Mahmut Oncul

Serum anti-mullerian hormone levels in the main phenotypes of polycystic ovary syndrome

OBJECTIVE To characterize the difference in circulating anti-Müllerian hormone (AMH) levels between the main polycystic ovary syndrome (PCOS) phenotypic groups and evaluate the role of AMH in predicting the severity of PCOS. STUDY DESIGN Cross-sectional, retrospective study. A total of 251 women were divided into four groups based on the main features of PCOS, as follows: Group 1 (polycystic ovarian morphology [PCOM]+/oligo-anovulation [OA]+/hyperandrogenism [HA]+), Group 2 (PCOM+/OA+/HA-), Group 3 (PCOM+/OA-/HA+), and Group 4 (PCOM-/OA+/HA+). AMH and other hormone levels were measured in serum. The main outcome was serum AMH concentrations in the main phenotypes of PCOS. RESULT(S) The mean serum AMH levels were 9.50±6.1 ng/mL in Group 1; 8.02±6.2 ng/mL in Group 2; 6.12±3.6 ng/mL in Group 3; and 3.06±2.4 ng/mL in Group 4. Circulating AMH levels in Group 1 (PCOM+/OA+/HA+) were three times higher than those in Group 4 (PCOM-/OA+/HA+). CONCLUSIONS The highest AMH levels were found in cases where all three main diagnostic criteria existed. AMH levels correlate best with PCOM. In addition, oligo-anovulation contributes to increased AMH levels. Hyperandrogenism criteria were found to have less influence on AMH levels. AMH levels seem to have a diagnostic role in determining the severity of PCOS.

Maternal serum and fetal cord blood irisin levels in gestational diabetes mellitus

AIM To investigate the relationship between maternal and cord blood irisin in gestational diabetes mellitus (GDM). METHODS Twenty women with GDM and 20 pregnant women with uncomplicated pregnancies were recruited for this case-control study. Maternal serum irisin and cord blood irisin levels were measured by enzyme-linked immunosorbent assay kit at the time of birth. The association of maternal serum and cord blood irisin levels with metabolic parameters was analyzed. RESULTS Women with GDM had significantly lower mean serum irisin levels compared to control group (258.3±127.9 vs. 393±178.9ng/ml, p<0.05). Mean cord blood irisin levels for GDM and control groups were not significantly different (357.2±248.0 vs. 333.2±173.4ng/ml, p>0.05). No significant differences were found in terms of maternal age, gestational week at birth, BMI at birth, birth weight, neonatal height, systolic and diastolic blood pressure between the groups as well (p>0.05). Serum irisin level was negatively correlated with BMI at birth and HOMA-IR (r=-0.401, p=0.010; r=-0.395, p=0.012, respectively). No correlations between irisin levels and others parameters were found in both groups. CONCLUSIONS Maternal serum irisin levels of patients with GDM are significantly lower compared with non-GDM controls. However, no significant difference was found between cord blood irisin levels of patients with GDM and healthy pregnant women.

Protein oxidation markers in women with and without gestational diabetes mellitus: a possible relation with paraoxonase activity.

AIMS To clarify the levels of protein oxidation markers such as protein carbonyl (PCO), protein hydroperoxides (P-OOH), advanced oxidation protein products (AOPP) and nitrotyrosine (NT), as well as antioxidative enzymes such as paraoxonase (PON-1) in women with and without gestational diabetes mellitus (GDM). METHODS The study was conducted on 23 women with GDM and 22 women without GDM. The levels of the P-OOH, AOPP, and PON-1 were determined by colorimetric methods; whereas NT and PCO levels were measured by ELISA. RESULTS The concentrations of protein oxidation markers were significantly increased and PON1 activity was significantly decreased in GDM group compared to those of normal pregnant women. The control group showed a significant negative correlation between PON-1 and PCO (r=-0.451, p=0.027); whereas in GDM group, there was a significant positive correlation between P-OOH and HbA1c (r=0.89, p=0.001). There was no significant correlation between AOPP, PON-1, P-OOH, PCO, and HbA1c in either group. CONCLUSIONS There is evidence of a possible association between protein oxidation and decreased PON1 activity in GDM. The increase in protein oxidation parameters in the GDM group leading to decreased PON1 activity might, we think, create a predisposition for clinical complications in GDM group.

Shear wave elastography of placenta: in vivo quantitation of placental elasticity in preeclampsia

PURPOSE We aimed to evaluate the utility of shear wave elastography (SWE) for assessing the placenta in preeclampsia disease. METHODS A total of 50 pregnant women in the second or third trimester (23 preeclampsia patients and 27 healthy control subjects) were enrolled in the study. Obstetrical grayscale and Doppler ultrasonography, SWE findings of placenta, and prenatal/postnatal clinical data were analyzed and the best SWE cutoff value which represents the diagnosis of preeclampsia was determined. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of preeclampsia were calculated based on SWE measurements. RESULTS Mean stiffness values were much higher in preeclamptic placentas in all regions and layers than in normal controls. The most significant difference was observed in the central placental area facing the fetus where the umbilical cord inserts, with a median of 21 kPa (range, 3-71 kPa) for preeclampsia and 4 kPa (range, 1.5-14 kPa) for the control group (P < 0.01). The SWE data showed a moderate correlation with the uterine artery resistivity and pulsatility indices. The cutoff value maximizing the accuracy of diagnosis was 7.35 kPa (area under curve, 0.895; 95% confidence interval, 0.791-0.998); sensitivity, specificity, PPV, NPV, and accuracy were 90%, 86%, 82%, 92%, and 88%, respectively. CONCLUSION Stiffness of the placenta is significantly higher in patients with preeclampsia. SWE appears to be an assistive diagnostic technique for placenta evaluation in preeclampsia.

Pregnancy outcomes and prognostic factors in patients with intrahepatic cholestasis of pregnancy

Abstract The aim of this study was to describe maternal and fetal characteristics associated with intrahepatic cholestasis of pregnancy (ICP) and to determine clinical and biochemical predictors of fetal complications. A total of 89 singleton pregnancies with ICP were analysed, retrospectively. All data concerning laboratory results, symptom onset time, treatment response, delivery time and infant information were recorded in the study protocol. The mean gestational age at diagnosis was 32.6 ± 3.4 weeks; mean time of delivery was 36.8 ± 1.9 weeks. Binary logistic regression revealed that gestational age at diagnosis was predictive of preterm delivery (OR = 2.3, 95% CI: 1.5–3.3, p = 0.001). The incidence of respiratory distress syndrome (RDS), fetal growth restriction, fetal distress and preterm delivery were significantly higher in patients who were diagnosed before 30 weeks than after 34 weeks’ gestation (p < 0.01). Gestational age at diagnosis is an important independent factor predicting adverse perinatal outcomes in patients with ICP.

Evaluation of ovarian reserve in Hashimoto's thyroiditis

Abstract Human ovary is commonly the target of an autoimmune attack in cases of organ- or non-organ-specific autoimmune disorders. Hashimoto’s thyroiditis (HT) is likely to be associated with ovarian dysfunction and diminished ovarian reserve. In this study, we aimed to evaluate the possible negative association between this significantly prevalent autoimmune disease and the ovarian reserve. Thirty-two premenopausal women with primary hypothyroidism, who under replacement therapy with thyroxine were recruited. Forty-nine healthy female subjects who had normal anti-thyroid antibody levels and were comparable with the HT group in terms of age and BMI values, comprised the control group. There was no statistically significant difference between the study and the control patients in terms of antral follicle count. Serum anti-Müllerian hormone (AMH) levels were significantly higher in woman with HT compared to the control group. The results of this study found no impairment in ovarian reserve parameters of patients with HT. Interestingly, the results revealed a significant increase in serum AMH levels of the patients with HT compared to controls. Hashimotos thyroiditis may share a common etiologic linkage with polycystic ovary syndrome; therefore, leading to elevated serum AMH levels, which we are currently unable to define elaborately. Chinese abstract 人类卵巢经常成为器官特异性或非器官特异性自身免疫性疾病的靶器官。桥本甲状腺炎(HT)或与卵巢功能不全和卵巢储备功能降低有关。本研究的目标为评估这种常见的自身免疫性疾病与卵巢储备可能存在的负相关性。 32名原发性甲状腺功能低下并使用甲状腺素进行替代治疗的绝经前妇女被纳入了此项研究。对照组包括49名抗甲状腺抗体正常的，与HT组年龄和BMI值相仿的受试者。在窦卵泡数方面，实验组和对照组并无明显的统计学差异。与对照组相比，HT组血清抗苗勒氏管激素水平显著升高。研究结果未发现HT患者的卵巢储备相关参数受到损伤。有趣的是，研究结果显示出HT患者相比较对照组AMH的显著升高。 桥本甲状腺炎与多囊卵巢综合征或具有相同的病原学联系。因此，导致了血清AMH的升高，这是我们目前无法精确判定的。

Maternal serum copeptin concentrations in early- and late-onset pre-eclampsia

OBJECTIVE Early-onset pre-eclampsia is primarily associated with placental dysfunction, whereas late-onset pre-eclampsia is defined as a maternal constitutional disorder. As a protein cosynthesized with vasopressin, copeptin is a potential marker of metabolic syndrome and insulin resistance, which shares similar risk factors with pre-eclampsia. The aim of this study was to investigate the copeptin levels in patients with early-onset and late-onset pre-eclampsia. MATERIALS AND METHODS A total of 80 pregnant women receiving antenatal and obstetric care were recruited. The patients were subdivided into four groups: Early-onset pre-eclampsia (n = 20), late-onset pre-eclampsia (n = 20), and two control groups of similar gestational ages for both pre-eclamptic groups (n = 20 in each group). The maternal serum copeptin levels were measured using an enzyme-linked immunosorbent assay. RESULTS The mean copeptin levels were 0.92 ± 0.57 ng/mL and 1.65 ± 0.95 ng/mL in the early-onset and late-onset pre-eclampsia groups, respectively. These values were higher compared with the control groups (0.54 ± 0.25 ng/mL and 1.15 ± 0.94 ng/mL, respectively). However, the difference was only statistically significant in the early-onset pre-eclampsia group (p = 0.011). Copeptin levels were associated only with gestational age and systolic-diastolic blood pressure. CONCLUSION Our results suggest that copeptin levels might be useful in the evaluation of the severity of pre-eclampsia. However, copeptin might be involved in early- rather than late-onset pre-eclampsia.

Maternal serum apelin and YKL-40 levels in early and late-onset pre-eclampsia

Objective: The aim of the present study is to investigate whether alterations in the serum levels of apelin and YKL-40 differ between early and late onset pre-eclampsia and whether there is a correlation between apelin and YKL-40 in women who subsequently develop early and late pre-eclampsia. Materials and methods: A total number of 80 pregnant women, 40 with normal pregnancy and 40 with pre-eclampsia, were included in the present study. Both the normal pregnant and pre-eclamptic subjects were subdivided into two groups. Serum YKL-40 and apelin concentrations were measured. Results: Mean maternal serum YKL-40 levels were both lower in women who subsequently developed early (87.45 ± 3.07 versus 103.40 ± 4.29) or late (96.43 ± 4.06 versus 99.87 ± 3.63) pre-eclampsia than those who remained normotensive. The difference was significant in early-onset preeclamptic women (p < 0.05) rather than late-onset pre-eclamptic ones (p > 0.05). Mean maternal serum apelin levels were both higher in women who subsequently developed early (8.6 ± 3.6 versus 5.7 ± 1.2) or late (9.6 ± 2.5 versus 8.1 ± 1.8) pre-eclampsia than those who remained normotensive. The difference was significant in early-onset preeclamptic women (p < 0.05) rather than late-onset pre-eclamptic ones (p > 0.05). There was a significant negative correlation between serum apelin and YKL-40 levels (r = −0.48, p = 0.001). Conclusion: Circulating levels of apelin are significantly increased in early-onset pre-eclampsia, indicating the role of apelin in the discrimination of the early-onset of pre-eclampsia. On the other hand, maternal serum YKL-40 levels are not elavated significantly, indicating that adipose-derived apelin is primarily involved in the vascular pathogenesis of early-onset pre-eclampsia than macrophage-derived YKL-40.

May AMH levels distinguish LOCAH from PCOS among hirsute women

OBJECTIVE To determine whether women with polycystic ovary syndrome (PCOS) would be distinguishable from women with late onset congenital adrenal hyperplasia (LOCAH) on the basis of antimullerian hormone (AMH) levels. STUDY DESIGN PCOS was diagnosed in 170 women; 105 were polycystic ovary morphology (PCOM)+/oligo-anovulation (OA)+/hyperandrogenism (HA)+, 40 PCOM+/OA-/HA+ and 25 PCOM-/OA+/HA+. These three groups were compared with 25 women in whom LOCAH was diagnosed. RESULTS The mean serum AMH levels were 8.12±1.85ng/ml in PCOM+/OA+/HA+ group, 5.34±1.82ng/ml in PCOM+/OA-/HA+ group, 3.02±1.76ng/ml in PCOM-/OA+/HA+ group and 4.43±1.29ng/ml in LOCAH group. The mean AMH level in PCOM+/OA+/HA+ group was approximately twofold higher than the mean AMH level measured in LOCAH group (p<0.001). Women with PCOM+/OA-/HA+ had higher serum AMH levels than those with LOCAH, women with LOCAH had higher serum AMH levels than those with PCOM-/OA+/HA+ but these differences were not statistically significant (p>0.05). CONCLUSIONS AMH is not suitable for distinguishing LOCAH from all types of hyperandrogenic patterns of PCOS, but is only applicable for a specific subtype, such as PCOS patients with three main diagnostic criteria. Therefore, ACTH stimulation test remains an essential clinical tool to diagnose LOCAH.

Diagnosis and outcome of pregnancies with prenatally diagnosed fetal dextrocardia.

Abstract Objective: To evaluate the incidence, associated cardiac and extracardiac malformations and clinical outcome of fetuses with dextrocardia. Method: A retrospective review of 3556 fetal echocardiograms between 2000 and 2011 revealed 39 cases of dextrocardia. Dextrocardia was defined as right-sided positioning of the fetal heart. Prenatal and postnatal records of the fetuses were reviewed. Results: The incidence was 1.1%. Of the 39 fetuses, 22 were primary dextrocardia and 17 were dextroposition. Diaphragmatic hernia was the most common cause of dextroposition with the incidence of 76%. Of the fetuses with dextroposition 35.5% had a cardiac anomaly. The survival rate of dextroposition was 31.2% and none of the survivors had an associated cardiac anomaly. Primary fetal dextrocardia was most common with situs solitus (45.4%), followed by situs ambiguous (36.3%) and then situs inversus totalis (18.1%). Structural cardiac malformations were found in 100%, 80% and 25% of fetuses with situs ambiguous, solitus and inversus, respectively. Of the dextroposition, 47.6% terminated pregnancy, 14.2% resulted in intrauterine death, 9.5% died after birth, and 28.5% survived. Conclusion: A wide spectrum of complex cardiac malformations are associated with fetal dextrocardia. Fetal echocardiography enables detection of complex cardiac anomalies so that parents can be appropriately counselled.