Patricio López-Jaramillo

Maternal and neonatal essential fatty acid status in phospholipids: an international comparative study

Objective: To investigate whether the steady decline in the maternal essential fatty acids (EFA) status during pregnancy observed in Dutch pregnant women is a local or general phenomenon.Design: The EFA status was measured during uncomplicated, singleton pregnancy of healthy women from the Netherlands, Hungary, Finland, England and Ecuador. In addition, the EFA status of their neonates were measured at birth. Fatty acid profiles were analyzed in phospholipids isolated from maternal plasma and from umbilical plasma and cord vessel walls.Results: Considerable differences between these centers were observed in the maternal EFA levels and EFA status indexes. However, the change in the absolute as well as relative amounts of the EFAs followed a similar course in the five populations during pregnancy. The neonatal EFA profiles reflected the differences found in maternal plasma during pregnancy and shortly after delivery. Comparable correlations were found, particularly, between the neonatal and the maternal n−3 fatty acids in the participating groups.Conclusions: It seems that the reduction in maternal EFA status during pregnancy is a general phenomenon, and is largely independent of differences in dietary habits and ethnic origin. Since the lowest values for certain maternal EFAs in a given country were significantly higher than the highest value of these EFAs throughout pregnancy in other countries, the functional implications of the pregnancy-associated reduction in the maternal EFA status for the fetal and neonatal development is not obvious and needs to be further elucidated.Sponsorship: Nutricia Research, Zoetermeer, the Netherlands.

Elevated C-reactive protein and pro-inflammatory cytokines in Andean women with pre-eclampsia

Objective: To investigate the concentration of markers of inflammation in non‐pregnant women, women with normal pregnancy and women with pre‐eclampsia. Methods: Pregnant women (n=26), women with pre‐eclampsia (n=25) and non‐pregnant normotensive women (n=21) were included in the study. C‐reactive protein was measured by latex‐enhanced immunoturbidimetric assay, serum tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) by high sensitivity ELISA. Kruskal–Wallis non‐parametric analysis of variance followed by the Mann–Whitney U‐test were used for statistical analyses. Results: Higher values (mean±S.E.M.) of C‐reactive protein were found in pre‐eclampsia (4.11±0.37 mg/dl) compared with normal pregnant women (2.49±0.26 mg/dl) and non‐pregnant controls (1.33±0.15 mg/dl). TNF‐α was significantly higher in women with pre‐eclampsia (15.74±5.09 pg/ml), in relation to the control group (2.76±0.41 pg/ml) and women with normal pregnancy (8.31±1.55 pg/ml). IL‐6 levels were significantly higher in pre‐eclamptic women (12.91±1.29 pg/ml) compared with normal pregnant (5.07±0.423 pg/ml) and control women (1.25±0.13 pg/ml). Conclusions: The results of this cross‐sectional study in a high‐risk Andean population show that both C‐reactive protein and pro‐inflammatory cytokines are present in higher concentrations in women with pre‐eclampsia. The study was undertaken in women with established pre‐eclampsia and it is not possible to determine whether the increased concentrations of C‐reactive protein and pro‐inflammatory cytokines were a cause or consequence of the disease.

Calcium supplementation reduces the risk of pregnancy‐induced hypertension in an Andes population

Summary. Previous studies have suggested that increased dietary calcium is associated with a decreased occurrence of pregnancy‐induced hypertension. In this study 106 young healthy nulliparous women, residing in Quito, Ecuador, were enrolled in a double‐blind, randomized, controlled clinical trial. From 24 weeks gestation until delivery they received either 2 g of elemental calcium per day or a placebo. Calcium supplementation was associated with a significantly decreased risk of pregnancy‐induced hypertension, with 4.1% developing pregnancy‐induced hypertension in the treatment group versus 27.9% in the placebo group. Treatment was associated with a decrease in both systolic and diastolic blood pressure over the course of pregnancy. In addition, there was a small but significant increase in serum ionized calcium levels in the calcium‐supplemented group during the treatment period.

Calcium supplementation and the risk of preeclampsia in Ecuadorian pregnant teenagers.

Objective To determine whether increased calcium intake (2 g/day) in pregnancy is effective in reducing the risk of preeclampsia in pregnant teenagers. Methods The present study was a prospective, randomized, double-blind, controlled clinical trial. Two hundred sixty teenaged pregnant girls attending the Hospital Gíneco-Obstétrico Isidro Ayora in Quito, Ecuador, were included. Selection criteria were age less than 17.5 years, nulliparity, first prenatal visit before 20 weeks gestation, and residency in Quito (2800-m altitude). We used a table of random numbers to assign 125 girls to receive 2000 mg of elemental calcium daily, beginning at 20 weeks of gestation and continuing until delivery; 135 women in the control group received a placebo. Blood pressure (BP) was measured twice every 4 weeks until delivery and at 48 hours after delivery. The diagnosis of preeclampsia was defined as BP greater than 140/90 mmHg on at least two occasions more than 6 hours apart and proteinuria greater than 30 mg/dL (over one cross by dipstick on two occasions 4-24 hours apart). Results The average daily calcium intake in this population was approximately 51% of the Recommended Dietary Allowance. Calcium supplementation was associated with a significantly decreased risk of preeclampsia (risk reduction 12.35%; P < .001), with 3.2% (n = 4) developing preeclampsia in the treatment group versus 15.5% (n = 21) in the placebo group. Moreover, calcium supplementation led to a reduction in systolic BP of 9.1 mmHg and in diastolic BP of 6.0 mmHg. Conclusion These results suggest that calcium supplementation during pregnancy in populations with low calcium intake is a safe, effective, and inexpensive preventive measure that significantly reduces the risk of preeclampsia.

Cyclic guanosine 3′3′ monophosphate concentrations in pre‐eclampsia: effects of hydralazine

Objective To elucidate the role of the L‐arginine: nitric oxide pathway in pregnancy and pre‐eclampsia.

Calcium, nitric oxide, and preeclampsia

A relationship between calcium dietary intake and incidence of preeclampsia was proposed. In the Andean Ecuadorian population, the average calcium intake, evaluated by a 24 hours dietary recall range between 52.3% of the US RDA to 77%. The calcium intake in women with preeclampsia was significantly lower in relation with normal pregnant women. Three prospective, randomized, double-blind, placebo-controlled clinical trials to investigate the effect of calcium supplementation (2 g/day of elemental calcium) in the incidence of pregnancy-induced hypertension and preeclampsia were conduced between 1984 and 1995. All the subjects included were nulliparous, younger that 25 years old, first prenatal visit before 24 weeks gestation, residency in Quito, and normotensives. These clinical trials showed a risk reduction in pregnancy induced hypertension and preeclampsia in the calcium group. Calcium supplementation was associated with an increase in the serum ionized calcium concentrations. Moreover, women with preeclampsia showed a significant decrease in the levels of the serum ionized calcium. Ionic calcium is crucial for the synthesis of vasoactive substances in the endothelium as prostacyclin and nitric oxide. Recent results suggest that an alteration in the action of NO may be related to a high inactivation by free radical superoxide, secondary to an inflammatory process.

Periodontal disease severity is related to high levels of C-reactive protein in pre-eclampsia.

Objective Recent studies have shown that pre-eclamptic women present a high prevalence of periodontitis, suggesting that active periodontal disease may play a role in the pathogenesis of pre-eclampsia. The present study analysed the effect of periodontal disease in the concentrations of serum high-sensitivity C-reactive protein (hs-CRP), and its association with pre-eclampsia. Methods A case–control study was carried out in Cali-Colombia, comprised of 398 pregnant women (145 cases and 253 controls) who were believed to have periodontal disease, between 28 and 36 weeks of gestational age. Pre-eclampsia cases were defined as blood pressure ≥ 140/90 mmHg and proteinuria ≥ 0.3 g/24 h. Controls were pregnant women with normal blood pressure, without proteinuria, matched by maternal age, gestational age and body mass index. Sociodemographic data, obstetric risk factors, periodontal state, subgingival microbial composition and hs-CRP levels were determined in both groups. Results The case and control groups were comparable for sociodemographic characteristics. In women with pre-eclampsia and confirmed periodontal disease (n = 138), hs-CRP levels increased according to the severity of the disease (gingivitis median 4.14 mg/dl; mild periodontitis median 4.70 mg/dl; moderate/severe periodontitis median 8.8 mg/dl; P = 0.01). A similar tendency was observed in controls with periodontal disease (n = 251), but it did not reach statistical significance (gingivitis median 5.10 mg/dl; mild periodontitis median 5.12 mg/dl; moderate/severe periodontitis median 6.90 mg/dl; P = 0.07). A significant difference in hs-CRP levels was observed in pre-eclamptic women with moderate/severe periodontitis compared to controls (P = 0.01). Conclusion These findings suggest that chronic periodontitis may increase hs-CRP levels in pregnant women and lead to complications such as pre-eclampsia.

Socioeconomic Pathology As a Cause of Regional Differences in the Prevalence of Metabolic Syndrome and Pregnancy-Induced Hypertension

The epidemic of cardiovascular disease being experienced by developing countries has resulted in a debate about the possible existence of regional differences in etiology and pathophysiology that could be associated with socio-economic factors. Clear demonstration of these differences is important because there may be a need for different approaches to prevention, diagnosis and treatment. There is some evidence that there are differences between populations in developed and developing countries in the pathophysiologic mechanisms underlying pregnancy-induced hypertension and metabolic syndrome, just as there are in the relative weightings of risk factors that predict the appearance of these conditions. Observations in our country suggest that increasing exposure to changes in lifestyle brought about by the consumer society (e.g., a lack of exercise, and a high-fat, high-calorie diet) results in a natural biological response (e.g., obesity, metabolic syndrome, and diabetes) that increases the risk of cardiovascular disease. We propose that the term socioeconomic pathology should be used to describe these changes associated with modern society so that they can be differentiated and considered in isolation from socioeconomic factors and other risk factors. We regard the interaction between these various factors as the most important cause of the rapidly increasing incidence of cardiovascular disease observed in developing countries in recent years.

The hypotensive effect of calcium supplementation during normal pregnancy in Andean women is not related to vascular production of prostacyclin by umbilical arteries

SummaryCalcium supplementation during pregnancy attenuates maternal blood pressure and reduces the risk of pregnancy hypertension in Andean women with low calcium intake. Calcium supplementation might result in an increase in the vascular production of prostacyclin, and this might be responsible for the hypotensive effect of calcium supplementation. We measured the release of prostacyclin from umbilical arteries in two groups of nulliparous women:- 14 supplemented with 2 g elemental calcium daily from 20 weeks pregnant to delivery, and 11 assigned to placebo starch tablets. The levels of 6-keto-prostaglandin F1α were similar in both groups. However, the calcium supplemented group had a mean blood pressure (106 ± 8/70 ± 8 mmHg; s.d.), lower (P<0.05) than the placebo group (112 ± 10/74 ± 6 mmHg). Although these data confirm that calcium supplementation attenuates maternal blood pressure in normal pregnancy in these women, the hypotensive effect is unlikely to be mediated by an increased vascular production ...

The clinical utility of the roll-over test in predicting pregnancy-induced hypertension in a high-risk Andean population

The utility of the roll‐over test (ROT) as a prognostic tool for predicting pregnancy‐induced hypertension (PIH) was examined in primiparas in Quito, Ecuador. In Study I, 14 of 16 subjects with a + ROT developed PIH (positive predictive value (PPV) = 88%); only 2 of 27 subjects with a ‐ ROT developed PIH (negative predictive value (NPV) = 92.5%). In Study II (n = 66), the PPV and NPV were 71.4% and 78.6%, respectively. Data from these and previous studies indicate that although the ROT is not a perfect predictor, its advantages recommend usage in populations with high PIH‐associated maternal and perinatal mortality.