Amrita Halmos

The Frequency of Peripheral Blood CD4+ CD25high FoxP3+ and CD4+ CD25− FoxP3+ Regulatory T Cells in Normal Pregnancy and Pre‐Eclampsia

Regulatory T cells (Tregs) play an important role in the development of pregnancy‐specific immune tolerance. We aimed to determine the peripheral frequency of a recently described Treg subpopulation, the CD4+ CD25− FoxP3+ Treg subset, and its correlation with the conventional CD4+ CD25high FoxP3+ Tregs in normal pregnancy (NP) and pre‐eclampsia (PE) compared to non‐pregnant (non‐P) women. We also examined the proportion of the activated CD4+ CD25high FoxP3high Treg subset within conventional Treg cells.

Serum human chorionic gonadotropin measurements may predict pregnancy outcome and multiple gestation after in vitro fertilization

OBJECTIVE To predict pregnancy outcome and multiple gestation using a common parameter by which hCG values are made comparable independently of the day of blood sampling. DESIGN Retrospective study. SETTING University-based IVF program. PATIENTS One hundred twenty IVF pregnancies conceived between November, 1995 and August, 1999. INTERVENTIONS None. MAIN OUTCOME MEASURES Early pregnancy loss (preclinical and first trimester abortions, ectopic pregnancies) or ongoing pregnancies (singleton and multiple deliveries, second trimester abortions). Day 11 hCG levels were calculated assuming an exponential increase of hCG values in early pregnancy. Receiver-operating characteristic analysis was used to determine cut-off levels with the best sensitivity and specificity for the prediction of pregnancy outcome. RESULTS Serum hCG levels in the group of early pregnancy loss were significantly lower than in ongoing pregnancies. A cut-off level of 50 IU/L predicts pregnancy outcome with a sensitivity of 75% and a specificity of 81%, while an hCG value >135 IU/L predicts a multiple ongoing pregnancy with a sensitivity of 80% and a specificity of 88%. CONCLUSION After IVF, early pregnancy loss or multiple gestation may be predicted with high sensitivity and specificity by using cut-off values of serum hCG derived from two measurements independently of the day of blood sampling.

Preeclampsia is associated with decreased serum α2-HS glycoprotein (fetuin-A) concentration

The purpose of this study was to determine serum α2-HS glycoprotein (AHSG) concentration and its diagnostic accuracy in preeclampsia. In this case–control study, the serum C-reactive protein (CRP) and AHSG levels were measured in 93 preeclamptic patients and in 127 healthy pregnant women by immunoturbidimetry and radial immunodiffusion. The serum CRP levels were significantly higher, whereas the serum AHSG concentrations were significantly lower in the preeclamptic group than in the control group (median (25th to 75th percentile), CRP: 6.71 mg l−1 (2.76–12.69) vs. 3.38 mg l−1 (1.69–7.27), respectively; AHSG: 660 μg ml−1 (612–768) vs. 744 μg ml−1 (660–816), respectively; P<0.001 for both). In preeclamptic patients, the serum AHSG concentrations showed significant inverse correlations with systolic blood pressure and serum CRP levels. A low serum AHSG level (⩽720 μg ml−1) was significantly associated with preeclampsia (adjusted odds ratio (95% confidence interval): 3.69 (1.82–7.51); P<0.001). According to the receiver operating characteristic curves, the measurement of serum AHSG concentrations was as accurate as that of serum CRP levels to detect preeclampsia. In conclusion, serum AHSG concentration is decreased and reflects—at least partly—systemic inflammation in preeclampsia.

Fas (TNFRSF6) gene polymorphism in pregnant women with hemolysis, elevated liver enzymes, and low platelets and in their neonates

OBJECTIVE: To estimate whether an A>G polymorphism at position −670 in the gene coding for Fas (gene symbol TNFRSF6) is associated with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. METHODS: In a retrospective study, buccal swabs from 81 women with the complete form of HELLP syndrome and 83 normotensive control women with uncomplicated full-term pregnancy, and 110 of their neonates, were analyzed for the presence of the TNFRSF6–670 polymorphism. Investigators were blinded to clinical outcomes. RESULTS: Pregnant women heterozygous for the TNFRSF6–670 genotype were more likely than those homozygous for TNFRSF6–670*A allele to have HELLP syndrome (P = .01; odds ratio 2.7, 95% confidence interval 1.2–5.9). Moreover, patients with homozygous carriage of the TNFRSF6–670*G allele were more likely than those homozygous for the wild type of the Fas gene (TNFRSF6–670*A/A) to have HELLP syndrome (P = .006; odds ratio 4.0, 95% confidence interval 1.7–9.8). In contrast, TNFRSF6–670 genotype distribution of neonates born to mothers with HELLP syndrome was not statistically different from that found in neonates born to healthy pregnant women (P = .4). In patients with HELLP syndrome, no association between TNFRSF6 genotype distribution and severity of hemolysis, platelet counts or liver enzymes levels was noted. CONCLUSION: A single A>G nucleotide substitution at position −670 in the maternal but not neonatal TNFRSF6 gene coding for Fas is associated with a higher risk for HELLP syndrome. LEVEL OF EVIDENCE: II-2