The relationship between inflammation markers and ketonuria in hyperemesis gravidarum

Vitamin D and hyperemesis gravidarum: A mendelian randomization study

BACKGROUND

The causality between vitamin D and hyperemesis gravidarum remains unknown. Our aim was to investigate the causal effect of vitamin D on hyperemesis gravidarum using the two-sample Mendelian randomization method.

METHODS

Independent single nucleotide polymorphisms significantly associated with serum 25-hydroxyvitamin D levels served as instrumental variables. The corresponding effect estimates for hyperemesis gravidarum were obtained from the Finngen Biobank. For Mendelian randomization analysis, inverse variance weighting was used as the primary method. We also used weighted median, MR-Egger regression, simple mode, and weighted mode as complementary methods to inverse variance weighting. The MR-Egger intercept test, Cochran's Q test, and "leave-one-out" sensitivity analysis were performed to assess the horizontal pleiotropy, heterogeneity, and stability of the causal association between 25-hydroxyvitamin D levels and hyperemesis gravidarum.

RESULTS

We found that an increase in 25-hydroxyvitamin D level was associated with a lower risk of hyperemesis gravidarum [odds ratio (OR): 0.568, 95 % CI: 0.403-0.800, p = 0.001]. The result demonstrates the causal relationship between 25-hydroxyvitamin D level and the risk of hyperemesis gravidarum in the European population.

CONCLUSIONS

The large Mendelian randomization analysis suggests that vitamin D may be causally associated with risk of hyperemesis gravidarum.

Maternal hepatic immunology during pregnancy

The liver plays pivotal roles in immunologic responses, and correct hepatic adaptations in maternal immunology are required during pregnancy. In this review, we focus on anatomical and immunological maternal hepatic adaptations during pregnancy, including our recent reports in this area. Moreover, we summarize maternal pregnancy-associated liver diseases, including hyperemesis gravidarum; intrahepatic cholestasis of pregnancy; preeclampsia, specifically hemolysis, elevated liver enzymes, and low platelet count syndrome; and acute fatty liver of pregnancy. In addition, the latest information about the factors that regulate hepatic immunology during pregnancy are reviewed for the first time, including human chorionic gonadotropin, estrogen, progesterone, growth hormone, insulin like growth factor 1, oxytocin, adrenocorticotropic hormone, adrenal hormone, prolactin, melatonin and prostaglandins. In summary, the latest progress on maternal hepatic anatomy and immunological adaptations, maternal pregnancy-associated diseases and the factors that regulate hepatic immunology during pregnancy are discussed, which may be used to prevent embryo loss and abortion, as well as pregnancy-associated liver diseases.

The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum

AIM

Hyperemesis gravidarum (HG) is one of the most common serious diseases in early pregnancy. This study aimed to investigate the clinical significance of hemoglobin, albumin, lymphocyte, and platelet (HALP) score and systemic immune inflammation (SII) index in the presence and severity of HG.

METHODS

This retrospective case-control study was conducted in a training and educational university hospital between January 2019 and July 2022. A total of 521 pregnant women, of whom 360 were diagnosed with HG at 6-14 weeks of gestation and 161 were low-risk pregnancies, were included in the study. Patients' demographic characteristics and laboratory parameters were recorded. Patients with HG were divided into three categories: mild (n = 160), moderate (n = 116), and severe (n = 84), according to disease severity. The modified PUQE scoring was used to determine the severity of HG.

RESULTS

The mean age of the patients was 27.6 (16-40) years. We divided the pregnant women into the control group and HG group. The HALP score was significantly lower in the HG group (average, 2.8 ± 1.3), whereas the SII index was found to be significantly higher (average, 895.8 ± 458.1). A negative correlation was found between the increase in the severity of HG and HALP score. The HALP score was the lower in severe HG (mean, 2.16 ± 0.81) and was significantly different from other HG categories (p < 0.01). Moreover, a positive correlation was noted between increased HG severity and SII index levels. The SII index was higher in the severe HG group and was significantly different from the others (1001.2 ± 437.2) (p < 0.01).

CONCLUSIONS

The HALP score and SII index can be useful, cost-effective, and easily accessible objective biomarkers to predict the presence and severity of HG.

Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum?

AIM

Hyperemesis gravidarum (HEG) is a condition characterized by nausea and vomiting, fluid electrolyte and acid-base imbalance, dehydration, weight loss, and ketonuria in early pregnancy. The relationship of HEG with inflammation has been studied in many studies. This study aimed to investigate the role of serum delta neutrophil index (DNI), a new inflammatory marker, and other inflammatory markers in demonstrating the disease's presence and severity in HEG patients.

MATERIAL AND METHOD

This retrospective study was conducted by accessing the electronic data of 79 pregnant women diagnosed with HEG in a tertiary center between 2017 and 2022 and 100 healthy pregnant women. The demographic characteristics of the study and control groups, as well as the hematological parameters in the complete blood count and the levels of inflammatory markers, were recorded.

RESULTS

There was no significant difference between the groups regarding hematological parameters, DNI, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and systemic inflammation index (p > 0.05). Neutrophil count and neutrophil-lymphocyte ratio (NLR) were higher in the HEG group compared to the control group (p < 0.05).

CONCLUSION

This is the first study to determine the relationship between HEG and serum DNI, a new inflammatory marker. We found that serum DNI values in HEG patients were not different from normal pregnancies and did not reflect the presence and severity of the disease. We also found that inflammatory markers other than the NLR were not different from normal pregnancies in HEG patients.

Maternal serum ischemia-modified albumin (IMA), total-sulphydryl concentrations, and some subclinic inflammatory markers in hyperemesis gravidarum (HG)

OBJECTIVE

This study investigates the relationship between Ischemia Modified Albumin and Total-Sulphydryl levels with some subclinical inflammatory markers in patients with hyperemesis gravidarum.

MATERIALS AND METHODS

A total of 258 pregnant women, 137 with hyperemesis gravidarum and 121 low-risk pregnancies, were included in this case-control study. The patients were divided into three groups according to the severity of hyperemesis gravidarum as mild (n = 53), moderate (n = 41) and severe (n = 43).

RESULTS

Serum Ischemia Modified Albumin levels were statistically different from the control group (P < 0.001). Among the subgroups, the highest Ischemia Modified Albumin value was observed in the severe hyperemesis gravidarum group, and the highest Total-Sulphydryl level was observed in the mild hyperemesis gravidarum group (P < 0.001). Serum potassium levels were higher in the control group (P < 0.001). While a negative correlation was observed between Ischemia Modified Albumin and Total-Sulphydryl, a positive correlation was observed in Platelet crit, C-reactive protein, and ketonuria. As the severity of the disease increases, Ischemia Modified Albumin, which is an oxidative stress factor, increases, and Total-Sulphydryl levels decrease (p < 0.001). Logistic regression analysis revealed that a one-unit increase in Ischemia Modified Albumin resulted in a statistically significant 1.9-fold increase in the risk of Severe hyperemesis gravidarum (OR 1.92, 95% CI 1.008-1.956; P = 0.01) CONCLUSION: This study shows that there is a condition in the pathophysiology of hyperemesis gravidarum, with an increase in Ischemia Modified Albumin and a decrease in Total-Sulphydryl levels, and oxidative stress occurs. It was important to detect increased Ischemia Modified Albumin and decreased antioxidant values in relation to the inflammatory factors that were effective in the severe hyperemesis gravidarum group.

The role of serum ADAMTS-1 levels in Hyperemesis Gravidarum

Background

We aimed to investigate the levels of ADAMTS-1, which is secreted from the extracellular matrix during trophoblastic invasion in hyperemesis gravidarum (HEG).

Methods

In this cross-sectional study, we compared 45 HEG patients aged between 21 and 34 in terms of ADAMTS-1 levels with a control group consisting of 44 healthy pregnant women. The demographic characteristics and several laboratory parameters of the patients were recorded. Both groups were also compared in terms of ketonuria. We evaluated the correlation between ADAMTS-1 levels and ketonuria.

Results

The 2 groups were matched in terms of age, gestational age, gravidity, parity, and body mass index. Some inflammatory markers, such as neutrophil count, MPV, PDW, and PCT levels, were significantly higher in the HEG groups compared to the control group (all p < 0.05). However, mean MCV and serum TSH levels were statistically significantly lower in this group (both p < 0.001). ADAMTS-1 levels were 12.6 ± 1.4 ng/ml in the HEG group and 6.2 ± 1.6 ng/ml in the control group (p < 0.001). It was significantly and positively correlated with urine ketone, neutrophil count, and PDW, whereas negatively correlated with MCV and TSH value in the HEG group. ROC analysis showed that a threshold value of 11.275 ng/ml for ADAMTS-1 predicted HEG patients with a sensitivity of 60% and specificity of 95.5%.

Conclusion

ADAMTS-1 serum levels are increased in HEG patients, and there is a positive correlation between ADAMTS-1 levels and ketonuria.