Eva Östlund

Plasma leptin in infants : Relations to birth weight and weight loss

Background. The hormone leptin, produced in the adipose tissue, is involved in the regulation of body weight. The release of the hormone is increased in obese adults and decreased after fasting in human adults. This study investigated whether the plasma leptin level was related to the infants birth weight and whether the level was reduced in connection with the physiological weight loss during the neonatal period. Methods. We measured the plasma leptin level in cord blood from infants who were large for gestational age (LGA) (n = 15), small for gestational age (SGA) (n = 16), and appropriate for gestational age (AGA) (n = 38). AGA infants (n = 120), who were exclusively breastfed, were also studied during their first 4 postnatal days in a cross-sectional method. One blood sample was collected before breastfeeding from each infant. Plasma leptin concentrations were determined by radioimmunoassay. Results. The median (range) concentration of leptin from cord blood was increased in LGA infants and decreased in SGA infants compared with the level in AGA infants. There was a positive correlation between the log of the plasma leptin level in cord blood and both the infants birth weight (r = 0.76; n = 69) and the body mass index (r = 0.63; n = 69). The normal 3% to 6% weight reduction that occurs during the first 4 postnatal days was associated with a 26% decrease in the plasma leptin level in healthy breastfed infants. Conclusions. The plasma leptin level is highly correlated to the size of adipose tissue mass and decreases in connection with the initial physiological weight loss in newborn infants. These data provide evidence that leptin is highly related to the nutritional status already during the fetal and neonatal periods.

Normalized endothelial function but sustained cardiovascular risk profile 11 years following a pregnancy complicated by preeclampsia.

Women with a history of preeclampsia are at increased risk of future cardiovascular disease. Preeclampsia is associated with elevated blood pressure, inflammation and endothelial dysfunction, and these findings remain 1 year after delivery. Whether these abnormalities persist long after delivery, and whether they may contribute to future cardiovascular disease, is not well studied. We studied 15 women with a history of preeclampsia and 16 matched controls with an uncomplicated pregnancy 11 years following the index pregnancy; all had also been previously examined at 1 year. We assessed arterial stiffness (pulse wave analysis), 24 h ambulatory blood pressure and endothelial function (forearm flow-mediated dilatation and pulse wave analysis following β receptor agonist provocation), and determined markers of glucose and lipid metabolism, inflammation and vascular function. The preeclampsia group had higher blood pressures and reduced night/day blood pressure ratios, increased body mass index and reduced glucose tolerance, and increased levels of tissue necrosis factor receptor 1 and intracellular adhesion molecule-1, suggesting inflammatory and vascular activation. However, the endothelial impairment observed in the preeclampsia group at 1 year was normalized at 11 years, whereas the control group remained unchanged during follow-up. Our findings of higher blood pressures, impaired glucose tolerance and normalization of endothelial function 11 years after preeclampsia suggest cardiovascular risk factors present already before pregnancy to be more important than permanent endothelial damage for the increased risk of future cardiovascular complications in women with a history of preeclampsia.

Transforming growth factor-β1 in fetal serum correlates with insulin-like growth factor-I and fetal growth

OBJECTIVE To estimate whether transforming growth factor‐β1 in fetal serum obtained by umbilical cord sampling at delivery is correlated with fetal growth. We also estimated whether transforming growth factor‐β1 is correlated with insulin‐like growth factor‐I and insulin‐like growth factor binding protein‐1, which have been shown to correlate with fetal growth. METHODS The active form of transforming growth factor‐β1 was analyzed in serum from cord blood from 68 fetuses by the enzyme‐linked immunosorbent assay technique. Of the 68 pregnant women, 12 had preeclampsia, 14 had preeclampsia and intrauterine growth restriction, 15 had intrauterine growth restriction alone, and seven had fetuses that were large for gestational age (LGA). Twenty pregnancies with fetuses appropriate for gestational age (AGA) served as controls. RESULTS Transforming growth factor‐β1 concentrations were significantly correlated with birth weight. The average transforming growth factor‐β1 concentration in the following groups were: intrauterine growth restriction, 22.4 ± 2.7 μg/L; intrauterine growth restriction plus preeclampsia, 22.9 ± 2.0 μg/L; preeclampsia without intrauterine growth restriction, 28.8 ± 2.1 μg/L; LGA, 30.3 ± 4.3 μg/L; and AGA, 36.8 ± 2.0 μg/L. Transforming growth factor‐β1 levels were significantly lower in pregnancies complicated by intrauterine growth restriction and showed a positive correlation with birth weight (r = 0.48, P < .001). Furthermore, there was a positive correlation between insulin‐like growth factor‐I levels and birth weight (r = 0.36, P < .01) and a negative correlation between insulin‐like growth factor binding protein‐1 and birth weight (r = −0.32, P < .01). There was also a correlation between transforming growth factor‐β1 and insulin‐like growth factor‐I (r = 0.29, P < .05) and between transforming growth factor‐β1 and insulin‐like growth factor binding protein‐1 (r = −0.25, P < .05). CONCLUSION Transforming growth factor‐β1 might be related to fetal growth in pregnancy. The results also support previous data showing that insulin‐like growth factor‐I and insulin‐like growth factor binding protein‐1 are related to fetal growth.

Fetal erythropoietin and endothelin-1: relation to hypoxia and intrauterine growth retardation.

Background. We have examined whether endothelin‐1 (ET‐1) and erythropoietin (EPO) in amniotic fluid, and EPO in fetal serum obtained by cordocentesis from fetuses with signs of intrauterine growth retardation (IUGR), were correlated to fetal growth and/or chronic fetal hypoxia.

Termination of second trimester pregnancy with mifepristone and gemeprost

Background. Earlier controlled clinical trials have demonstrated that combined treatment with the antiprogestagen, mifepristone and a suitable prostaglandin reduce the induction to abortion time in second trimester abortion. The aim of this study was to describe the results of the 197 consecutive second trimester terminations performed in routine clinical practice at our Department from 1996 to 1998.

Longitudinal study of vascular structure and function during normal pregnancy

To examine alterations in maternal vascular structure and function during normal pregnancy.

Soluble fibrin in plasma as a sign of activated coagulation in patients with pregnancy complications

BACKGROUND Disseminated intravascular coagulation (DIC) is a frequently observed complication in pregnant women. The laboratory diagnosis of DIC is difficult but the development in the detection of circulating soluble fibrin has improved the possibility. METHODS A number of pregnant women (n= 175) with obstetric complications e.g. preeclampsia, hypertension, intrauterine growth retardation (IUGR) and intrahepatic cholestasis was examined for plasma soluble fibrin and subjected to some routine hemostatic tests, mainly during the third trimester of pregnancy. RESULTS Of these patients, 57 of 175 (33%) had an elevated concentration of soluble fibrin (above 23 nmol/L) as compared with a healthy group of women sampled in the third trimester. Eighteen patients (10%) had highly increased levels, above 100 nmol/L. In comparison, none of the 23 healthy, pregnant women investigated had a value above 40 nmol/L. CONCLUSIONS Hemostatic abnormalities, including increased concentrations of soluble fibrin, are quite frequently observed in women with obstetric complications, most likely as a sign of a systemic activation of coagulation. Although a higher concentration of plasma soluble fibrin was observed in many of the women, no clear correlation to the outcome of the pregnancy was obtained. Whether or not plasma soluble fibrin is of any value, either diagnostically or the treatment of patients with pregnancy complications, remains to be shown.

A2. A longitudinal study of endothelial function during normal pregnancy

Abstract Aim: This study aimed to examine alterations in maternal endothelial function during normal pregnancy. Methods: We assessed endothelial function in the brachial artery (by post-ischemic hyperemia-induced flow-mediated vasodilation and glyceryl nitrate) and in the forearm skin microcirculation (by laser Doppler perfusion imaging and iontophoretic administration of acetylcholine (Ach) and sodium nitroprusside (SNP)) in 53 healthy primiparous women at 14, 24 and 34 weeks of gestation, and nine months post-partum (non-pregnant state). Results: Flow-mediated vasodilation in the brachial artery (FMD) increased during early pregnancy, whereas nonspecific vasodilatation by glyceryl trinitrate (GTN) decreased, indicating improved endothelial function. Consistent with this, endothelium-dependent skin microvascular reactivity to Ach also increased. Discussion: Normal pregnancy is associated with increased endothelial function assessed both in the brachial artery and in the forearm skin microcirculation.

Reassessment of data on timing peak flow-mediated vasodilatation confirms that endothelial function returns to normal 11 years after preeclampsia

Reassessment of data on timing peak flow-mediated vasodilatation confirms that endothelial function returns to normal 11 years after preeclampsia