposed for predicting IUGR. DATA COLLECTION AND ANALYSIS Data were extracted on characteristics, quality and predictive accuracy from each study to construct 2×2 tables. Summary receiver operating characteristic curves, sensitivities, specificities and likelihood ratios (LRs) were generated. MAIN RESULTS A total of 53 studies, including 39,974 women and evaluating 37 novel biomarkers, fulfilled the inclusion criteria. Overall, the predictive accuracy of angiogenic factors for IUGR was minimal (median pooled positive and negative LRs of 1.7, range 1.0-19.8; and 0.8, range 0.0-1.0, respectively). Two small case-control studies reported high predictive values for placental growth factor and angiopoietin-2 only when IUGR was defined as birthweight centile with clinical or pathological evidence of fetal growth restriction. Biomarkers related to endothelial function/oxidative stress, placental protein/hormone, and others such as serum levels of vitamin D, urinary albumin:creatinine ratio, thyroid function tests and metabolomic profile had low predictive accuracy. CONCLUSIONS None of the novel biomarkers evaluated in this review are sufficiently accurate to recommend their use as predictors of IUGR in routine clinical practice. However, the use of biomarkers in combination with biophysical parameters and maternal characteristics could be more useful and merits further research.
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Affiliation(s)
- A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, USA
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Demir B, Demir S, Pasa S, Guven S, Atamer Y, Atamer A, Kocyigit Y. The role of homocysteine, asymmetric dimethylarginine and nitric oxide in pre-eclampsia. J OBSTET GYNAECOL 2012; 32:525-8. [PMID: 22779953 DOI: 10.3109/01443615.2012.693985] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nitric oxide (NO) contributes to vasodilatation that is observed during normal pregnancy. Hyperhomocysteinaemia (HHcy) is a vascular risk factor associated with placental microvascular diseases and pre-eclampsia. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (NOS) has been linked to endothelial dysfunction. Maternal ADMA has been reported to be higher in women with pre-eclampsia and HHcy leads to accumulation of ADMA. The aim of this presented study is to evaluate the alterations of plasma homocysteine, ADMA and NO levels in mild pre-eclampsia. A total of 40 pre-eclamptic women and 40 healthy controls were included into the study. Mean systolic and diastolic blood pressure, mean serum homocysteine and ADMA levels were significantly higher and NO level was lower in patients. Serum homocysteine, ADMA and NO levels found to be correlated among them and with blood pressure. In conclusion, we found that homocysteine and ADMA levels were increased and NO levels decreased in pre-eclampsia.
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Affiliation(s)
- B Demir
- Ergani State Hospital, Department of Obstetrics and Gynecology, Diyarbakir, Turkey.
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15
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Cañete P, Monllor A, Pineda A, Hernández R, Tarín JJ, Cano A. Levels of heat shock protein 27 in placentae from small for gestational age newborns. Gynecol Obstet Invest 2012; 73:248-51. [PMID: 22414777 DOI: 10.1159/000334408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 10/16/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Recent data suggest that hsp27, a low-molecular-weight heat shock protein, exerts important cellular actions, including the modulation of oestrogen action. We investigated whether hsp27 was differentially expressed in placental samples from small for gestational age (SGA) neonates. METHODS This study was performed in an academic hospital. Samples of villous tissue were obtained from placentae of 31 SGA (n = 16) or adequate to gestational age neonates (n = 15) delivered vaginally. The histological distribution of hsp27 in placental villi was investigated by immunohistochemistry, and the concentration of the protein was quantified by ELISA. Differences between groups were assessed by the nonparametric Mann-Whitney U test. RESULTS Specific staining for hsp27 was detected in trophoblastic cells in most of the villi. The levels of hsp27 were lower in placentae from SGA neonates than from adequate to gestational age neonates. CONCLUSION The expression of hsp27 was reduced in placentae from SGA neonates. Further work is required in order to clarify the role of hsp27 in placental physiology.
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Affiliation(s)
- Patricia Cañete
- Service of Obstetrics and Gynecology, Fundación para la Investigación Hospital Universitario Dr Peset, Valencia, Spain
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Hogeveen M, Blom HJ, den Heijer M. Maternal homocysteine and small-for-gestational-age offspring: systematic review and meta-analysis. Am J Clin Nutr 2012; 95:130-6. [PMID: 22170376 DOI: 10.3945/ajcn.111.016212] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growth retardation in utero leading to small-for-gestational-age (SGA) newborns is associated with increased neonatal morbidity and mortality and with lifelong consequences such as poor cognitive function and cardiovascular diseases. Maternal total homocysteine (tHcy) concentrations have been linked to a wide range of adverse pregnancy outcomes and could possibly influence birth weight. OBJECTIVE We performed a systematic review of and meta-analysis on the association of maternal tHcy and birth weight. DESIGN A literature search of English, German, and French publications with the use of the PubMed database (January 1966-July 2010) found 78 abstracts. Search terms were as follows: homocysteine AND (birth weight OR small for gestational age OR intrauterine growth retardation). Studies were eligible if information on maternal tHcy and birth weight and the possible association between maternal tHcy and birth weight was available. Effect size estimates were converted to ORs as estimates of the RR of a woman to deliver SGA offspring when maternal tHcy exceeded the 90th percentile. RESULTS The search yielded 19 studies for analysis, consisting of 21,326 individuals. Pooled analysis resulted in a crude OR of 1.25 (95% CI: 1.09, 1.44). When this estimate was expressed as a linear effect, it corresponded to a decrease in birth weight of 31 g (95% CI: -13, -51 g) for a 1-SD increase in maternal tHcy. CONCLUSIONS Higher maternal tHcy concentrations are associated with a small increased risk for SGA offspring. The small estimated birth weight difference might be of little clinical relevance for the individual newborn; however, it could be of greater importance at a population level.
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Affiliation(s)
- Marije Hogeveen
- Department of Pediatrics, Radboud University, Nijmegen Medical Center, Netherlands.
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Úbeda N, Reyes L, González-Medina A, Alonso-Aperte E, Varela-Moreiras G. Physiologic changes in homocysteine metabolism in pregnancy: A longitudinal study in Spain. Nutrition 2011; 27:925-30. [DOI: 10.1016/j.nut.2010.10.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 10/01/2010] [Accepted: 10/14/2010] [Indexed: 11/27/2022]
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Laskowska M, Oleszczuk J. Homocysteine in pregnancies complicated by preeclampsia with and without IUGR: a comparison with normotensive pregnant women with isolated IUGR and healthy pregnant women. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ojog.2011.14037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The aim of this review is to evaluate the evidence for and against fasting plasma total homocysteine (tHcy) as a biomarker/risk factor of impaired reproductive function before and during pregnancy. Apart from nutritional and lifestyle factors, tHcy is also influenced by physiological factors specific to pregnancy such as hemodilution, increased glomerular filtration rate, and endocrinological changes. These lead to a considerable reduction under normal circumstances in tHcy by midpregnancy. Stimulating excess endogenous homocysteine production before and during pregnancy in animal experiments and adding exogenous homocysteine to cell cultures result in the impairment of reproductive and developmental processes from preconception throughout pregnancy and during subsequent development of the offspring. Different studies have confirmed that elevated tHcy is a risk factor for subfertility, congenital developmental defects, preeclampsia, and intrauterine growth retardation. There is conflicting evidence that elevated tHcy is a risk factor for miscarriage, gestational diabetes, premature rupture of the membranes, placental abruption, and offspring with Down syndrome. Prospective, sufficiently powered, studies from preconception/early pregnancy are required to determine whether tHcy is a risk factor for these pregnancy complications.
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Abstract
Total fasting plasma homocysteine (tHcy) is significantly reduced during early-mid normal pregnancy. Elevated tHcy during or outside of pregnancy has been associated with adverse pregnancy outcomes, affecting either the fetus or the evolution of the pregnancy. Examples of direct adverse effects on the fetus are neural tube defects, Down's syndrome, congenital heart defects and intrauterine growth retardation. Both fetal and maternal wellbeing can be affected by other adverse outcomes reported to be associated with elevated tHcy, such as recurrent spontaneous abortion, pre-eclampsia or placental vasculopathy. To date, endothelial activation of the placental vascularization system, apoptosis, toxicity and stimulation of uterine contractions have been proposed as possible modes of adverse action of homocysteine. The strength of the clinical evidence for a pathological role of elevated homocysteine in the evolution of pregnancy is examined in this review.
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Affiliation(s)
- Michelle M Murphy
- Universitat Rovira i Virgili, Unitat de Medicina Preventiva i Salut Pública, Facultat de Medicina i Ciències de la Salut, 43201 Reus, Spain.
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Giguère Y, Charland M, Bujold E, Bernard N, Grenier S, Rousseau F, Lafond J, Légaré F, Forest JC. Combining biochemical and ultrasonographic markers in predicting preeclampsia: a systematic review. Clin Chem 2009; 56:361-75. [PMID: 20044446 DOI: 10.1373/clinchem.2009.134080] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Early identification of pregnant women at risk for preeclampsia is a priority to implement preventive measures. Some biochemical and ultrasonographic parameters have shown promising predictive performance, but so far there is no clinically validated screening procedure. CONTENT Using a series of keywords, we reviewed electronic databases (Medline, Embase, all records to May 2009) reporting the performance of biological and ultrasonographic markers to predict preeclampsia, both single markers and combinations of markers. We analyzed the data according to gestational age and risk levels of the studied populations. We evaluated the methodological quality of included publications using QUADAS (quality assessment of diagnostic accuracy studies). We identified 37 relevant studies that assessed 71 different combinations of biochemical and ultrasonographic markers. Most studies were performed during the second trimester on small-scale high-risk populations with few cases of preeclampsia. Combinations of markers generally led to an increase in sensitivity and/or specificity compared with single markers. In low-risk populations, combinations including placental protein 13 (PP13), pregnancy-associated plasma protein A (PAPP-A), a disintegrin and metalloprotease-12 (ADAM12), activin A, or inhibin A measured in first or early second trimester and uterine artery Doppler in second trimester appear promising (sensitivity 60%-80%, specificity >80%). In high-risk populations, the combination of PP13 and pulsatility index in first trimester showed 90% sensitivity and 90% specificity in a single study limited to severe preeclampsia. SUMMARY Combinations of biochemical and ultrasonographic markers improved the performance of early prediction of preeclampsia. From a perspective of integrative medicine, large population-based studies evaluating algorithms combining multiple markers are needed, if screening approaches are to be eventually implemented.
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Affiliation(s)
- Yves Giguère
- CHUQ Research Center/Hôpital Saint-François d'Assise, Québec City, Québec, Canada
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Mao D, Che J, Li K, Han S, Yue Q, Zhu L, Zhang W, Li L. Association of homocysteine, asymmetric dimethylarginine, and nitric oxide with preeclampsia. Arch Gynecol Obstet 2009; 282:371-5. [PMID: 19806356 DOI: 10.1007/s00404-009-1234-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 09/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Endothelial dysfunction underlies the pathogenesis of preeclampsia, but its mechanism has not yet been completely understood. In this study we have aimed to measure homocysteine (Hcy), asymmetric dimethylarginine (ADMA), and nitric oxide (NO) levels as endothelial dysfunction markers in preeclamptic women. METHODS Control-case study with 62 preeclamptic patients and 30 controls without pregnancy complications was conducted. Plasma total Hcy, determined by capillary column gas chromatography/mass spectrometry (GC/MS), was correlated with serum ADMA (determined by liquid chromatography/tandem mass spectrometry using (13)C(6)-L: -arginine as the internal standard) and NO (analyzed by GC/MS). RESULTS There was a highly significant increase in the plasma concentration of homocysteine (P < 0.001) and ADMA (P < 0.001) and a highly significant decrease in the plasma concentration of nitric oxide (P < 0.001) among the preeclamptic patients. The differences were more significant between mild and severe preeclampsia, with and without eclampsia, with and without HELLP (hemolysis, elevated serum level of liver enzymes, and low platelets). In the combined patients and control groups a highly significant positive correlation was found between the plasma concentrations of homocysteine and ADMA (r = 0.853, P < 0.001). In addition, significant negative correlations were detected between the plasma concentrations of nitric oxide and the plasma concentration of homocysteine (r = -0.870, P < 0.001) and ADMA (r = -0.895, P < 0.001). These significant correlations were found to persist, even when they were restricted to the preeclamptic patients. CONCLUSIONS The homocysteine-ADMA-NO may be at least partly responsible for etiology in preeclampsia and could be regarded as markers for the severity of the disease. Therefore, L: -arginine may represent a novel therapy for the treatment of preeclampsia.
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Affiliation(s)
- Dongwei Mao
- Department of Obstetrics and Gynecology, The Forth Affiliated Hospital, Harbin Medical University, Harbin, China.
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Dodds L, Fell DB, Dooley KC, Armson BA, Allen AC, Nassar BA, Perkins S, Joseph KS. Effect of homocysteine concentration in early pregnancy on gestational hypertensive disorders and other pregnancy outcomes. Clin Chem 2007; 54:326-34. [PMID: 18070815 DOI: 10.1373/clinchem.2007.097469] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Increased total homocysteine (tHcy) may be associated with placental-mediated adverse pregnancy outcomes, but few prospective studies have measured tHcy before pregnancy outcome. This study was undertaken to determine whether increased tHcy measured in early pregnancy is associated with pregnancy loss, gestational hypertension (GH), preeclampsia, or small for gestational age (SGA) infants. METHODS We conducted a prospective cohort study between 2002 and 2005. We measured tHcy and serum folate in blood samples from pregnant women (<20 weeks' gestation) and collected detailed pregnancy information through a questionnaire and medical record review. RESULTS Of the 2119 women included in the study, 103 had a pregnancy loss, 115 had gestational hypertension, 65 had preeclampsia, and 129 had an SGA infant. Subjects with increased tHcy concentrations were at increased risk of pregnancy loss [relative risk (RR) 2.1, 95% CI 1.2-3.6] or preeclampsia (RR 2.7, 95% CI 1.4-5.0) than subjects with lower tHcy concentrations, but increased tHcy concentration was not associated with increased risk of developing GH or having an SGA infant. CONCLUSION The finding of high tHcy in early pregnancy as a risk factor for pregnancy loss and preeclampsia is consistent with a hypothesis that increased tHcy results in abnormalities of the placental vasculature.
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Affiliation(s)
- Linda Dodds
- Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Hui L, Challis D. Diagnosis and management of fetal growth restriction: the role of fetal therapy. Best Pract Res Clin Obstet Gynaecol 2007; 22:139-58. [PMID: 17698415 DOI: 10.1016/j.bpobgyn.2007.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Fetal growth restriction remains a major cause of perinatal morbidity and mortality in modern obstetric practice. Placental insufficiency is the most common association, but is often a diagnosis of exclusion. Currently, no treatment can ameliorate or reverse established growth restriction: maximising gestational age and judicious timing of steroid administration and delivery are the primary tasks for the obstetrician. Although comprehensive surveillance of the preterm fetus now includes ductus venosus Doppler studies, its effectiveness in timing delivery has yet to be confirmed in randomised controlled trials. More basic research on the regulation of fetal growth is needed before specific therapies for established growth restriction can be developed.
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Affiliation(s)
- Lisa Hui
- Division of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia.
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Bibliography. Current world literature. Maternal-fetal medicine. Curr Opin Obstet Gynecol 2007; 19:196-201. [PMID: 17353689 DOI: 10.1097/gco.0b013e32812142e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guven MA, Ertas IE, Kilinc M, Coskun A, Ekerbicer H. Combining mid-trimester maternal plasma homocysteine with uterine artery doppler velocimetry: is it useful? Arch Gynecol Obstet 2006; 275:439-43. [PMID: 17111155 DOI: 10.1007/s00404-006-0281-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 10/24/2006] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the possible association between mid-trimester maternal plasma homocysteine concentration, uterine artery Doppler measurements in a two-stage screening strategy, and outcome of pregnancy. MATERIALS AND METHODS This prospective observational study was conducted on healthy women undergoing screening for pre-eclampsia by uterine artery Doppler velocimetry at 20-22 and 24-26 weeks of gestation. Abnormal uterine artery blood flow was defined as an average resistance index (RI) > 0.58 and/or bilateral early diastolic notch. Homocysteine measurement was performed by two competitive immunoassay methods involving two steps at 20-22 and 24-26 weeks' gestation. RESULTS Sixty women enrolled. Abnormal Doppler findings were found in 18 of 60 (30%) women at 20-22 weeks of gestation. This proportion was reduced to 10% (6/60) at 24-26 weeks of gestation, and two of these six women developed pre-eclampsia later in pregnancy. There was no significant difference in the maternal plasma homocysteine levels in women with abnormal Doppler findings when compared with controls at first and second visits (p > 0.05). CONCLUSION Mid-trimester maternal homocysteine concentration is not elevated in women with abnormal uterine artery Doppler findings in a two-stage screening method.
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Affiliation(s)
- Melih A Guven
- Department of Obstetrics and Gynecology, School of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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Bibliography. Current world literature. Women's health. Curr Opin Obstet Gynecol 2006; 18:666-74. [PMID: 17099340 DOI: 10.1097/gco.0b013e328011ef42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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