Human chorionic gonadotropin and vascular endothelial growth factor in normal and complicated pregnancies.

OBJECTIVE: To study the relationships between maternal serum concentrations of beta-human chorionic gonadotropin (hCG) and vascular endothelial growth factor (VEGF) in both normal pregnant women during late pregnancy and women with pregnancy complications. METHODS: Sixty-six women in three groups were prospectively studied: 1) women diagnosed with fetal growth restriction (n = 22), 2) women with preeclampsia (n = 22), and 3) healthy pregnant women (controls) frequency matched for age, parity, and gestational age (n = 22). Primary outcomes were maternal serum concentrations of both beta-hCG and VEGF. Placental insufficiency was defined by a pulsatility index in umbilical artery greater than the 99th percentile for gestation. RESULTS: Maternal serum concentrations of beta-hCG and VEGF were greater in women with preeclampsia than in controls (P = .001 and P = .002, respectively) and women with fetal growth restriction (P = .002 and P = .002, respectively). Concentrations did not differ between women with fetal growth restricted fetuses and controls. Correlation between beta-hCG and VEGF was not significant in any of the studied groups. Serum VEGF concentrations were significantly increased in a subgroup of 12 women with placental insufficiency (P = .04) and correlated with beta-hCG concentrations (r = .63, P = .02). CONCLUSION: Both VEGF and beta-hCG maternal serum concentrations were increased in women with preeclampsia but normal in women with fetal growth restriction, although VEGF concentrations were increased in those cases with placental insufficiency. Maternal serum beta-hCG and VEGF concentrations did not correlate except in women with placental insufficiency.

Inflammatory cytokines in intrauterine growth retardation.

BACKGROUND: To evaluate maternal serum levels of two inflammatory cytokines in women with intrauterine growth retardation (IUGR), while studying separately women with or without placental insufficiency. METHODS: The study comprised 14 women with IUGR and Doppler-defined placental insufficiency, 14 women with IUGR without placental insufficiency, and 28 healthy pregnant women as a control group. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured using a commercially available kit. The Kruskal-Wallis test and the corrected Mann-Whitney U-test were used. RESULTS: There was a statistically significant difference in TNF-alpha levels among the three studied groups (p = 0.03). Women with IUGR and placental insufficiency showed statistically significant higher serum levels of TNF-alpha[2.2 pg/mL (1.3-4.1)] and a higher rate of detectable TNF-alpha[85.7% (12/14)] than those in the control group [0 pg/mL (0-2.7) and 32.1% (9/28)] (p = 0.01 and p = 0.001, respectively). On the contrary, there was no difference in either the TNF-alpha level [1.4 pg/mL (0-4.9)] or the rate of detectable TNF-alpha[57.1% (8/14)] between women with IUGR without placental insufficiency and women in the control group. The levels of IL-6 were similar in the three studied groups. CONCLUSION: TNF-alpha is increased in women with IUGR and placental insufficiency but normal in those with IUGR and normal placental perfusion. We suggest that elevations of TNF-alpha could be a specific phenomenon of certain subsets of IUGR, identifying cases with placental dysfunction.

Insulin, insulin-like growth factor-1, and insulin resistance in women with pregnancy-induced hypertension.

OBJECTIVE: The purpose of this study was to assess insulin, insulin sensitivity, and insulin-like growth factor-I in women with preeclampsia and gestational hypertension. STUDY DESIGN: Insulin resistance was measured with the short insulin-tolerance test in 20 women with preeclampsia, in 18 women with gestational hypertension, and in 20 normotensive control subjects. Sex hormone binding globulin, insulin-like growth factor-I, glucose, fructosamine, glycosylated hemoglobin, insulin, C-peptide, and lipids were measured in the fasting state. RESULTS: Women with gestational hypertension had a significant lower insulin sensitivity index (0.13 +/- 0.1) and a higher level of insulin-like growth factor-I (333.71 +/- 107.6 ng/mL) than women in the control group (0.21 +/- 0.1 [P <.05]; 218.11 +/- 82.3 ng/mL [P <.01]) and women with preeclampsia (0.21 +/- 0.12 [P <.05]; 234.78 +/- 92.76 ng/mL [P <.01]). There were no significant correlations between insulin sensitivity index and insulin-like growth factor-I. CONCLUSION: Insulin resistance is present in women with gestational hypertension but not in women with preeclampsia and did not correlate with insulin-like growth factor-I.