Are body roundness index and a body shape index in the first trimester related to foetal macrosomia?

This study investigated the effectiveness of maternal Body Roundness Index (BRI), Body Shape Index (ASBI), and Visceral Adiposity Index (VAI) in predicting foetal macrosomia and small for gestational age (SFGA) babies in obese and non-obese pregnant women. This prospective trial included 168 pregnant women (99 obese and 69 non-obese). A logistic regression model was used to identify the independent risk factors of foetal macrosomia and SFGA. BRI, waist/hip ratio, HbA1c and HOMA-IR were found to be significantly associated with increased macrosomia risk in obese women (OR = 1.469, % CI: 1.126-1.917, p = .005; OR = 4.289, % CI: 0.178-1.030, p = .012, OR = 6.277, %Cl: 1.233-31.948, p = .027, and OR = 1.393, %Cl: 1.060-1.832, p = .017). The present study indicates that first-trimester BRI and waist/hip ratio may be powerful determinants in predicting foetal macrosomia in obese pregnant women.Impact statementWhat is already known on this subject? Obesity is a major risk factor for maternal and foetal morbidity and mortality. The rate of obesity continues to increase rapidly around the world. The accuracy of ultrasound in estimated foetal weight is reduced in obese pregnant women. The Body Roundness Index (BRI) is a new anthropometric index that shows body fat distribution.What do the results of this study add? Our results show that the BRI was an independent risk factor associated with foetal macrosomia in obese pregnant women.What are the implications of these findings for future clinical practice and/or further research? BRI measurements should be taken before pregnancy to help predict shoulder dystocia, GDM, FGR and foetal macrosomia in obese women.

Association of adverse outcomes of intrahepatic cholestasis of pregnancy with zonulin levels.

Our aim was to investigate serum zonulin levels in intrahepatic cholestasis of pregnancy (ICP) and to determine the usefulness of zonulin in ICP follow-up. A prospective case-control study was carried out which included 88 pregnant women (44 patients with ICP and 44 controls). Maternal serum samples obtained from all participants and zonulin levels were determined by enzyme-linked immunosorbent assay (ELISA). Compared with controls, women with ICP had significantly higher zonulin levels (mean 0.728 ± 0.520 ng/mL vs. 1.303 ± 0.63 ng/mL, p <.001). According to the receiver operating characteristic (ROC) analysis performed for the predictive value of zonulin levels for ICP, the area under the curve (AUC) was 0.761 (95% CI: 0.661-0.860). Multivariable logistic regression analysis revealed serum zonulin levels was independently associated with adverse perinatal outcomes (OR = 1.278, 95% CI: 0.232-7.041), severity ICP (OR: 7.535, 95% CI: 1.597-13.553) and also unresponsiveness to treatment in ICP (OR: 4.178, 95% CI: 0.929-8.784).IMPACT STATEMENTWhat is already known on this subject? Zonulin is a regulator protein that increases the intestinal permeability by modulating the intercellular tight junctions (TJ). It is the only physiological protein known to control intestinal permeability and damage of the intestinal barrier is one of the causes of absorption disorders, inflammation and autoimmunity. ICP is a relatively non-threatening condition to women but is linked with a higher risk of preterm delivery, foetal distress and foetal death.What do the results of this study add? This study showed that increased levels of zonulin are associated with adverse perinatal outcomes, severity of ICP and unresponsiveness to treatment in ICP.What are the implications of these findings for clinical practice and/or further research? Focussing on preservation of intestinal permeability may be an alternative preventive strategy to reduce the adverse perinatal outcomes and severity of ICP. Further longitudinal studies are needed to verify the relationships among zonulin levels and pregnancy-related diseases.

Increased syndecan-1 and glypican-3 predict poor perinatal outcome and treatment resistance in intrahepatic cholestasis.

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) increases the risk of adverse pregnancy outcomes. This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid (UDCA). METHODS: This prospective, case control study included 88 pregnant women (44 women with ICP and 44 healthy controls). The primary end points were the perinatal outcome and the response to UDCA therapy. A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy. RESULTS: Women with ICP had significantly higher serum syndecan-1 (1.27 ± 0.36 ng/mL vs. 0.98 ± 0.50 ng/mL; P = 0.003), glypican-3 (1.78 ± 0.13 ng/mL vs.1.69 ± 0.16 ng/mL; P = 0.004), AST (128.59 ± 1.44 vs. 13.29 ± 1.32 U/L; P < 0.001), and ALT (129.84 ± 1.53 vs. 8.00 ± 3.67 U/L; P < 0.001) levels compared with the controls. The increased levels of syndecan-1 (OR = 4.715, 95% CI: 1.554-14.310; P = 0.006), glypican-3 (OR = 8.465, 95% CI: 3.372-21.248; P = 0.007), ALT (OR = 1.382, 95% CI: 1.131-1.690; P = 0.002), and postprandial bile acid (PBA) (OR = 3.392, 95% CI: 1.003-12.869; P = 0.026) were correlated to ICP. The adverse neonatal outcome was related to increased glypican-3 (OR = 4.275, 95% CI: 2.726-5.635; P = 0.039), and PBA (OR = 3.026, 95% CI: 1.069-13.569; P = 0.037). Increases of syndecan-1 (OR = 7.464, 95% CI: 2.130-26.153, P = 0.017) and glypican-3 (OR = 6.194, 95% CI: 2.951-13.002; P = 0.025) were the risk factors of decreased response to UDCA treatment. CONCLUSION: Syndecan-1 and glypican-3 might be powerful determinants in predicting adverse perinatal outcome in patients with ICP, and they can be used to predict the response to the UDCA treatment.

Is the low AMH level associated with the risk of cardiovascular disease in obese pregnants?

Our aim was to investigate whether Antimullerian Hormone (AMH), complete blood count (CBC), Homeostasis model assessment (HOMA-IR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight gain have any diagnostic value for the prediction of cardiovascular disease (CVD) in obese and non-obese pregnant patients. A prospective, case-control study was carried out, including 187 patients (93 obese, and 94 non-obese). CVD risk for each patient was evaluated according to the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA). A multivariate logistic regression model was used to identify the independent risk factors of CVD in obese and non-obese patients. The obese patients had significantly lower levels of AMH when compared to the non-obese ones (p = .002). Insulin, HOMA-IR, HbA1c, and SBP were significantly higher in obese patients than non-obese ones (p < .001, p < .001 and p = .001, respectively). Age, SBP, and decreased AMH levels had significantly associated with risk factors of CVD in the obese group (p = .001, p = .002, and p = .049, respectively). Our study suggests that decreased AMH levels, increased age, and SBP are associated with CVD in obese patients. AMH may be used to evaluate CVD risk in advanced aged, obese patients.IMPACT STATEMENTWhat is already known on this subject? Obesity is one of the most common medical complications of pregnancy. Obesity increases maternal complications such as preeclampsia, caesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications including macrosomia, hypoglycaemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes. Obese patients have lower serum AMH levels.What the results of this study add? A significant relationship between AMH levels and CVD risk in obese pregnant women was observed.What are the implications of these findings for clinical practice and/or further research? Based on this finding, we concluded that decreased AMH levels are predictive for CVD in obese pregnant women.

The influence of Body Roundness Index on sensorial block level of spinal anaesthesia for elective caesarean section: an observational study.

In this prospective trial, we investigate the effectiveness of maternal Body Roundness Index in predicting the spread of spinal anaesthesia and vasopressor requirement in parturients receiving spinal anaesthesia during the elective caesarean section. We prospectively enrolled 175 parturients. Spinal anaesthesia performed with 10 mg 0.5% hyperbaric bupivacaine at the L3-L4 intervertebral space and the optimal cut-off points of the BRI evaluated as 6.59 by receiver operating characteristic analysis calculating area under the curve. Parturients were divided into two groups with BRI <6.59 and BRI ≥6.59 for analyses. Multivariate logistic regression analysis was used to test for a relationship between variables and maximum sensory block level and vasopressor requirement. BRI was found as an independent risk factor associated with maximum sensory block level (OR = 1.378, 95% CI: 1.125-1.687, p = 0.002). Hypotension and bradycardia events after spinal anaesthesia was not associated with BRI and other variables. The present study indicates that BRI was a practical tool to predict spinal drug distribution in term parturients undergoing caesarean delivery.Impact statementWhat is already known on this subject? Spinal anaesthesia is a commonly used anaesthetic technique for the caesarean section. However, the spinal drug distribution is highly unpredictable. Anthropometric variables may predict the intrathecal drug distribution in parturients. Body Roundness Index (BRI) captures body circumference regarding height to predict body fat percentage, consider the shape of the human body as an ellipse. An ellipsoid body shape might affect the spread of spinal anaesthesia.What do the results of this study add? Our results show that the BRI was as an independent risk factor associated with maximum sensory block level in term parturients undergoing caesarean delivery.What are the implications of these findings for future clinical practice and/or further research? A future study would present the possibility to design a formula for the exact amount of local anaesthetic to be used in spinal anaesthesia with the aid of maternal BRI.

Are serum levels of ADAMTS5, TAS and TOS at 24-28 gestational weeks associated with adverse perinatal outcomes in gestational diabetic women?

We aimed to determine the role of placental A Disintegrin and Metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and maternal serum ADAMTS5, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels at 24-28th gestational weeks in GDM. This study included 57 patients, who had been diagnosed as having GDM at their 24-28th gestational week, and 29 controls. The maternal blood samples were collected at the 24-28th gestational week and ADAMTS5 was studied with the enzyme-linked immunosorbent assay (ELISA) method, whereas an automated colorimetric method was used to study TAS, TOS, and OSI. The level of ADAMTS5 in maternal serum of patients with GDM were significantly lower than the controls (p = .017); whereas TOS and OSI levels were significantly higher (p = .003 and p = .008). Multivariable logistic regression analysis revealed ADAMTS5 and TOS levels were independently associated with adverse perinatal outcomes (p = .004 and p = .018). We found that serum ADAMTS5 levels decreased and TOS level increased in GDM pregnant at 24-28th gestational weeks. In addition, we found that increased levels of serum ADAMTS5 and decreased TOS levels at 24-28th weeks were associated with adverse perinatal outcomes independent of the mode of treatment in GDM.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. The insulin resistance, which starts at the 24-28th gestational weeks, increases during gestation. GDM increases maternal complications like preeclampsia, cesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications like macrosomia, hypoglycemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes.What the results of this study add? A significant relationship between ADAMTS5, TOS levels and adverse perinatal outcome. insulin resistance and was observed.What the implications are of these findings for clinical practice and/or further research? Based on this finding, we concluded that increased levels of oxidative stress and decreased ADAMTS5 levels are associated with GDM and predictive for adverse perinatal outcomes. The results of the present study were consistent with the previous reports and indicated that increased oxidative stress in GDM patients are related to adverse perinatal outcomes.

Dynamic Thiol/Disulfide Homeostasis in Predicting Adverse Neonatal Outcomes in Fetal Growth Restriction.

Aim: The main aim of this study was to investigate thiol/disulfide homeostasis associated with fetal growth restriction (FGR) and to evaluate whether alterations are predictive for adverse neonatal outcomes. Methods: 273 pregnant women (77 with FGR and 196 with normal fetal growth) were enrolled in this prospective case-control study. Results: Native thiol and total thiol were decreased in FGR compared to the control group (p < .001; p < .001). Decreased levels of maternal serum native and total thiol were significantly associated with adverse neonatal outcomes in FGR (OR: 0.983, 95% CI 0.976-0.991, p < .001; OR: 0.983, 95% CI 0.976-0.991, p < .001). Decreased maternal serum total thiol levels were the only significantly associated risk factor with adverse neonatal outcomes in FGR (OR: 0.981, 95% CI 0.963-1.000, p = .046). Conclusion: The decrease in the antioxidants of thiol/disulfide mechanism may be related to the development of both FGR and adverse neonatal outcome in FGR.

Comparison of Serum A Disintegrin and Metalloproteinase with Thrombospondin Motifs-19 Levels in Different Fertility Situations: Could It Be a Serum Marker of Ovarian Function and Oocyte Pool?

BACKGROUND/AIMS: A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) enzymes take part in extracellular matrix (ECM) remodeling which has been shown to contribute to the ovulation and follicular functions. We aimed to compare serum levels of ADAMTS-19 in patients with different fertility situations. METHODS: A total of 86 women were enrolled to this cross sectional and case-control study. Four groups were constituted with respect to women's clinical and hormonal status: group 1, women with premature ovarian failure (POF; n = 21); group 2, women with natural menopause (n = 21); group 3, women with polycystic ovary syndrome (PCOS; n = 22); and group 4, healthy fertile controls. Serum ADAMTS-19 levels and individual characteristics were compared among groups. RESULTS: -ADAMTS-19 levels were found as 36.7 ± 10.2, 40.1 ± 12.6, 46.7 ± 16.1, and 51.0 ± 18.8 ng/mL in POF, fertile, natural menopause, and PCOS groups, respectively (p = 0.012). Especially, ADAMTS-19 levels in the PCOS group were significantly higher than the POF group, as found in dual comparisons (p = 0.010). CONCLUSIONS: ADAMTS-19 was found to be higher in PCOS patients than in POF patients. This work provides a novel vantage point for function of ECM within the ovary. ADAMTS-19 may have a potential for being an important marker of ovarian function and oocyte pool.

Increased levels of serum serglycin and agrin is associated with adverse perinatal outcome in early onset preeclampsia.

Goal: Our aim was to determine whether alterations in serum serglycin and agrin levels in early-onset preeclampsia (EOPE) are useful in predicting adverse perinatal outcomes such as fetal growth restriction (FGR), intrauterine fetal demise (IUFD), preterm delivery and/or neonatal unit admission. Materials and Methods: A prospective case-controlled study enrolled 88 pregnant patients (44 EOPE and 44 controls). Maternal serum serglycin and agrin levels were determined before the 34th gestational week by enzyme-linked immunosorbent assay. Results: Compared with controls, women with EOPE had significantly higher serglycin and agrin levels (p = .018; p = .048). Multivariable logistic regression analysis revealed serglycin was independently associated with FGR in EOPE (OR 0.866; 95% CI 0.779-0.953). Agrin was independently associated with IUFD in EOPE (OR 0.757, 95% CI 0.636-0.879). Conclusions: The current study suggests that increased maternal serum serglycin is associated with FGR, and increased maternal serum agrin is associated with IUFD in EOPE.

Maternal venous SHARP1 levels in preeclampsia.

AIM: Owing to its mysterious etiology, pathogenesis of preeclampsia (PE) remains controversial. Here we aimed to compare the levels of an angiogenesis marker, split and hairy related protein-1 (SHARP1), in PE vs. normal pregnancy. METHODS: Thirty-one patients with early-onset PE (EOPE), 26 patients with late-onset PE (LOPE), and 33 patients as a control group were recruited for this study in a tertiary referral center in Ankara, Turkey. Maternal venous SHARP1 levels and individual characteristics of the three groups were compared. RESULTS: Age and body mass indices were similar among the three groups. SHARP1 levels in patients with PE (27.7±13.2 ng/mL) were significantly lower than in the control group (34.7±17 ng/mL) (P=0.006). Additionally, SHARP1 levels were significantly different among patients in EOPE, LOPE, and control groups (P=0.022). Birth weights and Apgar scores in patients in EOPE group were significantly lower than the other two groups and showed a gradual increase from the EOPE group to the LOPE and the control group. Binary logistic regression method demonstrated that maternal venous SHARP1 level was a risk factor for PE. CONCLUSIONS: Maternal venous SHARP1 levels in PE are lower than a normal pregnancy. Its clinical applicability and role as a candidate for making sense of the distinctive pathogenesis of the EOPE and LOPE remain to be elucidated.

Impact of Gestational Diabetes Mellitus and Maternal Obesity on Cord Blood Dynamic Thiol/Disulfide Homeostasis.

AIM: Our aim in this study was to investigate the effect of maternal obesity and gestational diabetes mellitus (GDM) on cord blood dynamic thiol/disulfide homeostasis. METHODS: A prospective case-control study was carried out in 125 pregnant women (27 GDM, 30 obese, 68 controls). Cord blood samples were collected from all participants and native thiol-disulfide exchanges were examined with automated method enabling the measurement of both sides of thiol-disulfide balance. RESULTS: Disulfide amounts, disulfide/native thiol and disulfide/total thiol ratios were increased (p < 0.001), while native thiol/total thiol was decreased in the cord blood of babies born to an obese or diabetic mother (p < 0.001). Moreover, increased disulfide amounts, disulfide/native thiol, disulfide/totalthiol ratios and decreased native/total thiol were found to be significantly associated with adverse outcomes in GDM. CONCLUSION: The current study suggests that the offsprings born to obese or diabetic mothers are exposed to increased oxidative stress.

Decreased oxidative stress may contribute to the disease process in placenta accreta

Background/aim: The main aim of this study was to investigate serum total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and arylesterase levels in pregnant women with placenta accreta and to compare those with age-matched healthy pregnant women. Materials and methods: A total of 27 pregnant women who had clinically and pathologically proven placenta accreta and 30 age- and BMI- matched healthy pregnant women were enrolled in this case control study. Maternal serum TOS, TAS, OSI, and arylesterase levels were evaluated using logistic regression analysis to determine if there was an association with abnormal placental invasion or not. Results: Decreased OSI (OR= 0.999, 95%CI: 0.998-1.000, P = 0.035) and increased arylesterase levels (OR= 0.981, 95%CI: 0.970-0.993, P = 0.001) were significantly associated with the presence of placenta accreta. Maternal serum TOS, TAS, OSI, and arylesterase levels were not predictive for adverse perinatal outcomes (P > 0.05). Conclusions: Decreased OSI and increased arylesterase levels are significantly associated with placenta accreta and may contribute to the abnormal invasion process.

The association of thiol/disulphide homeostasis and lipid accumulation index with cardiovascular risk factors in overweight adolescents with polycystic ovary syndrome.

OBJECTIVE: To assess thiol/disulphide homeostasis and lipid accumulation product index, and to determine whether they are associated with increased cardiovascular disease (CVD) risk or not in overweight adolescents with polycystic ovary syndrome (PCOS). DESIGN: Case-control study. SETTING: Education and Research Hospital. PATIENTS: Group 1: 43 overweight+PCOS, Group 2: 45 normal weight+PCOS, Group 3: 27 overweight adolescents and Group 4: 96 age-matched, normal weight healthy controls. INTERVENTIONS: Serum lipid profiles, hormonal parameters and thiol/disulphide homeostasis were measured. Lipid accumulation index (LAP index) and homeostasis model assessment (HOMA-IR) were calculated. MAIN OUTCOME MEASURES: The relation between thiol/disulphide homeostasis and LAP index, and increased CVD risk were evaluated in overweight adolescents with PCOS. RESULTS: Native and total thiol levels were significantly lower in overweight+PCOS adolescents when compared with both normal weight PCOS and control adolescents (P = 0·002). LAP index values were significantly higher in Group 1 when compared separately with the rest of the three groups (P < 0·001). Multivariable logistic regression analysis revealed serum total thiol levels of lower than 405·45 µmol/l were independently associated with increased risk of CVD in overweight PCOS adolescents (OR: 1·019, 95% CI: 1·001-1·036). In addition, a LAP index greater than 21·54 was also associated with increased CVD risk in overweight PCOS adolescents (OR: 1·270, 95% CI: 1·174-1·374). CONCLUSION: In conclusion, we suggest that increased LAP index and decreased total thiol levels may contribute to the increased CVD risk in overweight adolescents with PCOS.

Increased levels of serum clusterin is associated with intrauterine growth restriction and adverse pregnancy outcomes in preeclampsia.

AIM: Our aim was to investigate serum clusterin levels in preeclampsia and to determine whether any changes in clusterin levels are useful in distinguishing the presence of concomitant intrauterine growth restriction (IUGR) and in predicting adverse pregnancy outcomes. METHODS: A prospective case-control study was carried out which included 86 pregnant women (47 patients with preeclampsia and 39 healthy controls). Maternal serum samples obtained from all participants and clusterin levels were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared with controls, women with preeclampsia had significantly higher clusterin levels (mean 83.8±23.6 vs. 119.2±40.5, P<0.01). Further analysis revealed the highest clusterin levels were in patients with preeclampsia and IUGR (P<0.001). According to the receiver operating characteristic (ROC) analysis performed for the predictive value of clusterin levels for adverse maternal outcomes, the area under the curve (AUC) was 0.738 (95% CI: 0.616-0.859). The best clusterin cut-off value in predicting adverse maternal outcomes was 102.6 pg/mL with 75% sensitivity and 66% specifity. Multivariable logistic regression analysis revealed serum clusterin levels of >102.6 pg/mL was independently associated with preeclampsia (OR: 6.18, 95% CI: 2.41-15.9) and maternal adverse outcomes (OR: 5.13, 95% CI: 2.01-13.1) and also clusterin levels higher than 117.4 pg/mL were associated with adverse neonatal outcomes (OR: 5.02, 95% CI: 1.04-24.3). CONCLUSIONS: The current study suggests that increased levels of clusterin is associated with IUGR and probably predictive for adverse pregnancy outcomes in preeclampsia.

Are progranulin levels associated with polycystic ovary syndrome and its possible metabolic effects in adolescents and young women?

PURPOSE: Polycystic ovary syndrome (PCOS) is an important disease that may alter metabolic balances of the whole body. Progranulin is a growth factor which is related to epithelial, neuronal growth and oogenesis. Here, we aimed to investigate the diagnostic value of the levels of Progranulin in the clinical setting of PCOS, and its metabolic effects. METHODS: Forty-one adolescents and young women with PCOS and 39 age and body mass index matched adolescents and young women as a control group who attended to the youth center of a tertiary referral center were included in this cross-sectional case-control study. Progranulin levels, indices of insulin sensitivity, lipidemic markers, metabolic syndrome (MetS) criteria were compared between the groups. RESULTS: Progranulin levels in patients with PCOS (7.48 ± 1.93 ng/mL) were significantly higher than in the control group (6.25 ± 1.98 ng/mL) (p = 0.006). Luteinizing hormone (LH) levels, LH/Follicle stimulating hormone (FSH) ratios, free testosterone, dehydroepiandrosterone sulfate (DHEAS), C-reactive protein (CRP) levels in patients with PCOS were significantly higher than in the control group (p < 0.05, for all). The MetS was present in 8 (19.5 %) of the patients in the study group and in 1 (2.3 %) of the patients in the control group (p = 0.029). There was significant inverse correlation between high-density lipoprotein cholesterol (HDL-C) and progranulin levels of patients diagnosed with PCOS (p = 0.008). CONCLUSIONS: Progranulin may be a novel biomarker for cardiovascular risk in patients with PCOS, thus these cases should be directed to close follow-up for possible cardiovascular diseases. Future larger studies should focus on this entity.

ADAMTS4 and Oxidative/Antioxidative Status in Preterm Premature Rupture of Membranes.

AIM: To determine the function of a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS4), total oxidant status (TOS), total antioxidant status (TAS), and aryl esterase (ARES) in preterm premature rupture of membranes (PPROM) and to investigate the association with premature rupture of membranes (PROMs). MATERIAL AND METHODS: 58 pregnant women were included in this prospective study which comprised 29 PPROM patients as the study group and 29 patients, having healthy amniotic membranes, as the control group. ADAMTS4, TAS, TOS, and ARES levels were studied in the amniotic membrane homogenates of the patients. RESULTS: ADAMTS4, TAS TOS, and ARES levels of amniotic membrane lysates were significantly different between PPROM and control groups (p < 0.001, p < 0.001, p = 0.008 and p = 0.002, respectively). Increased amniotic membrane ADAMTS4 (OR: 1.051 95% CI 1.006-1.098, p = 0.024) and TOS (OR: 12.777 95% CI 1.595-102.323, p = 0.016) were found to be significantly associated with the increased risk of PPROM. CONCLUSION: ADAMTS4, TOS, and ARES levels were higher and TAS level was lower in PPROM patients than the normal healthy control group which had healthy amniotic membranes at term. As a result, ADAMTS4 may have a role in the pathogenesis by causing increased oxidative and inflammatory environment in PPROM.

Role of ADAMTS5 in Unexplained Fetal Growth Restriction (FGR).

AIM: We aim to determine the role of serum and placental A disintegrin and metalloproteinase with thrombospondin motif 5 (ADAMTS5) in fetal growth restriction (FGR). MATERIAL AND METHODS: 43 pregnancies suffering FGR and 45 healthy ones were homogenized for their body mass indices, ages, and gestational weeks. Expression of ADAMTS5 in placental samples was determined by immunohistochemical methods and concurrent maternal serum ADAMTS5 levels were determined with enzyme-linked immunosorbent assay. RESULTS: Expression of ADAMTS5 was higher in FGR group than the healthy control in placenta. Both the cytoplasmic staining pattern of the syncytiotrophoblasts and staining of the decidual plate were shown in the FGR group; but not in the control group. A negative correlation between serum ADAMTS5 levels and birth weight in FGR group was observed. CONCLUSION: Increased ADAMTS5 levels were observed in placental insufficiency cases. This study demonstrates that ADAMTS5 may be a sensitive indicator of placental insufficiency which has variable factors in etiology. Additional work is needed to delineate the mechanism of its involvement.

The association between placenta previa and leukocyte and platelet indices - a case control study.

OBJECTIVES: Despite medical advances, rising awareness, and satisfactory care facilities, placenta previa (PP) remains a challenging clinical entity due to the risk of excessive obstetric hemorrhage. Etiological concerns gave way to life-saving concerns about the prediction of maternal outcomes due to hemorrhage. Our study aimed to detect an early predictive marker of placenta previa. MATERIAL AND METHODS: Ninety-three pregnant patients diagnosed with PP and 247 controls were recruited for this retro-spective study. Platelet and leukocyte indices were compared between the two groups. RESULTS: The groups were similar with regard to age distribution (31.2 ± 5.1 years [mean ± SD] in the PP group and 31.7 ± 4.2 years in controls), body mass index (BMI) (27.7 ± 3.6 kg/m2 in the PP group and 27.4 ± 4.6 kg/m2 in controls), and most characteristics of the obstetric history. Total leukocyte count, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly higher in the PP group. Mean platelet volume (MPV) and large platelet cell ratio (P-LCR) values were significantly lower in the PP group as compared to controls, with regard to third trimester values. However, patients who were diagnosed postnatally with placenta percreta had lower MPV and P-LCR values than other patients with PP. There were no statistically significant differences between the two groups as far as first trimester values were concerned. CONCLUSIONS: Platelet and leukocyte indices in the third trimester of pregnancy may be valuable predictors of placenta previa and placenta percreta. More comprehensive studies are needed to address this issue.

Oxidative stress markers in severe preeclampsia and preeclampsia-related perinatal morbidity - preliminary report.

OBJECTIVES: The aim of the study was to determine maternal serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase (PON) and arylesterase levels in severe preeclamptic pregnants and also to investigate whether these parameters are implicated in the occurence of perinatal morbidity or not. MATERIAL AND METHODS: A case-control study was carried out including 60 pregnant women (30 with severe preeclampsia and 30 healthy controls). The optimal cut off points of oxidative stress markers for the diagnosis of severe preeclampsia and for the prediction of adverse perinatal outcomes were evaluated by receiver operating characteristic (ROC) analyses. Multi-variate logistic regression analysis was used to determine if a relationship between adverse perinatal outcomes and serum oxidative stress markers was present or not. RESULTS: TAS (OR = 37.486, 95% CI 3.535-397.519, p = 0.003), TOS (OR = 15.588, 95% CI 2.135-113.818, p = 0.007) and ary-lesterase (OR = 31.356, 95% CI 2.284-430.548, p = 0.01) were found to be diagnostic for preeclampsia. Statistically significant positive correlation of adverse perinatal outcomes with serum TAS, PON and arylesterase levels were determined. Besides, a significant negative correlation was found between serum TAS levels and gestational week (r = -0.342, p = 0.007) and also between serum PON levels and birthweight (r = -0.262, p = 0.043). CONCLUSIONS: Increased maternal serum TAS, TOS and arylesterase levels are significantly associated with the presence of severe preeclampsia. Furthermore, elevated maternal serum TAS, PON and arylesterase levels are significantly and positively correlated with adverse perinatal outcomes. We suggest that in preeclampsia increased oxidative status may cause adverse perinatal outcomes and antioxidants may be increased in order to protect the fetus against oxidative damage.

The unprecedented recurrent diploid/tetraploid mosaicism of trisomy-18 (mixoploidy; 4n+18/2n+18): clinical report.

We report on a 32-year-old woman who presented at gestational age of 14 weeks. During ultrasonographic examination, we discovered that her fetus had several important abnormalities, including a cystic hygroma, craniofacial defects (low-set ears, broad nose), heart defects (single atrium, single ventricle), agenesis of corpus callosum, limb defects (clenched hands, pes equinovarus). Chorionic villus sampling and karyotyping revealed diploid/tetraploid mosaicism with trisomy 18 (mixoploidy; 4n+18/2n+18). Her second pregnancy was terminated because of the same clinical manifestations 1 year prior. Her first pregnancy resulted in the birth of an entirely healthy boy. As far as know, no other similar case has been presented in the literature.