Giovanni Baviera

Endoglin, PlGF and sFlt-1 as markers for predicting pre-eclampsia

Objective. To evaluate the ability of endoglin, placental growth factor (PlGF) and the soluble form of vascular endothelial growth factor receptor (sFlt‐1) measurements in gestational weeks 24–28 were used to predict pre‐eclampsia. Design. Observational, prospective study. Setting. Department of Gynecological, Obstetrical Sciences and Reproductive Medicine, University of Messina. Sample. Fifty‐two pre‐eclamptic and 52 healthy pregnant women. Methods. A maternal serum sample was frozen and stored at 1‐h 50‐g glucose challenge test between 24 and 28 weeks’ gestation. A second maternal serum sample was collected at admission for the onset of the disease in the pre‐eclamptic group and at admission for delivery in the control group. Levels of endoglin, sFlt‐1 and the PlGF were measured in the stored serum. Pre‐eclamptic subjects were also divided into women with early‐onset (<37 weeks) and women with late‐onset pre‐eclampsia (≥37 weeks). Results. Levels of endoglin, sFlt‐1, and sFlt‐1: PlGF ratio were found to be higher in the pre‐eclamptic group in both trimesters. No differences were found between early‐ and late‐onset pre‐eclamptic. The Receiver Operating Characteristics curve, applied to the second trimester marker values, showed the best diagnostic profile for sFlt‐1: PlGF (area under the curve, AUC =0.92) followed by endoglin (AUC =0.88), sFlt‐1 (AUC =0.87) and PlGF (AUC = 0.83). This finding was confirmed by Bayesian analysis which highlighted a specificity, a sensitivity, a diagnostic accuracy, a positive predictive value and a negative predictive value of 88.5% for sFlt‐1: PlGF using a cut‐off of 38.47. Conclusions. Endoglin, PlGF and sFlt‐1 might be used as markers for predicting pre‐eclampsia, but sFlt‐1: PlGF seems to be more accurate.

Adiponectin and insulin resistance in early- and late-onset pre-eclampsia

Objective  To evaluate the importance of adiponectin and insulin resistance in early‐ and late‐onset pre‐eclampsia.

Plasma homocysteine in early and late pregnancies complicated with preeclampsia and isolated intrauterine growth restriction

Background.  Elevated circulating homocysteine is an independent risk factor for cardiovascular disease. Increased homocysteine plasma levels have been reported to occur in approximately 20–30% of women with preeclampsia and it has been suggested that they may predict the subsequent development of preeclampsia.

The effect of the phytoestrogen genistein and hormone replacement therapy on homocysteine and C-reactive protein level in postmenopausal women

Background.  The aim of the study was to evaluate the effect, in postmenopausal women, of the phytoestrogen genistein and hormone replacement therapy (HRT) on circulating two independent factors of cardiovascular risk: homocysteine and C‐reactive protein (CRP).

Second trimester neutrophil gelatinase-associated lipocalin as a potential prediagnostic marker of preeclampsia.

Neutrophil gelatinase‐associated lipocalin (NGAL) concentrations, a product of neutrophils, were investigated in normal and preeclamptic pregnancies. Prospectively collected data and late second trimester (24–26 weeks) serum samples from 48 women who subsequently developed preeclampsia (PE) and 96 control women with uncomplicated pregnancies were compared. Serum NGAL values, as determined by quantitative sandwich enzyme immunoassay, were significantly increased in the preeclamptic compared to the control women: 76.9 ng/ml (interquartile range 39.7–96.5) versus 16.0 ng/ml (interquartile range 11.2–24.4) (p<0.001), and were positively correlated to blood pressure and proteinuria, showing a high sensitivity (75%) and specificity (94.5%). The results suggest that serum NGAL might be involved in the pathophysiology of PE and could be a marker for this syndrome.

Neutrophil gelatinase-associated lipocalin serum evaluation through normal pregnancy and in pregnancies complicated by preeclampsia

Neutrophil gelatinase‐associated lipocalin (NGAL) was evaluated prospectively through normal pregnancy and pregnancies complicated by preeclampsia syndrome. Sixty women enrolled in the study were evaluated for serum NGAL levels at 9–11 weeks gestation, at 24–26 weeks gestation and at delivery. Thirty women were affected by preeclampsia and 30 women with uncomplicated pregnancies formed the control group. NGAL serum concentrations in the preeclampsia group were higher compared to the control group, with significant differences in each trimester. In the first trimester, the median values were: 29.9 ng/mL [interquartile range (IQR) 24.1–50.1] versus 13.6 ng/mL (IQR 9.1–19.9; p < 0.001); in the second trimester: 59.6 ng/mL (IQR 25.3–82.6) versus 16.3 ng/mL (IQR 11.3–23.3; p < 0.001); and in the third trimester: 57.2 ng/mL (IQR 18.7–70.9) versus 15.8 ng/mL (IQR 9.1–22.5; p < 0.001). NGAL serum values were positively correlated with systolic and diastolic blood pressure and with proteinuria.

Neurokinin B and nitric oxide plasma levels in pre‐eclampsia and isolated intrauterine growth restriction

Objective  To verify if neurokinin B plasma level is increased in pre‐eclampsia and IUGR. Also, to ascertain if there is a correlation between neurokinin B plasma level and nitric oxide production.

Midtrimester Amniotic Fluid Leptin and Insulin Levels and Subsequent Gestational Diabetes

Aims: To evaluate midtrimester amniotic fluid leptin levels in pregnancies subsequently complicated by gestational diabetes. Methods: We studied 32 pregnant women with gestational diabetes and a control group of 43 normal pregnancies with an adequate gestational age fetus. All underwent a midtrimester amniocentesis: leptin and insulin were measured in the amniotic fluid. Data were compared with the Mann-Whitney U-test. Results: Median leptin concentrations in the amniotic fluid of the gestational diabetes mellitus patients were significantly higher than in the control group (15.1 vs. 7.9 ng/ml) (p = 0.001); amniotic insulin concentrations were also higher in the gestational diabetes mellitus than in the control group (0.67 vs. 0.38 µU/ml) (p = 0.02). Furthermore, amniotic fluid leptin levels were directly correlated with amniotic insulin concentrations; instead, there was no correlation with maternal BMI and birth weight. Conclusion: Our data suggest that in pregnancies subsequently complicated by gestational diabetes, amniotic fluid leptin and insulin levels are higher in the early fetal period.

Is mid-trimester maternal serum inhibin-A a marker of preeclampsia or intrauterine growth restriction?

Background. To evaluate maternal serum Multiple of Median inhibin‐A in mid‐trimester blood samples of women who subsequently developed preeclampsia, gestational hypertension and intrauterine growth restriction and controls. Also, to verify whether this marker is related to these pathological conditions.

Placental growth hormone in Down's syndrome screening.

A number of serum markers have been proposed to improve the sensitivity (and specificity) of the triple test, which, until now, has been the gold standard in second-trimester serum screening for Downs syndrome. Among them, human placental growth hormone (hPGH) has been proposed because of its significantly elevated serum levels in pregnancies affected by chromosomal aneuploidies. Our experience, on maternal serum stored from 32 Downs syndrome-affected pregnancies, confirms a slight but significant increase in hPGH levels compared with controls. These data summarized to that of the previous screening could give a calculated detection rate of 71.9%, better than that of the standard triple test alone (65.6%).