Aykan Yucel

Thiol/disulfide homeostasis in patients with idiopathic recurrent pregnancy loss assessed by a novel assay: Report of a preliminary study

To evaluate the relationship between idiopathic recurrent pregnancy loss (RPL) and oxidative stress (OS) by means of thiol/disulfide homeostasis via a novel technique.

Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus.

Fetal cardiac left ventricular function in pregnant women with pregestational or gestational diabetes mellitus was investigated by exploring fetal myocardial performance index (MPI) and E wave/A wave peak velocity (E/A) ratio.

Total oxidative and anti-oxidative status, and ADAMTS-12 levels in placenta previa and early-onset severe preeclampsia.

AIMnThis study was carried out due to the discussions in the literature stating that the inverse association between placenta previa (PP) and preeclampsia (PE). The aim of this study was to determine whether total antioxidant status (TAS), and total oxidant status (TOS) and ADAMTS-12 levels differ among early-onset (<34th gestational week) severe PE (EOS-PE), PP and uncomplicated pregnancies.nnnMETHODSnIn this case-control study, serum samples obtained from 26 pregnant with EOS-PE, 31 pregnant with PP, and 32 healthy patients with uncomplicated pregnancies (control group).nnnRESULTSnTOS levels were significantly higher in the EOS-PE than in the control group and PP groups (p=0.002, p=0.05, respectively). TAS levels were significantly lower in the EOS-PE than in the control (p<0.001). Although TAS levels were lower in the EOS-PE group than in the PP group, the differences were not statistically significant (p=0.09). There were no significant differences in the ADAMTS-12 levels of the groups.nnnDISCUSSIONnThe data in this study suggested that the balance between oxidative and anti-oxidative substances were comparable and normal in pregnancies complicated by PP when compared to normal pregnancies without placentation abnormality. In support of this, we encountered no case with PE and fetal growth restriction in our study groups suggesting normal placental angiogenesis. Contrarily, EOS-PE was associated with decreased TAS and increased TOS levels in the maternal serum.

Maternal serum vitamin D levels in pregnancies complicated by neural tube defects.

Abstract Objective: The association between vitamin D deficiency and abnormal neural development has been proposed previously. We aimed to evaluate maternal serum vitamin D levels in pregnancies complicated by neural tube defects (NTDs) and compared them with healthy pregnant women. Methods: A total of 60 pregnant women were included in this controlled cross-sectional study. Thirty of the patients whose pregnancies were complicated by meningocele, meningomyelocele, encephalocele, anencephaly and fetal acrania constituted the study group, whereas 30 normal pregnant women constituted the control group. The main parameters recorded for each woman were as follows: age, body mass index (BMI), gestational week (GW), gravidity, abortion, co-morbidities, dressing style, consumption of milk and dairy products and serum levels of 25(OH)VitD3, calcium, albumin and total protein. Results: The mean maternal serum 25(OH)VitD3 level was 6.2u2009±u20095.0u2009ng/ml in the study group and 9.1u2009±u20097.3u2009ng/ml in the control group (p: 0.071). The mean maternal serum calcium level was statistically significantly higher in the control group, and calcium-rich dietary intake was also more common in this group (pu2009<u20090.05). There was no statistically significant difference between groups in terms of age, BMI, GW, dressing style and serum levels of albumin and total protein. Conclusions: Vitamin D deficiency is common among pregnant women, and maternal serum calcium levels were lower in pregnancies complicated by NTD than healthy pregnant women. Larger further studies are required to evaluate the effects of calcium-rich dietary sources or vitamin D and calcium in the development of NTDs.

Thiol/disulphide homeostasis in pregnant women with Familial Mediterranean fever

Objective: To investigate the presence of oxidative stress (OS) in pregnant women with Familial Mediterranean fever (FMF) in the first trimester by evaluating thiol/disulphide homeostasis. Study design: A total of 31 pregnant women with a diagnosis of FMF, between 110 and 136 weeks of gestation, were compared with 51 healthy pregnant controls at the same gestational weeks. A recently defined method was used to measure plasma native thiol, total thiol and disulphide levels. Results: There were no differences between groups in terms of maternal age, body mass index and numbers of gravida and parity. Antenatal complications (45.2% vs. 9.8%, Pu2009=u20090.001) and primary caesarean section (22.6% vs. 5.9%, Pu2009=u20090.037) were higher in the FMF group. Pregnant women with FMF had significantly lower first trimester serum levels of native thiol (297.5u2005μmol/l (153.2–441.8) vs. 366.1u2005μmol/l (288.7–432.4), Pu2009=u20090.000), total thiol (327.2u2005μmol/l (171.0–471.0) vs. 389.9u2005μmol/l (317.1–449.8), Pu2009=u20090.000) and higher levels of disulphide (14.2u2009±u20094.5u2005μmol/l vs. 12.4u2009±u20093.4u2005μmol/l, Pu2009=u20090.045). No differences were found in these parameters among FMF patients with and without antenatal complications. Conclusions: The main outcome demonstrates a relation between OS and pregnant women with FMF in the first trimester of gestation. OS in the first trimester may be a major aetiological factor of unfavourable pregancy outcomes in this group of patients.

Decreased placental and maternal serum TRAIL-R2 levels are associated with placenta accreta

OBJECTIVESnTNF-related apoptosis-inducing ligand receptor-2 (TRAIL-R2) is produced both by decidual and trophoblast cells during pregnancy and known to participate in apoptosis. In this study, we aimed to determine and to compare maternal serum and placental TRAIL-R2 levels in patients with placenta accreta, non-adherent placenta previa and in healthy pregnancies. We also aimed to analyze the association of placenta accreta with the occurrence of previous C-sections.nnnSTUDY DESIGNnA total of 82 pregnant women were enrolled in this case-control study (27 placenta accreta patients, 26 non-adherent placenta previa patients and 29 age-, and BMI-matched healthy, uncomplicated pregnant controls). TRAIL-R2 levels were studied in both maternal serum and placental tissue homogenates. Determining the best predictor(s) which discriminate placenta accreta was analyzed by multiple logistic regression analyses. Adjusted odds ratios and 95% confidence intervals were also calculated.nnnRESULTSnBoth placental and serum TRAIL-R2 levels were significantly lower in placenta accreta group (median 34.82 pg/mg and 19.85 pg/mL, respectively) when compared with both non-adherent placenta previa (median 39.24 pg/mg and 25.99 pg/mL, respectively) and the control groups (median 41.62 pg/mg and 25.87 pg/mL, respectively) (p < 0.05). Placental TRAIL-R2 levels and previous cesarean section were found to be significantly associated with placenta accreta (OR: 0.934 95% CI 0.883-0.987, p = 0.016 and OR:7.725 95% CI: 2.717-21.965, p < 0.001, respectively). Placental and serum TRAIL-R2 levels were positively correlated.nnnCONCLUSIONnDecreased levels of placental TRAIL-R2 and previous history of cesarean section were found to be significantly associated with placenta accreta, suggesting a possible role of apoptosis in abnormal trophoblast invasion.

Decreased oxidative stress may contribute to the disease process in placenta accreta

Background/aim: The main aim of this study was to investigate serum total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and arylesterase levels in pregnant women with placenta accreta and to compare those with age-matched healthy pregnant women. Materials and methods: A total of 27 pregnant women who had clinically and pathologically proven placenta accreta and 30 age- and BMI- matched healthy pregnant women were enrolled in this case control study. Maternal serum TOS, TAS, OSI, and arylesterase levels were evaluated using logistic regression analysis to determine if there was an association with abnormal placental invasion or not. Results: Decreased OSI (OR= 0.999, 95%CI: 0.998-1.000, P = 0.035) and increased arylesterase levels (OR= 0.981, 95%CI: 0.970-0.993, P = 0.001) were significantly associated with the presence of placenta accreta. Maternal serum TOS, TAS, OSI, and arylesterase levels were not predictive for adverse perinatal outcomes (P > 0.05). Conclusions: Decreased OSI and increased arylesterase levels are significantly associated with placenta accreta and may contribute to the abnormal invasion process.

Can fetal left ventricular modified myocardial performance index predict adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

Abstract Objective: To investigate fetal left ventricular function using the left ventricular modified myocardial performance index (mod-MPI) and E wave/A wave peak velocity (E/A) ratio, and to explore the success of mod-MPI in the prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP). Methods: Forty-one ICP cases were compared with 41 gestational age-matched healthy controls. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods [ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT)], which were employed in the calculation of mod-MPI [mod-MPIu2009=u2009(ICTu2009+u2009IRT)/ET]. The E/A ratio was calculated as well. Results: Fetal left ventricular mod-MPI values were significantly higher in the ICP group compared to controls (0.56u2009±u20090.09 versus 0.37u2009±u20090.04, pu2009<u20090.001), whereas the E/A ratio was lower (0.62u2009±u20090.11 versus 0.69u2009±u20090.10, pu2009=u20090.011). The optimal cutoff level for mod-MPI in prediction of adverse perinatal outcomes was >0.48 [sensitivity: 81.8%, specificity: 67.6%, area under the curve (AUC): 0.750, 95% CI: 0.613–0.887, pu2009=u20090.008]. Conclusions: Fetuses of ICP cases have significant left ventricular dysfunction. Mod-MPI can be used in the prediction of adverse perinatal outcomes in ICP.

Dietary sodium and potassium intake were associated with hypertension, kidney damage and adverse perinatal outcome in pregnant women with preeclampsia.

ABSTRACT Objectives: In this study, we hypothesized that dietary salt and potassium intake may be related with blood pressure, kidney damage and perinatal outcome in pregnants with preeclampsia (PE). Methods: In total, 200 women (50 control women with healthy pregnancy, 150 women with PE) were recruited for the study. Daily salt and potassium intake was estimated based on calculation of 24-hour urinary sodium U[Na+] and potassium U[K+] excretion. U[Na+]/[K+] was calculated by dividing U[Na+] by U[K+]. At the end of the measurements, the pregnant women with PE (n=150) were divided into tertiles according to U[Na+]/[K+]: low Na/K group (n=50, mean U[Na+]/[K+]: 1,04±0,32), medium Na/K group (n=50, mean U[Na+]/[K+]: 2,49± 0,54), high Na/K group (n=50, mean U[Na+]/[K+]: 6,62±3,41). Results: The mean SBP and DBP levels were significantly lower in low Na/K group compared with medium or high Na/K groups (p=0.024, p=0.0002; respectively). Serum creatinine was significantly lower in low Na/K group than high Na/K group (p=0.025). Frequency of severe preeclampsia is lower in low Na/K group than medium or high Na/K groups (p=0.002, p=0.0001; respectively). Birth weight and gestational age at birth were higher in low Na/K group compared with high Na/K group (p=0.045, p=0.0002; respectively). After adjusting for covariates, SBP and DBP and creatinine levels were independently associated with 24 hours urinary [Na+]/[K+] Conclusion: These findings suggest that pregnant with PE with high dietary salt and low potassium intake may have greater maternal and neonatal morbidity risk than pregnant with PE under low dietary salt and high potassium intake.

Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy

Morbidly adherent placenta (MAP) is a growing concern currently and is still a diagnostic challenge for obstetricians. As emergency hysterectomy due to unscheduled delivery in MAP carries significant risks, we aimed to evaluate whether first and second trimester serum analytes may be used in the prediction of MAP requiring hysterectomy. A retrospective chart review of all identified cases of placenta previa totalis with and without MAP was performed. A total of 316 pregnant women diagnosed as placenta previa totalis were identified and included in the analysis. Cases were examined in three groups (Group 1: 204 nonadherent placenta previa patients; Group 2: 61 MAP patients managed with endouterine hemostatic square sutures and/or Bakri balloon tamponade; and Group 3: 51 patients with MAP requiring hysterectomy). Among all first and second trimester screening analytes only maternal serum alphafetoprotein (MS‐AFP) levels were significantly higher in patients with MAP requiring hysterectomy (pu2009<u20090.001). According to the Receiver Operating Characteristic (ROC) analysis performed for the predictive value of MS‐AFP levels, the area under the curve (AUC) was 0.742 [95% confidence interval (CI): 0.505–0.979]. The best MS‐AFP cut‐off value was 1.25 multiple of the median (MoM) with 85.94% sensitivity and 71.43% specificity (pu2009=u20090.036). The best predictors which affect the increased risk of hysterectomy, was further evaluated by multivariate logistic regression analyses. Only elevated maternal serum alphafetoprotein (MS‐AFP) was found to be an independent predictor of MAP requiring hysterectomy [odds ratio (OR)u2009=u200925.329, 95% confidence interval (CI):1.487–43.143, pu2009=u20090.025]. In conclusion, increased second trimester MS‐AFP levels independently predict morbidly adherent placenta requiring hysterectomy among women with placenta previa totalis.