The prevalence of Helicobacter pylori in the Hispanic population affected by hyperemesis gravidarum.

OBJECTIVE: The purpose of this study was to determine the prevalence of Helicobacter pylori seropositivity in pregnant Hispanics affected by hyperemesis gravidarum. STUDY DESIGN: This was a prospective cross-sectional study conducted over a 22-month period. Serum from pregnant Hispanics affected by hyperemesis gravidarum and unaffected Hispanics matched for age, gravidity, parity, and country of origin were tested for H pylori immunoglobulin G (IgG). IgG levels specific for H pylori were determined by enzyme-linked immunosorbent assay (ELISA). Assuming the background prevalence of H pylori serum positivity in the Hispanic population is approximately 60%, 38 patients in each group were needed to detect a 30% difference in affected patients versus controls with a power of 80% and P = .05. Statistical analysis was performed using Yate's chi-square, Student t test, Mann-Whitney U, and binary logistic regression. RESULTS: A total of 82 patients between the ages of 18 to 39 years were enrolled. Of 40 patients diagnosed with hyperemesis gravidarum, 26 (65%) were seropositive for H pylori compared with 28 of 42 (67%) unaffected controls (P = 1.0). There were no statistical differences in maternal age or countries of origin between the 2 groups. CONCLUSION: The overall prevalence of H pylori seropositivity in this patient population is 66%. In pregnant Hispanics affected by hyperemesis gravidarum, H pylori seropositivity is not increased compared with unaffected controls.

Newly diagnosed adult-onset Still disease in pregnancy.

BACKGROUND: Adult-onset Still disease is a rare febrile disorder that can present for the first time during pregnancy. It is a diagnosis of exclusion with nonspecific laboratory results. Good maternal and fetal outcomes can be expected after initial diagnosis and treatment. CASE: A 21-year-old (gravida 2, para 1) at 20 weeks' gestation presented with fever, malaise, arthralgias, and cough. She had an extensive evaluation that led to the diagnosis of adult-onset Still disease. She was treated with prednisone and had immediate improvement. She delivered a viable infant at 34 weeks after suspected intrauterine growth restriction and continued to have recurrent symptoms postpartum. The second woman, 38 years old and gravida 3, para 1, aborta 1, presented at 22 weeks' gestation with similar symptoms and also had a similar diagnostic evaluation. She was diagnosed with adult-onset Still disease and started on prednisone, with immediate improvement, delivering a viable infant at 41 weeks' gestation. CONCLUSION: Adult-onset Still disease in pregnancy can be confused with many other diseases, but its diagnosis, after exclusion of other infectious, malignant, and rheumatic conditions, can portend good maternal and fetal outcomes.

FGL2 prothrombinase messenger RNA expression in gravid and nongravid human myometrium.

OBJECTIVE: Thrombin is a potent uterotonic agent that may play an important role in human parturition. FGL2 is a prothrombinase that cleaves prothrombin to thrombin. The purpose of this study was to determine FGL2 messenger RNA expression in human myometrium and to assess its relationship to the expression of EP3-6 prostaglandin receptor and inducible nitric oxide synthase. STUDY DESIGN: Myometrium was obtained from gravid women who underwent cesarean delivery (n = 19), from premenopausal (n = 10) and menopausal (n = 10) women who underwent hysterectomy, and from nonpregnant women who received 200 mg of misoprostol vaginally 12 hours before hysterectomy (n = 8). FGL2 messenger RNA expression was determined with the use of semiquantitative polymerase chain reaction and was compared with previously determined messenger RNA expression levels for EP3-6 and inducible nitric oxide synthase for the same samples. Statistical analysis was performed with the use of independent t test, Fisher exact test, analysis of variance, and linear regression, where appropriate. RESULTS: All samples that were analyzed contained demonstrable quantities of FGL2 messenger RNA. The highest FGL2 expression was found in gravid women, followed by women who were treated with misoprostol, by premenopausal nonpregnant women, and by menopausal women (P <.0001, analysis of variance). Significantly higher levels of FGL2 expression were found in the gravid women compared with the women who were treated with misoprostol (P <.001), the premenopausal nonpregnant women (P <.001), and the menopausal women (P <.0001). FGL2 messenger RNA expression correlated with EP3-6 and inducible nitric oxide synthase expression in all samples combined (r = 0.55, P <.0001; and r = 0.67, P <.001, respectively). CONCLUSION: The expression of FGL2 messenger RNA is increased in gravid myometrium compared with nonpregnant samples. Its expression significantly correlates to EP3-6 and inducible nitric oxide synthase expression. FGL2 prothrombinase expression may mediate the role of thrombin in human parturition.

Molecular epidemiology of preeclampsia.

UNLABELLED: Numerous articles have been published that address the possible genetic influences on the development of preeclampsia (PE). However, to our knowledge, a complete review of the results has not yet been completed. We undertook a MEDLINE search to identify English-language articles published after January 1, 1990 that examined the possible role of specific genes in the etiology of PE. After a brief introduction and a concise review of the prevailing etiologic hypotheses, we have categorized the candidate genes into six categories, based on their hypothesized role in PE etiology. The purpose of this paper is to review the literature, comment on its quality, and provide a reference for researchers interested in the molecular epidemiology of preeclampsia. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the prevailing etiologic hypotheses of preeclampsia, to outline the published data on possible genetic influence on the development of preeclampsia, and to clearly state the definition of preeclampsia.