Marzena Laskowska

Comparative analysis of the maternal and umbilical interleukin-8 levels in normal pregnancies and in pregnancies complicated by preeclampsia with intrauterine normal growth and intrauterine growth retardation.

Objectives. The aim of this study was to determine the maternal and umbilical cord serum levels of interleukin-8 (IL-8) in pregnancies complicated by preeclampsia with intrauterine normal growth and intrauterine growth retardation (IUGR), and in normotensive pregnancies. Patients and methods. The study was carried out on 15 patients with singleton pregnancies complicated by preeclampsia with appropriate for gestational age weight infants and 12 pregnant patients with preeclampsia complicated by IUGR. The control group consisted of 10 healthy normotensive delivering patients with singleton uncomplicated pregnancies. Maternal and umbilical serum IL-8 concentrations were estimated using the ELISA method. Results. There were no statistically significant differences in patient profiles between the groups. Systolic and diastolic blood pressure and mean arterial blood pressure were higher in the study groups in comparison with the control group. Lower birth weight and lower gestational age at birth were observed in the group of patients with preeclampsia complicated by IUGR. Increased maternal and umbilical serum levels of IL-8 were found in both preeclamptic patient groups in comparison with the control group. The umbilical cord blood concentrations of IL-8 in all groups of patients tended to be higher in comparison with the maternal blood. Conclusions. It seems that these higher IL-8 concentrations may be associated with apoptosis, inflammation, neutrophil activation, endothelial cell damage and dysfunction, and increased endothelial permeability. They may also participate in an attempt to compensate for the imbalanced apoptosis and vascular resistance. Our findings suggest a possible significant role of IL-8 in the pathogenesis and sequelae of preeclampsia, especially in preeclamptic pregnancies complicated by IUGR.

Evaluation of maternal and umbilical serum TNFα levels in preeclamptic pregnancies in the intrauterine normal and growth-restricted fetus

Objective. The aim of this study was to carry out a comparative analysis of the maternal and umbilical cord TNFα serum levels in pregnancies complicated by severe preeclampsia with normal intrauterine fetal growth, in preeclamptic pregnancies with intrauterine growth restriction (IUGR), and in normotensive pregnant patients. Patients and methods. The study was carried out on eight patients with severe preeclampsia complicated by IUGR and 18 preeclamptic patients with normal intrauterine fetal growth. The control group consisted of 18 healthy normotensive patients with singleton uncomplicated pregnancies. Maternal and umbilical serum TNFα concentrations were estimated using a sandwich ELISA assay. Results and conclusions. Pregnant women with severe preeclampsia had significantly higher maternal and umbilical serum TNFα levels than those in the normotensive controls. Our findings and other reports indicate that TNFα may participate in the pathogenesis and sequelae of preeclampsia with and without IUGR. The results of excessive umbilical serum activity of tumor necrosis factor α (TNFα) in preeclamptic pregnancy complicated by intrauterine growth restriction (IUGR) may suggest additional changes and dysfunction of the placental–fetal unit and deterioration of placental function, leading to fetal hypotrophia in the course of preeclampsia.

Pregnancy in Women with Epilepsy

The aim of this study was to analyze the outcome of pregnancy and delivery in epileptic women. A retrospective review of the 41 pregnant women with epilepsy who delivered in the Department of Obstetrics and Perinatology of the University School of Medicine in Lublin over 7 years (1993–1999) was carried out. Women with epilepsy had more pregnancy complications including premature labor, anemia, hypertension, vaginal bleeding, urinary tract infection, nausea and vomiting. An increased risk of congenital malformations and intrauterine fetal growth retardation was observed. Women with epilepsy require more extensive pregnancy planning including neurologic and preconceptional care.

Nitric oxide for treatment of threatened preterm labor.

Objective: The aim of our study was the assessment of effectiveness of nitroglycerin as a donor of nitric oxide, administered in the form of transdermal therapeutic system, applied in the treatment of threatening preterm labor. Patients and methods: The study was carried out on 30 pregnant patients with the symptoms of threatening preterm labor between 27th and 34th week of gestation. The patients were given nitroglycerin in the form of transdermal system releasing 5 mg of nitroglycerin in 24 h. Results: In our study the decrease in contractility and relaxation of uterus was observed in all obstetric patients. No changes in the fetal pulse rate and cardiotocographic tracing in the course of treatment and after completing treatment were observed. Conclusion: Nitroglycerin in the form of transdermal therapeutic system releasing nitric oxide may be an effective and safe tocolytic drug, however, further investigation needs to be performed.

A comparison of maternal serum levels of endothelial nitric oxide synthase, asymmetric dimethylarginine, and homocysteine in normal and preeclamptic pregnancies.

Background The aim of this study was to determine the maternal serum concentrations of eNOS, ADMA, and homocysteine in preeclamptic pregnancies. Material/Methods The study was carried out on 62 patients with pregnancy complicated by early onset and 53 patients with late onset preeclampsia. The control group consisted of 65 healthy normotensive pregnant patients. The serum eNOS, ADMA and homocysteine concentrations were determined using ELISA assays. Results Our study revealed elevated levels of homocysteine and ADMA in the serum of women with preeclampsia. The highest levels were observed in patients with early onset preeclampsia, but the differences between both groups of preeclamptic patients with early and late onset of preeclampsia were not statistically significant. Both groups of preeclamptic women had slightly lower levels of maternal serum endothelial nitric oxide synthase than in normotensive pregnant women, but these differences were not statistically significant. Conclusions The higher levels of homocysteine and ADMA observed in patients with early onset preeclampsia may suggest that higher levels of maternal serum homocysteine and ADMA correlate with the severity, and may determine the earlier clinical onset of the disease. The elevated levels of ADMA and the unchanged levels of eNOS in preeclamptic pregnancies suggest that NO deficiency in this pregnancy disorder results not from a reduced level or activity of eNOS, but from elevated levels of ADMA, an endogenous eNOS inhibitor. The lowering of increased levels of homocysteine and ADMA may be helpful in therapy of vascular disturbances occurring in preeclampsia.

Maternal and Umbilical sTNF-R1 in Preeclamptic Pregnancies with Intrauterine Normal and Growth Retarded Fetus

Objective: The aim of this study was to determine the maternal and umbilical cord sTNF R1 serum levels in pregnancies complicated by severe preeclampsia with normal intrauterine fetal growth and in preeclamptic pregnancies with intrauterine growth retardation (IUGR). Patients and Methods: The study was carried out on 8 patients with preeclampsia complicated by intrauterine growth retardation (group PI) and 18 preeclamptic patients with appropriate-for-gestational-age weight infants (group P). The control group consisted of 18 healthy normotensive delivering patients with singleton uncomplicated pregnancies (group C). Maternal and umbilical serum sTNF-R1 concentrations were estimated using a sandwich enzyme-linked immunosorbent assay (ELISA). Results and Conclusions: Pregnant women with severe preeclampsia had higher maternal and umbilical serum sTNF-R1 levels than did normotensive controls. Furthermore significantly higher umbilical levels of sTNF-R1 were observed in the group of patients with preeclampisa complicated by IUGR, compared with preeclamptic patients with appropriate-for-gestational-age weight infants. The umbilical sTNF-R1 levels in preeclamptic groups tended to be higher in comparison with the maternal levels. Our results and those of other reports seem to suggest that TNFα and sTNFR1 play a crucial role in pathogenesis and sequelae of preeclampsia with and without intrauterine growth retardation.

Placental angiotensin II receptor AT1R in normotensive patients and its correlation between infant birth weight

OBJECTIVE To evaluate angiotensin II type 1 receptor (AT1R) in the third trimester placenta from normotensive women and the correlation between placental AT1R immunoreactivity and infant birth weight. PATIENTS AND METHODS The study was carried out on 18 healthy normotensive patients with singleton uncomplicated pregnancies. Immunohistochemistry was used to examine the localization of AT1R in the human placenta. RESULTS Immunohistochemistry using a monoclonal antibody showed that angiotensin II (Ang II) receptor subtype 1 is localized in the decidual cells, syncytiotrophoblast, cytotrophoblast, Hofbauer cells and vascular endothelium. In our study group of patients, we found a significant negative correlation between histological staining in placental tissue and infant birth weight. CONCLUSION It seems that the appropriate placental AT1R expression and its normal vascular and endocrine activity plays a very important role in oxygenation and nutrition of the fetus and this ensures proper fetal development and growth.

sCD40 Ligand determined in maternal and umbilical cord blood in pregnancies complicated by pre-eclampsia with and without intrauterine growth retardation

Objective: The aim of this study was determination and comparative analysis of the maternal and umbilical cord sCD40L serum levels in pregnancies complicated by pre-eclampsia with and without intrauterine growth retardation (IUGR) and in normotensive pregnancies. Patients and Methods: The study was carried out on 16 patients with singleton pregnancies complicated by severe pre-eclampsia with appropriate-for-gestational-age weight infants and 14 pregnant patients with severe pre-eclampsia complicated by IUGR. The control group consisted of 13 healthy normotensive delivering patients. Five milliliters of blood were taken by venipuncture from each pre-eclamptic patient and from each woman from the control group before active phase of labor and 5 ml of umbilical vein blood were taken immediately after delivery and collected in sterile tubes. Maternal and umbilical serum sCD40L concentrations were estimated using a sandwich ELISA assay. Results and Conclusions: Our results reveal the higher levels of maternal and umbilical sCD40L serum levels in pregnancy complicated by pre-eclampsia with and without IUGR. The mean maternal values were 4.022 ± 2.399 ng/ml in group P, 3.914 ± 2.824 ng/ml in group PI and 0.885 ± 0.064 ng/ml in healthy controls. The mean umbilical values were 2.633 ± 1.984 ng/ml in group P, 2.703 ± 1.996 ng/ml in group PI and 1.112 ± 0.436 ng/ml in the control group. It seems that these higher concentrations of sCD40L protect maternal immune cells bearing CD40 receptor from Fas-mediated apoptosis. Our findings may suggest also enhanced platelet activation in pre-eclamptic patients. It may be one of the factors responsible for the enhanced procoagulatory and proinflammatory properties, and increased cytokine production, and endothelial cell dysfunction in pregnancies complicated by pre-eclampsia.

Differences in the association between maternal serum homocysteine and ADMA levels in women with pregnancies complicated by preeclampsia and/or intrauterine growth restriction.

Objective. The aim of our study was to investigate the association between homocysteine and asymmetric dimethylarginine in preeclamptic women with and without intrauterine growth restriction compared with normal healthy uncomplicated pregnancies and normotensive pregnancies complicated by idiopathic isolated intrauterine fetal growth restriction. Methods. The maternal serum homocysteine and asymmetric dimethylarginine concentrations were determined using a sandwich enzyme-linked immunosorbent assays. Results. A statistically significant positive correlation of maternal serum homocysteine levels with the serum asymmetric dimethylarginine levels was observed in healthy normotensive uncomplicated pregnant women from the control group and in preeclamptic patients with appropriate-for-gestational-age fetuses (R = 0.380079, p-value = 0.002311* and R = 0.455797, p-value = 0.004030* for the control and the P groups, respectively). However, this correlation was not significant in women with pregnancy complicated by intrauterine growth restriction, both isolated and in the course of severe preeclampsia. Conclusion. These findings provide support for the hypothesis that elevated levels of asymmetric dimethylarginine in pregnancy complicated by preeclampsia are associated with elevated homocysteine levels. But our results also demonstrate that in pregnancies complicated by intrauterine growth restriction, this mechanism is important, although not the only one.

Asymmetric dimethylarginine in normotensive pregnant women with isolated fetal intrauterine growth restriction: a comparison with preeclamptic women with and without intrauterine growth restriction

Objective. The aim of this study was to evaluate maternal asymmetric dimethylarginine (ADMA) levels in pregnancies complicated by isolated fetal intrauterine growth restriction (IUGR), in preeclamptic pregnancies with and without IUGR, and in healthy normotensive pregnant women with proper weight fetuses. Patients and methods. The study was carried out on 54 normotensive pregnant patients with pregnancy complicated by IUGR, 35 patients with IUGR in the course of preeclampsia, 29 preeclamptic patients with appropriate-for-gestational-age weight infants and 54 healthy normotensive pregnant patients. The ADMA concentrations were evaluated using an ELISA assay. Results. The preeclamptic women and normotensive patients with pregnancy complicated by isolated IUGR revealed higher levels of maternal serum ADMA. The mean values of maternal serum ADMA were 0.5730 ± 0.1769 μmol/l in the P group, 0.5727 ± 0.1756 μmol/l in the PI group, 0.6129 ± 0.1517 μmol/l in the IUGR group, and 0.5017 ± 0.1116 μmol/l in the control group. The levels of ADMA were additionally higher in the patients with HELLP syndrome and in patients with pregnancy complicated by eclampsia. Conclusions. It seems that ADMA is an active agent not only in preeclamptic patients, but also in normotensive pregnant women with isolated fetal IUGR and could be a marker of severity of preeclampsia.