Micronutrients in Multiple Pregnancies-The Knowns and Unknowns: A Systematic Review.

Maternal diet and nutritional status are of key importance with regard to the short- and long-term health outcomes of both the mother and the fetus. Multiple pregnancies are a special phenomenon in the context of nutrition. The presence of more than one fetus may lead to increased metabolic requirements and a faster depletion of maternal macro- and micro- nutrient reserves than in a singleton pregnancy. The aim of this systematic review was to gather available knowledge on the supply and needs of mothers with multiple pregnancies in terms of micronutrients and the epidemiology of deficiencies in that population. It was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The authors conducted a systematic literature search with the use of three databases: PubMed/MEDLINE, Scopus and Embase. The last search was run on the 18 October 2020 and identified 1379 articles. Finally, 12 articles and 1 series of publications met the inclusion criteria. Based on the retrieved studies, it may be concluded that women with multiple pregnancies might be at risk of vitamin D and iron deficiencies. With regard to other microelements, the evidence is either inconsistent, scarce or absent. Further in-depth prospective and population studies are necessary to determine if nutritional recommendations addressed to pregnant women require adjustments in cases of multiple gestations.

Circulating electrolytes in the bloodstream of transition Sarda goats make the difference in body fluid distribution between single vs. twin gestation.

Health of transition goats can be explored through the assessment of the metabolic profile. Selected circulating parameters of clinical importance may be used for indicating homeostasis perturbations during the transition period. The present study aimed to characterize the metabolic profile of transition dairy goats raised under a pasture-based system to determine whether the conceptus number (single vs. twin gestation) influences circulating concentrations of different parameters in the bloodstream, including nutrient- and fluid-related metabolites for health assessment. Sarda dairy goats diagnosed for single (n = 5) or twin gestation (n = 6) were selected out of a flock of 156 heads and sampled for blood weekly, throughout one month before and one month after kidding. Significantly (p < .01), differences in blood serum metabolite concentrations before and after birthing were observed in both groups of animals, as to glucose (Glu), total cholesterol (TC) and triglycerides (TG), total protein (TP) and Urea. Circulating creatinine (Crea) turned out to differ significantly (p < .01) between single vs. twin kidding does. Significant correlations (p < .001) between groups of circulating electrolytes (Na, Chloride, Mg, K) were also observed and this datum was assumed to change following the different distribution of fluids in the body of the doe, in the last third of gestation, at birthing and during early lactation, respectively. Interestingly, electrolyte levels in this trial displayed different concentrations in the bloodstream according to physiological stage and kid numbers.

Is twin pregnancy, calving and pregnancy loss predictable by serum pregnancy-specific protein b (pspb) concentration 28-35 days after ai in dairy cows?

Double ovulation occurs more frequently in multiparous cows with high milk production than in primiparous cows and the rate of twin pregnancy/calving is increasing worldwide. Diagnosis of twin pregnancy is possible by ultrasound at the time of early pregnancy examination [28-34 days after artificial insemination (AI)]. Pregnancy proteins are also well-known indicators of gestation. The risk of pregnancy loss during the first trimester of gestation for cows carrying twins is three to nine times higher than for cows carrying singletons. Pregnancy-specific protein B (PSPB) is a good indicator not only of pregnancy but also of pregnancy loss. The aims of this study were (a) to collect calving data in some Hungarian Holstein-Friesian herds (n = 7,300) to compare PSPB serum concentrations (measured 29-35 days post insemination) in twin- and singleton-calving cows (Trial 1), and (b) to check the predictive value of PSPB serum concentration for twin pregnancy and pregnancy loss in high-producing Spanish Holstein-Friesian cows (n = 98; Trial 2). Our results showed almost 7% twin calving rate. Although hormonal treatments are commonly believed to be major causes of twin pregnancies, our data do not support this hypothesis. The only exception is the single PGF injection, which significantly increased twin calving. No effect of milk production on the risk of twin pregnancy was found, and twin pregnancy increased with parity. The AI bull, the bull's sire, the bull's grandfather and the cow's father also affected twin calving (P ≤ 0.02). We found much higher frequency of twin calving in cows diagnosed pregnant with higher than 3 ng/ml serum PSPB concentrations at 29-35 days after insemination. In Trial 2, non-significant but well-marked differences were found in PSPB serum concentration between singleton- and twin-pregnant cow samples (2.1 and 2.9 ng/ml) at different bleeding times. Probably the small size of the study population and the effects of milk production on PSPB values may explain this lack of significance.

Iron deficiency and anemia are prevalent in women with multiple gestations.

BACKGROUND: Little attention has been placed on the unique iron demands that may exist in women with multiple gestations. This merits attention because iron deficiency (ID) during pregnancy is associated with adverse pregnancy outcomes that are known to be more prevalent in multiple births. OBJECTIVE: We characterized longitudinal changes in iron status across pregnancy in a cohort of healthy women with multiple gestations and identified determinants of maternal ID and anemia. DESIGN: A group of 83 women carrying twins, triplets, or quadruplets (aged 20-46 y) was recruited from 2011 to 2014. Blood samples obtained during pregnancy (∼24 wk; n = 73) and at delivery (∼35 wk; n = 61) were used to assess hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin, serum iron, erythropoietin, serum folate, vitamin B-12, C-reactive protein, and interleukin-6. RESULTS: The prevalence of tissue ID (sTfR >8.5 mg/L) increased significantly from pregnancy to delivery (9.6% compared with 23%, P = 0.03). Women with depleted iron stores (SF <12 µg/L, n = 20) during pregnancy had a 2-fold greater risk of anemia at delivery, and 25% (n = 5) developed iron deficiency anemia (IDA). Overall, 44.6% of women studied (n = 37/83) were anemic at delivery, and 18% of women (n = 11/61) had IDA. Erythropoietin during pregnancy was significantly negatively associated with hemoglobin at delivery. Women with erythropoietin >75th percentile during pregnancy exhibited a 3-fold greater risk of anemia, suggesting that erythropoietin is a sensitive predictor of anemia at delivery. Inflammation was present at delivery, which limited the utility of ferritin or hepcidin as iron-status indicators at delivery. CONCLUSIONS: ID and anemia are highly prevalent in women with multiple gestations. Additional screening and iron supplementation may be warranted in this high-risk population given the known associations between ID anemia and adverse maternal and neonatal outcomes. This trial was registered at clinicaltrials.gov as NCT01582802.

Preeclampsia in high risk women is characterized by risk group-specific abnormalities in serum biomarkers.

OBJECTIVE: To determine if early pregnancy serum biomarkers in high-risk women who develop preeclampsia vary according to risk factor. STUDY DESIGN: We performed a secondary analysis of the Maternal-Fetal Medicine Units Network randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in high-risk women. Serum biomarker levels at enrollment (before initiation of aspirin or placebo) were compared between women who did and did not develop preeclampsia, both for the group as a whole and within each of 4 high-risk groups (insulin-dependent diabetes, hypertension, multiple gestation, and previous preeclampsia) using a regression model adjusting for gestational age at collection and prepregnancy body mass index. RESULTS: 1258 women were included (233 with insulin-dependent diabetes, 387 with chronic hypertension, 315 with a multiple gestation, 323 with previous preeclampsia). Multiple early pregnancy serum biomarkers differed between women who did and did not develop preeclampsia. Each high-risk group had a unique and largely nonoverlapping pattern of biomarker abnormality. Differences between those who did and did not develop preeclampsia were noted in vascular cell adhesion molecule in the diabetes group; human chorionic gonadotropin, soluble tumor necrosis factor receptor-2, tumor necrosis factor-alpha, selectin and angiogenin in the chronic hypertension group; interleukin-6, placental growth factor, soluble fms-like tyrosine kinase plus endoglin to placental growth factor ratio in the multiple gestation group; and angiogenin in the previous preeclampsia group. CONCLUSION: Patterns of serum biomarkers vary by high-risk group. These data support the hypothesis that multiple pathogenic pathways lead to the disease recognized clinically as preeclampsia.

Maternal serum analyte screening for fetal aneuploidy.

In the first and second trimesters, chemicals produced by the fetoplacental unit are measured to assess risks of fetal abnormalities. Consistent associations between levels of these proteins in such pregnancies enable these biomarkers to be used to calculate risk for Down syndrome and other chromosomal abnormalities in individual pregnancies. Special consideration may be required when assessing risk in multiple pregnancies and pregnancies achieved with infertility therapy.

Evaluación del índice de riesgo del primer trimestre en casos de embarazo múltiple con presencia de un feto perdido / Evaluation of the risk index of the first-trimester combined screening test in cases of multiple pregnancy with a «vanishing twin»

Fundamento y objetivo. Justificar una evaluación correcta del test combinado de cribado prenatal del primer trimestre, en casos especiales de embarazos gemelares con pérdida de uno de los embriones, debido al aumento de estos casos, sobre todo en gestantes sometidas a técnicas de reproducción in vitro. Paciente y métodos. Se documenta un caso clínico de gestación gemelar bicorial biamniótica con pérdida del primer feto en la semana 12. Se le solicita cribado prenatal en el que la estimación del índice de riesgo del primer trimestre no se pudo valorar como tal. Discusión y conclusiones. El índice de riesgo no es calculable debido a la pérdida de uno de los fetos. Los niveles de la fracción libre de la subunidad beta de la gonadotropina coriónica humana (Beta-hCG) en suero no se ven afectados pero sí se produce un aumento significativo de los niveles de la proteína plasmática A asociada al embarazo (PAPP-A), que depende del tiempo transcurrido desde la pérdida fetal, por lo que no puede considerarse ni como un feto aislado ni como 2. Por tanto, para evaluar el riesgo se recomienda una estimación de la translucencia nucal fetal (TN) y la Beta-hCG libre, o únicamente la TN, atendiendo también a unos múltiplos de la mediana (MoM) dentro de la normalidad(AU)

Background and purpose. To justify an accurate assessment of the first-trimester combined screening test, in special cases of twin pregnancies with a vanishing twin; because the increase in such cases specially is being seen in pregnant women undergoing in vitro fertilization techniques. Patients and methods. We report a case of biamniotic bichorionic twin pregnancy with loss of the first fetus at week 12. Prenatal screening was asked in wich it couldn’t been estimated the risk index for the first trimester screening test. Discussion and conclusions. The risk index is not calculable due to the loss of one fetus. The levels of the free fraction of the beta subunit of human chorionic gonadotropin (Beta-hCG) in serum are not affected but there is a significant increase in the levels of pregnancy associated plasma protein-A (PAPP-A), which depends on the time since fetal loss; so the serum levels cannot be regarded neither as an isolated fetus or as 2. Therefore to assess the risk of the first-trimester combined screening test, it is recommended to estimate the fetal nuchal translucency thickness (NT) and Beta-hCG, or just only NT, also considering the median multiples (MoM) within the normal limits(AU)

Endocrine markers for identifying prolificacy potential and predicting fetal number in goats.

Identifying prolificacy potential and determination of fetal number during pregnancy for proper care and management of the pregnant goats bearing multiple fetuses and achieving the benefits out of multiple births are essential for sustainable goat farming. Our objectives were (1) to examine prolificacy potential in goats by using pituitary response to gonadotrophin releasing hormone (GnRH) challenge test, (2) to investigate hormonal profiles for the prediction of fetal number in pregnant goats and (3) to find out the most reliable timing of blood sampling for discriminating prolificacy trait and differentiating the goats bearing single, twin and triplet fetuses. In first experiment (GnRH challenge test), plasma FSH concentrations were significantly higher (P<0.01) among the goats belonging to triplet vs. twin vs. single kidding size groups after GnRH administration. Multivariate stepwise discriminant function analysis recognized that one blood sampling at 220min after GnRH administration can be used to distinguish prolificacy potential in goats. In second experiment, plasma progesterone levels were significantly higher (P<0.01) in goats bearing triplet vs. twin vs. single fetus between day 84 and 21 prior to parturition. Plasma estrone sulphate concentrations were found to be higher (P<0.05) in does bearing multiple fetuses than the does bearing single fetus between day 126 and 28 prior to parturition. A single blood sampling at day 63 prior to parturition was the most probable suitable time for discriminating kidding size by using plasma progesterone as marker.

Difference in the D-dimer rise between women with singleton and multifetal pregnancies.

INTRODUCTION: The differences in the d-dimer rise between women with singleton and multifetal pregnancies have not been studied extensively. MATERIALS AND METHODS: d-Dimer levels were determined in 1089 blood specimens from 1089 women in various stages of pregnancy, including 977 and 112 women with singleton and multifetal pregnancies, respectively. None of the 1089 women developed hypertension or clinical venous thromboembolism during pregnancy or in the postpartum period. RESULTS: The D-dimer levels were significantly and positively correlated with gestational week at examination in women with singleton or multifetal pregnancies. The d-dimer levels (µg/ml, mean ± SD [number of specimens]) determined at the 1st trimester did not differ significantly (0.81 ± 0.82 [102] for singleton vs. 1.20 ± 0.77 [7] for multifetal), but those at the 2nd (1.61 ± 1.45 [216] vs. 2.62 ± 2.26 [59]) and 3rd (2.37 ± 2.22 [659] vs. 4.02 ± 2.14 [46]) trimesters were significantly higher in women with multifetal than singleton pregnancies. The 90th percentile value was 4.31 µg/ml for 1089 specimens. A significantly greater number of women exceeded 4.31 µg/ml during the 2nd (16.9% vs. 5.6%, P=0.0043) and 3rd (34.8% vs. 10.6%, P < 0.0001) trimesters among those with multifetal than with singleton pregnancies. CONCLUSIONS: The degree of D-dimer rise in pregnancy was greater in women with multifetal than with singleton pregnancies.

Anti-Müllerian hormone as an independent predictor of twin versus singleton pregnancy in fresh cycles.

This study evaluated anti-Müllerian hormone (AMH) as a possible predictor of twin pregnancy in women undergoing fresh cycles who had more than one embryo transferred. A retrospective study was performed of 139 patients undergoing fresh non-donor cycles which resulted in either singleton or twin pregnancy between 2009 and 2010 in this fertility clinic. Random serum AMH and other clinically relevant variables were compared. For further analysis, the population was stratified by age (<34 and ⩾34 years). Random serum AMH concentrations were 1.4-times greater in women conceiving twins compared with singletons (P=0.03). In women aged ⩾34, the AMH concentration in twins was 1.8-fold greater than singletons (P=0.001). Multivariate analysis demonstrated that AMH was an independent predictor of twins. ROC curve analysis showed that AMH had a significant predictive ability for twin pregnancy in women aged ⩾34 (AUC 0.67, P=0.01). In contrast, in women aged <34, AMH was not different between twin and singleton pregnancies. In summary, random serum AMH is an independent predictor of twin gestation when more than one embryo is transferred in women aged ⩾34. Considering a woman's AMH before transferring more than one embryo may assist in reducing the incidence of twins. Transferring multiple embryos to increase the chance of pregnancy and live birth rate is a common practice among assisted reproduction providers but often results in a high proportion of multiple pregnancies. Identifying factors predictive of multiple pregnancies is of paramount importance for the successful development of strategies to minimize multiple gestations. Anti-Müllerian hormone (AMH) has been shown to be closely correlated with a woman's egg reserve. Aside from the strong association of serum AMH concentration with quantitative ovarian response, serum AMH concentration has been associated with qualitative aspects of assisted reproduction such as embryo quality and pregnancy rates. Our objective was to evaluate AMH as a possible predictor of twin pregnancy in women undergoing fresh cycles who had more than one embryo transferred. Our study included 139 patients undergoing fresh non-donor cycles which resulted in either a singleton or twin pregnancy between 2009 and 2010 in our fertility clinic. Random serum AMH concentrations were compared. For further analysis, the population was divided into two groups (age <34 and ⩾34). AMH concentrations were 1.4-times greater in women conceiving twins compared with singletons. In women aged ⩾34, the AMH concentration in twins was 1.8-fold greater than singleton pregnancies. AMH was an independent predictor of twins with a significant predictive ability for twin pregnancy in women aged ⩾34. In contrast, in women aged <34, AMH was not different between twin and singleton pregnancies. In conclusion, considering a woman's AMH before transferring more than one embryo may assist in reducing the incidence of twins.

Maternal body mass index and serum concentrations of human chorionic gonadotropin in very early pregnancy.

OBJECTIVE: To study the association of maternal prepregnancy body mass index (BMI) with serum concentrations of hCG in early pregnancy. DESIGN: Cross-sectional study. SETTING: Oslo University Hospital, Norway, 1996-2010. PATIENT(S): Among 3,301 pregnancies with live-born offspring conceived after assisted reproductive techniques, 2,611 women had information on serum hCG concentrations on day 16 after ovulation induction and prepregnancy BMI: 2,110 mothers with singleton and 501 mothers with multiple pregnancy. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Human chorionic gonadotropin concentration. RESULT(S): Geometric mean hCG concentration was higher in multiple pregnancies (190 IU/L) than in singleton pregnancies (106 IU/L). In singleton pregnancies geometric mean serum concentration decreased from 117 IU/L in women with BMI <20 kg/m(2) to 86 IU/L in women with BMI ≥ 35 kg/m(2). In multiple pregnancies, the corresponding decrease was from 226 IU/L to 130 IU/L. There was a significant negative association of BMI with hCG concentrations log transformed in the study sample as a whole (regression coefficient -0.013), in singleton pregnancies (regression coefficient -0.012), and in multiple pregnancies (regression coefficient -0.03). CONCLUSION(S): Serum hCG concentrations were negatively associated with maternal prepregnancy BMI. One possible explanation may be an effect of adipose tissue-derived signaling molecules on hCG secretion by the implanting embryo.

Triplet pregnancy with partial hydatiform mole.

Triplet pregnancy with a coexisting mole is extremely rare. A 26 years old primigravida with multiple gestation and severe pre-eclampsia at 32 weeks gestation was brought to Sri Ramachandra University casualty. In view of abnormal Doppler study with discordant twins emergency lower segment caesarean section was done six days later. Part of the placenta showed molar changes. Histopathology confirmed partial mole. Patient received three cycles of methotrexate in view of rising titres of betahCG. Three months after delivery both babies are alive and well and betahCG for the mother became normal. This pregnancy continued beyond 32 weeks gestational age with both babies being alive. Hence this case is being reported to highlight its rarity.

Candidates for the determination of antithrombin activity in pregnant women.

BACKGROUND: Some women exhibit a gradual decrease in antithrombin activity until the time of delivery, with antithrombin activity reaching <65% of the normal level (pregnancy-induced antithrombin deficiency, PIATD). However, the clinical features of such women are not well understood and are unfamiliar to many obstetricians. FINDINGS: PIATD is more likely to occur as the number of fetuses increases (approx. 1.0%, 10%, and 40% for singleton, twin, and triplet pregnancies, respectively) and in women with hypertension, isolated proteinuria and/or edema. However, normotensive women account for 60% of women with PIATD. Antithrombin can escape from the blood into the interstitial space. Women with PIATD suffer from a decreased plasma volume and are more likely to develop liver dysfunction, irrespective of the presence or absence of hypertension. Because antithrombin activity continues to decrease until the time of delivery in women with PIATD, women with unrecognized PIATD may be identified as patients with so-called "acute fatty liver of pregnancy" if delivery is delayed. CONCLUSION: Knowledge of AT activity in obstetrical practice may improve management of pregnant women. The determination of AT activity should be considered in women with multifetal pregnancies, hypertension, isolated proteinuria and/or edema.

Are first-trimester screening markers altered in assisted reproductive technologies pregnancies?

PURPOSE OF REVIEW: To review the current literature on first-trimester screening with respect to specific issues for assisted reproductive technologies (ARTs) singleton and twin pregnancies. RECENT FINDINGS: A number of different first-trimester sonographic and biochemical markers have been validated in first-trimester screening for trisomy 21. Among sonographic markers, measurement of fetal nuchal translucency is the most investigated and least affected screening method in ART pregnancies, achieving comparable results in singletons and twins compared with spontaneous conceptions. The small deviation of nuchal translucency thickness observed in ART singletons did not influence overall screening performance, including the number of false-positive results. First-trimester maternal serum free ß-human chorionic gonadotropin and pregnancy-associated plasma protein-A levels are more obviously altered in assisted conceptions and carry the risk of higher false-positive rates if not adjusted accordingly. The reason behind the alterations is currently not quite explored, but might be attributed to infertility and a higher incidence of placental disorders rather than to the use of ART. In twin pregnancies, chorionicity is an important confounding variable with evident impact on nuchal translucency measurements and maternal biochemistry, but both issues have not been sufficiently investigated in ART twins so far. SUMMARY: First-trimester measurement of fetal nuchal translucency in singleton and twin gestations is associated with similar screening results when compared with spontaneous conception. Adjustments for the mode of conception are required if maternal serum biochemistry is included in the screening algorithm. Further studies on assisted conception twins are essential to permit more conclusive results on this issue.

Clinical indications for abnormal early gestational 50-g glucose tolerance testing.

Providers occasionally screen women thought to be at particularly increased risk of gestational diabetes mellitus (GDM) with a first- or second-trimester ("early") glucose tolerance test (GTT). We sought to describe how the frequency of abnormal early GTT varies by indication for testing. This is a retrospective cohort study of women receiving prenatal care in our clinic who underwent a 50-g GTT at less than 24 weeks between 2003 and 2006. Three hundred five women received an early GTT. The most common indications for early screening were obesity (53%), family history of diabetes (15%), prior history of GDM (10%), and multifetal gestation (5%). The frequency of abnormal testing in patients with multifetal gestations and a personal history of GDM was higher than in those undergoing early testing because of obesity. The frequency of abnormal early GTT varies by indication for testing. These data may be used in the allocation of health care resources.

Diferencias en el metabolismo lipídico, niveles de homocisteína, folato y vitamina B12 entre gestaciones gemelares y únicas / Differences in lipid metabolism, homocysteine levels, serum folic acid and vitamin B12 between single and twin pregnancies

Antecedentes: Se están usando diferentes tipos de suplementación nutricional durante la gestación, sin embargo, existen escasez de estudios que se centren en los resultados metabólicos de los mismos. Objetivos: Comprobar si mediante la suplementación se logra el control del impacto de los múltiples cambios metabólicos que conlleva una gestación múltiple, usando análisis comunes. Método: Comparamos tres diferentes grupos de pacientes entre la semana gestacional 25 y 27. Un grupo de 46 gestaciones únicas, un grupo de 38 gestaciones gemelares espontáneas y otro grupo de 32 gestaciones gemelares tras técnicas de reproducción asistida. Comparamos niveles de colesterol LDL, HDL, triglicéridos, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Resultados: Los niveles de triglicéridos fueron más altos en ambos grupos de gemelares (p<0,001) y los niveles de colesterol fueron similares en los tres grupos. Las concentraciones de folato sérico fueron mayores en las gestaciones gemelares (p<0,001). El resto de parámetros estudiados fueron similares en los tres grupos. Conclusión: La suplementación siguiendo las recomendaciones de la ACOG y la SEGO es efectiva en el control de colesterol LDL, HDL, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Sólo los niveles de triglicéridos no se relacionan con la suplementación y pueden estar relacionados con mayor incidencia de colestasis y preeclampsia en gestaciones múltiples.

Background: Different ways of nutritional supplementation are being advised by physicians during pregnancy, but there is a lack of literature focused on its metabolical results. Aims: Check if the control of the impact that the multiple metabolic changes related to multiple pregnancies have on the mother's homeostasis is achieved with the supplementation, through common used blood tests. Method: We compare three different groups of patients between the 25 and 27th week of gestation. One group of 46 single pregnancies, a second group of 38 spontaneous twin pregnancies and another group of 32 twin pregnancies after assisted reproduction techniques. We compare the levels of LDL, HDL-cholesterol, triglycerides, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Results: The levels of triglycerides were higher in both groups of twin pregnancies (p<0.001), but the levels of cholesterol remain similar. Folic acid concentrations were higher in the groups of twin pregnancies (p<0.001). The rest of levels studied were similar in the 3 groups. Conclusion: The supplementation following the ACOG and SEGO recommendations seems to be effective in controlling the values of LDL, HDL-cholesterol, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Only the levels of triglycerides appear unaffected by the supplementation and can be related with the higher incidence of preeclampsia and cholestasis seemed among twin pregnancies.

Soluble endoglin for the prediction of preeclampsia in a high risk cohort.

OBJECTIVES: To evaluate soluble endoglin (sEng) and the soluble fms-like tyrosine kinase 1 (sFlt1) to placental growth factor (PlGF) ratio for the prediction of preeclampsia in high-risk women, and to evaluate differences in sEng between women with high-risk singleton and multiple gestation pregnancies. STUDY DESIGN: We collected serial serum specimens from 119 women at high preeclampsia risk. sEng, sFlt1 and PlGF were measured by ELISA. RESULTS: Among subjects who did not develop preeclampsia, mean serum sEng was significantly higher in those with multiple gestation pregnancies vs. high-risk singletons. Among women with singleton gestations, mean serum sEng was higher in subjects who developed early-onset (<34 weeks) and late-onset (>or= 34 weeks) preeclampsia, as compared with subjects without preeclampsia, from 22 weeks and 28 weeks gestation onward, respectively. The within-woman rate of change of sEng was also higher in women who later developed preeclampsia. CONCLUSIONS: sEng is higher in women with multiple gestations vs. high-risk singleton pregnancies. In high-risk women, serum sEng is increased prior to preeclampsia onset.

Effect of changes in renal circulation on serum uric acid levels in women with twin pregnancy.

OBJECTIVE: We examined the relationship between serum uric acid levels and changes in renal circulation in women with twin pregnancy compared with those in women with singleton pregnancy. METHODS: The Doppler waveforms of the bilateral maternal main renal arteries were obtained from 15 women at 37-38 weeks of nonpreeclamptic twin pregnancy and 16 healthy women at the same gestational age of singleton pregnancy. The resistance index (RI), pulsatility index (PI), and acceleration time were determined. RESULTS: The mean serum uric acid level in the twin pregnancy group was significantly higher than that in the singleton pregnancy group (5.0 ± 0.9 vs. 3.7 ± 0.6 mg/dl, P < 0.01). Although there were no significant differences in the RI or PI levels between the singleton and twin pregnancy groups, the acceleration time in the twin pregnancy group was significantly prolonged compared with that in the singleton pregnancy group (82.2 ± 29 vs. 59.9 ± 17 ms, P = 0.01). There was a significant correlation between serum uric acid levels and acceleration times (r(2) = 0.55, P < 0.01). CONCLUSION: The changes in renal circulation may be one of the possible mechanisms leading to hyperuricemia in women with twin pregnancies.

Is it useful to measure C-reactive protein and leukocytes in patients with prelabor rupture of membranes?

Neonatal infection is the main complication of prelabor rupture of membranes (PROM). We studied the accuracy of measuring C-reactive protein (CRP) and leukocytes in maternal serum to predict neonatal infection. We performed a retrospective cohort study in two hospitals in the Netherlands between 2003 and 2006. We included consecutive women hospitalized for PROM. In both hospitals, CRP and leukocytes were measured routinely in maternal serum every 2 days until delivery. End points considered were clinical neonatal infection and proven neonatal sepsis. The accuracy of CRP and leukocytes was assessed using receiver operating characteristic (ROC) analysis. We included 299 women with PROM, 12 of whom had a twin pregnancy. Gestational age at inclusion varied between 26 weeks and 0 days and 41 weeks and 5 days with a median of 37 weeks and 3 days. In 47 women (16%), the neonate developed a clinical infection. The areas under the ROC curve of CRP and leukocytes in the prediction of clinical neonatal infection were 0.61 and 0.62, respectively. Of the 47 infected neonates, six neonates (2%) had a proven neonatal sepsis. In the mothers of these septic neonates, maternal CRP did not rise above 50 mg/L and leukocyte values varied between 9.8 and 25.8 x 10 (9)/L. In women with PROM, CRP and leukocytes should not be measured routinely.