[Relationship between dopamine-beta-hydroxylase gene polymorphism and hypertensive disorder complicating pregnancy].

OBJECTIVE: To investigate the association between the single nucleotide polymorphism (SNP) at locus 589 of dopamine-beta-hydroxylase (DbetaH) gene and hypertensive disorder complicating pregnancy (HDCP). METHODS: One hundred and seven pregnant women with hypertensive disorder complicating pregnancy (HDCP group) and 95 normal pregnant women (control group) matched for age and gestation were selected. Genotypes of the SNP at locus 589 were typed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: (1) The frequencies of DbetaH GG, GA and AA genotypes of the SNP at locus 589 were 75.7%, 21.5% and 2.8% in HDCP group, respectively. They were 72.6%, 24.2% and 3.2% in normal control group, respectively (P > 0.05). The frequencies of the two alleles G and A were 86.4% and 13.6% in HDCP group, and 84.7% and 15.3% in normal control group, respectively (P > 0.05). (2) No evident differences existed in distribution of genotypes of the SNP at locus 589 between mild preeclampsia, severe preeclampsia and eclampsia groups (P > 0.05). CONCLUSION: The SNP at locus 589 of DbetaH gene is not associated with hypertensive disorder complicating pregnancy, nor is it associated with the severity of hypertensive disorder complicating pregnancy.

Oxidative-antioxidative system in peripartum acute renal failure and preeclampsia-eclampsia.

BACKGROUND: Preeclampsia-eclampsia and acute renal failure in peripartum women can be the cause of mortality and morbidity. There are many different reports about oxidative-antioxidative systems in preeclampsia-eclampsia. Until now, products of activated oxidative-antioxidative systems were not evaluated in peripartum women with acute renal failure. In this study, our aim was to evaluate the oxidative-antioxidative systems in peripartum women with acute renal failure and/or preeclampsia-eclampsia. METHODS: The study groups consisted of 17 peripartum women (first week of delivery) with acute renal failure (G I), 11 preeclamptic (G II), 11 healthy pregnancy (> or = 30 weeks of pregnancy) (G III), and 11 healthy women (G IV) aged between 18-38 years. Superoxide dismutase (SOD), glutathione peroxidase (GSHPx) in erythrocytes, and plasma malondialdehyde (MDA) levels were measured in all groups. SOD, GSHPx, and MDA levels were also measured at the onset of acute renal failure (G IA), regression of renal dysfunction (G IB) and recovery of renal functions (G IC). RESULTS: MDA levels were 11.95+/-4.25, 9.22+/-3.62, 5.10+/-3.65, 3.40+/-1.27, 4.91+/-2.06, 4.24+/-1.67 mmol/mL in G IA, G IB, G IC, G II, G III, and G IV, respectively. SOD activity in erythrocyte were 3269.23+/-1437.83, 2641.35+/-1411.13, 2056.35+/-1143.11, 924+/-160.04, 1057.91+/-257.03, 861.63+/-243.28 Ug/Hb in G IA, G IB, G IC, G II, G III, and G IV, respectively. GSHPx activity in erythrocyte was 70.17+/-23.52, 58.27+/-23.75, 45.44+/-17.60, 24.48+/-6.77, 26.28+/-7.27, 32.95+/-8.24 Ug/Hb in G IA, G IB, G IC, G II, G III, and G IV, respectively. MDA levels and activities of SOD, GSHPx in erythrocytes were highest in GIA The values of MDA, SOD, and GSH-Px in G IA, G IB, and G IC were significantly different from each other and decreased while regaining of renal functions. Preeclampsia-eclampsia or normal pregnancy did not cause elevation of plasma MDA levels and GSHPx, SOD in erythrocyte. CONCLUSION: Although SOD and GSHPx in erythrocytes and plasma MDA level were found to be similar in healthy women, pregnant women, and preeclamptic women; SOD, GSHPx, and MDA increased at the beginning and decreased during recovery of renal functions in peripartum women with acute renal failure.

[Folic acid levels, homocysteine and polymorphism of methylenetetrahydrofolate reductase enzyme (MTHFR) in patients with pre-eclampsia and eclampsia]. / Niveles de ácido fólico, homocisteína y polimorfismo de la enzima metilentetrahidrofolatorreductasa (MTHFR) en pacientes con preeclampsia severa y eclampsia.

UNLABELLED: Preeclampsia and eclampsia are the primary causes of maternal mortality. In the state of Nuevo León, from 1990 to 1998, these conditions represented 44.1% of maternal deaths. The presence of thrombogenic substances (homocysteine, C protein, and anticardiolipin antibodies) in the mother's blood has been related to this problem. The C677T polymorphism of the enzyme methylene tetrahydrofolate reductase (MTHFR) favors the increase of homocysteine levels, while folic acid (FA) supplementation decreases its levels. OBJECTIVE: To establish the role of FA in the physiopathology of preeclampsia in our environment. KIND OF STUDY: Longitudinal, prospective and comparative. CASES: Women with severe preeclampsia and/or eclampsia (n-13). CONTROLS: Women in the third trimester of a normal pregnancy (n + 15). 20 mL Blood samples were taken during the first 24 hours of puerperium, and their AF, homocysteine and MTHFR polymorphism were measured. The t Student test and the Exact Fisher test were used to compare between both groups. RESULTS: The values obtained for homocysteine were (x + SD): CASES: 9.85 micromoles/L + 2.88, and controls: 7.61 micromoles/L + 1.32 (p < 0.04). The frequency (%) of the genetic polymorphism for MTHFR was: positive homozygotes (T/T): 38.46 vs. 20, heterozygotes (C/T): 38.46 vs. 26.6, negative homozygotes (C/C): 23 vs 53, for cases and controls, respectively. CONCLUSIONS: According to our study, the frequency of the homozygote state (T/T) of MTHFR and increased blood levels of homocysteine is greater in women suffering from preeclampsia.

Glucose-6-phosphate dehydrogenase is present in normal and pre-eclamptic placental trophoblasts: ultrastructural enzyme-histochemical evidence.

The present study investigated the localization of glucose-6-phosphate dehydrogenase (G6PD) activity in the human placenta at various gestational ages. Placentae from patients with severe pre-eclampsia were also studied. Ultrastructural enzyme-histochemical analysis was performed by newly developed G6PD histochemistry using copper ferrocyanide as a capturing agent. Precipitates indicative of G6PD activity were markedly visible in the cytotrophoblastic cytoplasm and faintly in the syncytiotrophoblastic cytoplasm of placentae at various gestational ages, as well as those from pre-eclampsia. Frequently, precipitations were localized on the cytosolic side of the endoplasmic reticular membranes of the cytotrophoblasts. Stringent cytochemical control experiments performed also ensured the specific detection of G6PD activity. The results indicated that cytochemically detectable G6PD was localized in cytotrophoblastic cytoplasm. This enzyme may play significant roles in the carbohydrate metabolism of the human placenta, and further maintenance of villous tree architecture. Combining the previous data, the human placenta has many carbohydrate metabolizing-enzymes, similar to the adult liver.

[Development of symptoms and perinatal complications in HELLP syndrome]. / Symptomentwicklung und perinatale Komplikationen bei HELLP-Syndrom.

At the Kiel University Department of Gynaecology, 21 patients between the 21th and 39th week of gestation were treated in 1987 and 1988 following diagnosis of HELLP syndrome. At the time of diagnosis all patients presented an advanced gestosis/eclampsia. 9 patients developed the classical signs and symptoms, while hospitalised. The typical signs of gestosis, hypertension, proteinurea, oedema and hypoproteinaemia preceded the changes in laboratory values caused by the HELLP syndrome. Upper abdominal pain and increase in transaminase values occurred on the average 3.4 or 2.7 days prior to the decrease of, thrombocyte count. In 19 of the 21 cases, pregnancy was terminated by caesarean section. Severe peripartal complications occurred in 7 cases e.g. foetal death in utero (n = 3), eclampsia (n = 5), renal failure (n = 2), cerebral oedema (n = 1), intracerebral haemorrhage (n = 1), disseminated intravascular coagulation (n = 1), abdominal wall haematoma (n = 1). 6 of these patients were admitted after complications had occurred prior to admittance. All 18 infants born alive survived the neonatal period. The average birth weight was 1,571 g. 11 infants were discharged clinically normal. The remaining infants included 5 cases pointing to retinopathy and 3 cases of cerebral palsy. One infant developed post-haemorrhagic hydrocephalus.

In vitro activity of nicotinamide adenine dinucleotide- and nicotinamide adenine dinucleotide phosphate-linked 15-hydroxyprostaglandin dehydrogenases in placentas from normotensive and preeclamptic/eclamptic pregnancies.

Concentrations of prostaglandins E2 and I2 may be decreased in preeclamptic and eclamptic pregnancies. Because these prostaglandins produce vasodilation and inhibit platelet aggregation it has been suggested that a reduction in their biosynthesis might play an important role in the pathogenesis of the hypertension and coagulation abnormalities associated with preeclampsia. Placental tissue is an extremely rich source of several enzymes that catalyze the catabolism of prostaglandins. The present study was initiated to determine whether one of these catabolic enzymes might be increased in preeclamptic/eclamptic pregnancies. The activities of the NAD- and the NADP-linked 15-hydroxyprostaglandin dehydrogenases were measured in 16 preeclamptics (mean diastolic pressure, 108 +/- 13 mmHg) and compared with 16 normotensive controls matched for age (20.8 +/- 5.43 vs. 20.6 +/- 5.16) and gestational week of delivery (34.6 +/- 5.40 vs. 35.0 +/- 5.06). These results indicate that the activity of the placental NAD-linked 15-hydroxyprostaglandin dehydrogenase is elevated in preeclampsia (40.1 +/- 31.3 vs. 14.9 +/- 8.30 mU/g tissue, P less than 0.01). If this increase were also expressed in vivo, its effect on prostaglandin metabolism could be mistaken for impaired prostacyclin biosynthesis unless both the 6-keto- and 6,15-diketo-metabolites of prostacyclin were measured.

The HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome in severe hypertensive crises of pregnancy--does it exist?

The HELLP syndrome, comprising haemolysis, elevated liver enzyme values and a low platelet count, was studied in 26 women with hypertensive crises of pregnancy and in matched controls. Platelet counts and bilirubin, lactate dehydrogenase, aspartate transaminase and haematocrit levels together with peripheral blood smears were studied on the day of admission and on the 7th day after delivery. Only 1 woman with pre-eclampsia was found to have had the HELLP syndrome; the case report is presented and the laboratory investigations are discussed.

Eclampsia II. Clinical significance of laboratory findings.

Sixty-seven cases of eclampsia were managed between August 1977 and July 1980. Routinely acquired laboratory tests of these cases have been analyzed. In addition, the group of patients with eclampsia was compared with a group of 24 healthy pregnant women. There was no significant difference in platelet count, serum fibrinogen, and bilirubin values. The activated partial thromboplastin time was abnormal in 42% of patients with eclampsia. There was no clinical evidence of disseminated intravascular coagulation in any patient. Patients with eclampsia had abnormalities of lactic dehydrogenase, alkaline phosphatase, SGOT, uric acid, BUN, and creatinine. However, in any individual patients there was no single test of great clinical usefulness and no test predictive of maternal or fetal outcome. At present the authors recommend complete blood count (including blood smear and platelet count), clot observation, and serum creatinine tests. Liver function tests are reserved for the patient with upper abdominal pain. Additional tests are recommended if the diagnosis of eclampsia is questionable or if an additional disease process is suspected.