Effect of vascular endothelial growth factor on fetal vessels among obese pregnant women.

OBJECTIVE: To determine the role of vascular endothelial growth factor (VEGF) in placental hypoperfusion in obesity. METHODS: The prospective study enrolled women with a first-trimester singleton pregnancy in Izmir, Turkey, between January and April 2011. Participants were divided into three groups: obese (body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] >30) with cesarean delivery; normal weight (BMI <30) with vaginal delivery (NVD); and healthy controls (BMI <30) with cesarean delivery. Before delivery, serum C-reactive protein (CRP), and uterine and fetal Doppler measurements were taken. VEGF was evaluated immunohistochemically from the umbilical cord. RESULTS: Overall, 109 women completed the study: obesity group (n=13, 11.9%), NVD group (n=50, 45.9%), and control group (n=46, 42.2%). Serum CRP was higher in the obesity group than in the control or NVD groups (P=0.009). VEGF score was highest in the NVD group (9.39 ± 3.11), and lowest in the obesity group (4.58 ± 2.78) (P<0.001). VEGF score decreased by 0.81 for each increase in BMI of 1 (P=0.002). CONCLUSIONS: Maternal obesity was related to decreased VEGF expression. Although not supported by Doppler findings, decreased VEGF expression owing to maternal obesity might trigger endothelial dysfunction and inflammation.

Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes.

AIM: To determine whether procalcitonin (ProCT) levels can be used to predict subclinical intra-amniotic infection by comparing maternal plasma levels in preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM) at term with the levels in healthy pregnant women. METHODS: The mean plasma ProCT levels of 32 patients with PPROM, 35 patients with PROM at term, 24 healthy women at preterm gestation and 30 healthy women at term were compared. In the PPROM group, the presence or absence of histological chorioamnionitis and neonatal infection were used as a reference to analyze ProCT levels. RESULTS: The mean ProCT level of patients in the PPROM group was significantly higher than those in the PROM group and healthy controls. Patients in the PPROM group diagnosed with histological chorioamnionitis had significantly higher ProCT levels than those of the remaining patients. At a cut-off of 0.054 ng/mL, the sensitivity and specificity of ProCT to predict histological chorioamnionitis were 92.3% and 68.4%, respectively. CONCLUSION: ProCT levels were significantly higher in patients with PPROM, and facilitate identification of those who require expectant management.