Evaluation of catalase, myeloperoxidase and ferroxidase values in pregnant women with hyperemesis gravidarum.

OBJECTIVES: To investigate maternal serum catalase, myeloperoxidase and ferroxidase levels in pregnant women withHyperemesis Gravidarum and to compare the results with healthy pregnancies. MATERIAL AND METHODS: In this study, 60 female patients admitted to the Health Sciences University, Gazi Yasargil Trainingand Research Hospital, Gynecology and Obstetrics Department were evaluated. The patients were divided into two groups:Group 1 included 30 pregnant women with hyperemesis gravidarum; Group 2 included 30 healthy pregnant women.Pregnancies over 14 weeks were excluded from the study. RESULTS: The laboratory and laboratory characteristics of both groups are shown in Table 1. No significant differences werefound between the groups in terms of the maternal age, gestational age, gravidity, parity, fasting glucose level, and BMI.The maternal blood CAT levels were significantly higher in the HG group (219.6 ± 111.3 kU/L) when compared to the controlgroup (71.5 ± 52.5 kU/L) (p < 0.001). The maternal blood MPO levels were lower in the control group (121.5 ± 36.3 U/L)than in the study group (90.9 ± 56.4 U/L) (p = 0.016). However, the ferroxidase levels were similar between the twogroups. The independent variables BMI, age, parity, gravidity and gestational week effects were adjusted according to thelogistic regression method with groups. Significant differences were observed between the two groups in the levels ofCAT (0.001), MPO (0.005) values. CONCLUSIONS: This study suggests that antioxidants in response to oxidative stress gave different reactions with differentmechanisms; Also, we believe that insufficient food intake suppresses the immune system and this has an important roleon antioxidants.

Adenosine deaminase activity in normal pregnancy and pregnancy associated disorders.

Adenosine deaminase (ADA) is an enzyme of purine salvage pathway and has two important isoenzymes ADA1 and ADA2. The activity of ADA has been changed in diseases characterized by altered cell-mediated immunity. It was observed that total serum ADA activity was decreased during normal pregnancy compared with non-pregnant women. However, total serum ADA activity and serum ADA2 activity was increased in hyperemesis gravidarum and pre-eclampsia in pregnant women. Less information is available regarding role of ADA in abortions (recurrent and missed) and anembryonic pregnancies. Here, we review the activity of ADA and its isoenzymes. Despite these findings, it will be interesting to know whether activity of ADA will be same if ADA is estimated throughout the pregnancy and in pregnancy related complications from early first trimester to third trimester, as all studies until now were carried out at a particular stage of pregnancy.

Paraoxonase-1 activity in patients with hyperemesis gravidarum.

There is increasing evidence that oxidative stress may play a role in the pathophysiology of hyperemesis gravidarum. Serum paraoxonase-1 (PON-1) is a high density lipoprotein (HDL)-associated enzyme that prevents oxidative modification of low density lipoprotein. The aim of the study was to measure the serum levels of PON-1 activity in women with hyperemesis gravidarum. Thirty-four women with hyperemesis gravidarum and 31 healthy pregnant women were enrolled in the study. Serum PON-1 activity was measured spectrophotometrically. Lipid hydroperoxide (LOOH) levels were measured by iodometric assay. PON-1 activity was significantly lower and LOOH levels were significantly higher in pregnant women with hyperemesis gravidarum than in healthy pregnant women (P < 0.0001, for all). There were significant correlations between PON-1 and LOOH, triglyceride, total cholesterol, HDL, low density lipoprotein (LDL) and high sensitive C-reactive protein (HSCRP; P < 0.0001, for all). By using multiple regression analysis LDL, HDL, HSCRP and LOOH were independent determinants of serum PON-1 activity in the study. Decreased PON-1 activity might be related to increased oxidative stress and inflammation in pregnant women with hyperemesis gravidarum. Subjects with hyperemesis gravidarum might be more prone to the development of atherogenesis due to low serum PON-1 activity.

Plasma 5'-nucleotidase activities increase in women with hyperemesis gravidarum.

OBJECTIVES: To investigate plasma activities of 5'-nucleotidase, a key enzyme in the production of adenosine and evaluate the relationship between changes in 5'-nucleotidase activities and pregnancy-related hormones, estrogen, progesterone and human chorionic gonadotropin (hCG) in women with hyperemesis gravidarum. DESIGN AND METHODS: Plasma 5'-nucleotidase activities and estradiol, progesterone and hCG levels were measured in 21 women with hyperemesis gravidarum and normal pregnancies, matched for age, parity and gestational week. RESULTS: In women with hyperemesis gravidarum, plasma 5'-nucleotidase activities averaged 8.1 +/- 0.6 IU/L, which were significantly increased compared to those in normal pregnant women (5.5 +/- 0.5 IU/L)(p < 0.05). The increases in plasma 5'-nucleotidase activities were accompanied by elevations of plasma estradiol, progesterone and hCG levels. CONCLUSIONS: The increase of plasma 5'-nucleotidase activities may be at least partly attributed to elevations of pregnancy-related hormones, suggesting changes in purine metabolism in women with hyperemesis gravidarum.

Serum adenosine deaminase activity in women with hyperemesis gravidarum.

BACKGROUND: Serum adenosine deaminase (ADA) activity increases in diseases where cellular immunity is stimulated. Since hyperemesis gravidarum is characterized by enhanced cell-mediated immunity, serum ADA activity may be altered. The present study evaluated the relation between serum ADA activity and changes in cell-mediated immunity as causes of changes in ADA activity in hyperemesis gravidarum. METHODS: Serum activities of total ADA and its isoenzymes, ADA1 and ADA2, were measured in women with hyperemesis gravidarum (n = 24) and normal pregnancies (n = 24). Peripheral blood lymphocyte and monocyte counts were also measured. RESULTS: In hyperemesis gravidarum, serum total ADA and ADA2 activities averaged 16.8 +/- 0.5 and 13.3 +/- 0.7 U/l, respectively, which were significantly higher than those in normal pregnancies (10.2 +/- 0.5 and 7.8 +/- 0.5 U/l, respectively) (p < 0.05). The mean values for ADA1 activity in women with hyperemesis gravidarum and normal pregnancies were similar. The increase in total ADA activity was accompanied by the increase in lymphocyte and monocyte counts. CONCLUSIONS: These results suggest that increased serum total ADA activity reflects increases in ADA2 activity, which may be at least in part attributed to enhanced cell-mediated immunity in hyperemesis gravidarum.

Liver enzyme elevation induced by hyperemesis gravidarum: aetiology, diagnosis and treatment.

Three primigravidae were admitted during the first trimester of pregnancy with nausea, vomiting, ketonuria and liver enzyme elevation of varying severity. A 29-year-old woman had elevated aminotransferase values, at levels described in the literature (ASAT 112 U/l, ALAT 214 U/l). The second patient, a woman aged 26 years, had undergone in vitro fertilisation and showed higher liver enzyme elevation, including the total bilirubin level (ASAT 250 U/l, ALAT 474 U/l, total bilirubin 59.8 micromol/l). A 30-year-old woman had extremely high aminotransferase values (ASAT 705 U/l, ALAT 1674 U/l) and she is the first reported patient with ALAT values exceeding 1,000 U/l in connection with hyperemesis gravidarum. Gallstone disease, viral and drug-induced hepatitis were excluded in all of these patients. Treatment was symptomatic and the abnormal liver tests returned to normal promptly when the vomiting resolved, independent of the severity of liver enzyme elevation. The pregnancies proceeded normally and all three patients delivered healthy babies.

Abnormal liver enzymes and ketonuria in hyperemesis gravidarum. A retrospective review of 80 patients.

We reviewed retrospectively a cohort of 80 patients with hyperemesis gravidarum hospitalized between 1976 and 1986 for the presence of abnormal liver enzymes and ketonuria. Thirteen (16%) had abnormal liver enzymes, generally less than four times the upper limit of normal. In this group, hyperemesis gravidarum began at the 14th week of pregnancy as compared to the 6th week in the normal enzyme group (p less than 0.01). Both groups were similar with regard to age, number of children and pregnancies, and duration of vomiting. Ketonuria was significantly more severe (p less than 0.01) in the abnormal enzyme group, implying a more severe state of starvation and dehydration. The correlation coefficient between the degree of ketonuria and level of liver enzymes was low for alkaline phosphatase (r = 0.18), GPT (r = 0.15), and GOT (r = 0.28). The concept that dehydration and starvation are important factors for the induction of liver cell injury is supported by our data. Lack of correlation between the degree of ketonuria and liver enzyme levels is suggestive of other mechanisms (hormonal, genetic) that may interact to produce transaminasemia.