Evidence of Neuroinflammation and Blood-Brain Barrier Disruption in Women with Preeclampsia and Eclampsia.

Cerebral complications in preeclampsia are leading causes of maternal mortality. Animal models suggest that an injured blood-brain barrier and neuroinflammation may be important but there is paucity of data from human studies. Therefore, we aimed to evaluate this in women with preeclampsia and eclampsia. We included women recruited to the South African Preeclampsia Obstetric Adverse Events (PROVE) biobank. Blood and cerebrospinal fluid (CSF) were collected around delivery. CSF was analyzed for neuroinflammatory markers interleukin 1ß, interleukin 6, interleukin-8 and tumor necrosis factor alpha (TNF-alpha). The CSF to plasma albumin ratio was measured to assess blood-brain barrier function. Women with eclampsia (n = 4) showed increased CSF concentrations of all pro-inflammatory cytokines and TNF-alpha compared to women with normotensive pregnancies (n = 7) and also for interleukin-6 and TNF-alpha compared to women with preeclampsia (n = 4). Women with preeclampsia also showed increases in pro-inflammatory cytokines IL-6 and IL-8 but not TNF-alpha in the CSF compared to women with normotensive pregnancies. In particular, women with eclampsia but also women with preeclampsia showed an increase in the CSF to plasma albumin ratio compared to normotensive women. In conclusion, women with preeclampsia and eclampsia show evidence of neuroinflammation and an injured blood-brain barrier. These findings are seen in particular among women with eclampsia.

Associations of Hypothyroxinemia With Risk of Preeclampsia-Eclampsia and Gestational Hypertension.

Objective: To investigate the association between hypothyroxinemia and the risk of preeclampsia-eclampsia and gestational hypertension. Design: Historical cohort study. Methods: The study included pregnant individuals who delivered live-born singletons and had at least one thyroid function assessment during pregnancy at a tertiary hospital. Hypothyroxinemia was defined as thyroid-stimulating hormone (TSH) levels within the normal reference range and free thyroxine (FT4) levels lower than the tenth percentile. Risk ratios (RRs) with 95% confidence intervals (95% CIs) for preeclampsia-eclampsia and gestational hypertension between women with and without a diagnosis of hypothyroxinemia during pregnancy were estimated using a generalized estimating equation model. Results: A total of 59,463 women with live-born singletons were included in the analysis. Logistic regression models with restricted cubic spline suggested that there was a U-shaped association between FT4 levels and preeclampsia-eclampsia risk. Compared with euthyroid women, those with hypothyroxinemia had an increased risk of preeclampsia-eclampsia (RR = 1.16, 95% CI: 1.02-1.31), and the risk increased with the increasing severity of hypothyroxinemia (p for trend < 0.001). Moreover, persistent hypothyroxinemia from the first to second trimesters was associated with an increased risk of preeclampsia-eclampsia (RR = 1.37, 95% CI: 1.03-1.83), especially for women with severe hypothyroxinemia (RR = 1.70, 95% CI: 1.12-2.58). In contrast, there was no association between hypothyroxinemia and gestational hypertension. Conclusion: Our study suggested that hypothyroxinemia was only associated with an increased risk of preeclampsia-eclampsia, especially in women with persistent hypothyroxinemia in the first half of pregnancy. Analyses of the associated risk of gestational hypertension with hypothyroxinemia were not significant.

Predictive value of 4-Hydroxyglutamate and miR-149-5p on eclampsia.

This research aimed at exploring the predictive value of 4-Hydroxyglutamate and miR-149-5p on eclampsia. Preeclampsia patients admitted to our hospital (n = 204), with 112 mild patients and 92 severe patients. Thereinto, pregnant women who underwent physical examination were regarded as a normal group (NG) (n = 100). Serum 4-Hydroxyglutamate levels and miR-149-5p in each group were detected. The serum 4-Hydroxyglutamate level in pregnant women in the NG was markedly lower than that in preeclampsia, while the miR-149-5p level was higher (p = 0.001). The serum 4-Hydroxyglutamate level in severe preeclampsia was higher than that in mild preeclampsia, while the miR-149-5p level was lower (p = 0.001). Partial thromboplastin time (APTT) and prothrombin time (PT) of preeclampsia patients were lower than those of the NG, while Fibrinogen (Fib) was higher (p = 0.001). With the aggravation of the condition of patients, PT, APTT decreased and Fib index increased. In preeclampsia patients, serum 4-Hydroxyglutamate was negatively correlated with PT and APTT, positively correlated with Fib content (p < 0.001); serum miR-149-5p was dramatically positively correlated with PT and APTT, negatively correlated with Fib content (p < 0.001). 4-Hydroxyglutamate and miR-149-5p were relevant to the occurrence time of preeclampsia; 4-Hydroxyglutamate, miR-149-5p and their combination could be used for preeclampsia diagnosis. According to the situation of newborn, they were divided into good and poor groups. The 4-Hydroxyglutamate level in the good group was lower than that in the poor group, while the miR-149-5p level was higher. The adverse prognosis of preeclampsia patients was predicted by 4-Hydroxyglutamate and miR-149-5p. 4-Hydroxyglutamate is highly expressed in preeclampsia, while miR-149-5p is low. Single and combined detection of 4-Hydroxyglutamate, miR-149-5p can be used for preeclampsia diagnosis and prediction.

Prevalence of vitamin D deficiency in Egyptian patients with pregnancy-induced hypertension.

Background Hypertensive disorders of pregnancy can cause severe maternal and fetal acute morbidity and mortality. Women with pre-eclampsia have been found to have alterations in calcium and vitamin D metabolism. There are conflicting results regarding the role of vitamin D deficiency in the development of pre-eclampsia. The aim was to compare 25 (OH) D level in patients with pre-eclampsia, eclampsia and normotensive pregnant women as well as to study the prevalence of Vitamin D deficiency among the 3 groups. Patients and methods Two hundred patients with pre-eclampsia, 100 with eclampsia and 200 normotensive pregnant controls were compared as regards vitamin D level. Results Mean 25(OH)D level was lower in the pre-eclampsia (14.8 ± 5.4 ng/mL) and in the eclampsia group (10.5 ± 1.6 ng/mL) than in the pregnant controls (19.5 ± 6.5 ng/mL) (P = 0.002). This difference was only significant between the eclampsia group and the pregnant controls (P = 0.02). All eclampsia cases had vitamin D insufficiency as compared to 17.5% in the pre-eclampsia group and 39.5% in the control group. Deficiency of vitamin D (<12 ng/mL) was 47.5% in the pre-eclampsia group, 80% in the eclampsia group and only 10.5% in the control group (P = 0.035). Conclusion Vitamin D deficiency is highly prevalent among Egyptian pregnant females. Our study supports the hypothesis that low vitamin D level can play a role in the development of pre-eclampsia and eclampsia. Thus, supplementation might prevent or delay the development of pre-eclampsia and eclampsia especially in patients at a high risk.

Cyclosporin A ameliorates eclampsia seizure through reducing systemic inflammation in an eclampsia-like rat model.

Our previous studies have shown that the maternal hyperinflammatory response in pre-eclampsia lowered the eclampsia-like seizure threshold. Cyclosporin A (CsA), which is an effective immunosuppressant, could attenuate the inflammatory responses in LPS-induced pre-eclampsia rats. Here, we hypothesized that CsA may ameliorate seizure severity through reducing systemic inflammation in pre-eclampsia/eclampsia. In the current study, the effects of CsA on pre-eclampsia manifestation, eclampsia-like seizure activities and systemic inflammation were examined in a pre-eclampsia model. Pregnant rats were given an intraperitoneal injection of the epileptogenic drug pentylenetetrazol (PTZ) following a tail vein injection of lipopolysaccharide to establish the eclampsia-like seizure model. CsA (5 mg/kg) was administered intravenously through the tail after LPS infusion. Mean systolic blood pressure and proteinuria in pre-eclampsia were detected. After PTZ injection, seizure activity was assessed, inflammatory responses were determined and pregnancy outcomes were analyzed. The results showed that CsA treatment significantly decreased blood pressure and proteinuria and increased the fetal and placental weight (P < 0.01). Meanwhile, CsA treatment significantly reduced serum IL-1ß, TNF-α, and IL-17 levels (P < 0.01), decreased the seizure scores and prolonged the latency to seizure (P < 0.01). CsA effectively attenuated pre-eclampsia manifestation and eclampsia-like seizure severity. In addition, CsA treatment significantly reduced the inflammatory cytokine levels and improved pregnancy outcomes following eclampsia-like seizures. The decreased inflammatory cytokines in pre-eclampsia are coincident with attenuated pre-eclampsia manifestation after CsA treatment, suggesting that CsA treatment might decrease the eclampsia-like seizure severity through decreasing systemic inflammation in pre-eclasmpsia/eclampsia.

Effects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the association between preeclampsia (PE) and eclampsia (E) on subsequent metabolic and biochemical outcomes. METHODS: Systematic review and meta-analysis of observational studies. We searched five engines until November 2018 for studies evaluating the effects of PE/E on metabolic and biochemical outcomes after delivery. PE was defined as presence of hypertension and proteinuria at >20 weeks of pregnancy; controls did not have PE/E. Primary outcomes were blood pressure (BP), body mass index (BMI), metabolic syndrome (MetS), blood lipids and glucose levels. Random effects models were used for meta-analyses, and effects reported as risk difference (RD) or mean difference (MD) and their 95% confidence interval (CI). Subgroup analyses by time of follow up, publication year, and confounder adjustment were performed. RESULTS: We evaluated 41 cohorts including 3300 PE/E and 13,967 normotensive controls. Women were followed up from 3 months after delivery up to 32 years postpartum. In comparison to controls, PE/E significantly increased systolic BP (MD = 8.3 mmHg, 95%CI 6.8 to 9.7), diastolic BP (MD = 6.8 mmHg, 95%CI 5.6 to 8.0), BMI (MD = 2.0 kg/m2; 95%CI 1.6 to 2.4), waist (MD = 4.3 cm, 95%CI 3.1 to 5.5), waist-to-hip ratio (MD = 0.02, 95%CI 0.01 to 0.03), weight (MD = 5.1 kg, 95%CI 2.2 to 7.9), total cholesterol (MD = 4.6 mg/dL, CI 1.5 to 7.7), LDL (MD = 4.6 mg/dL; 95%CI 0.2 to 8.9), triglycerides (MD = 7.7 mg/dL, 95%CI 3.6 to 11.7), glucose (MD = 2.6 mg/dL, 95%CI 1.2 to 4.0), insulin (MD = 19.1 pmol/L, 95%CI 11.9 to 26.2), HOMA-IR index (MD = 0.7, 95%CI 0.2 to 1.2), C reactive protein (MD = 0.05 mg/dL, 95%CI 0.01 to 0.09), and the risks of hypertension (RD = 0.24, 95%CI 0.15 to 0.33) and MetS (RD = 0.11, 95%CI 0.08 to 0.15). Also, PE/E reduced HDL levels (MD = -2.15 mg/dL, 95%CI -3.46 to -0.85). Heterogeneity of effects was high for most outcomes. Risk of bias was moderate across studies. Subgroup analyses showed similar effects as main analyses. CONCLUSION: Women who had PE/E have worse metabolic and biochemical profile than those without PE/E in an intermediate to long term follow up period.

[Association between both maternal and fetal angiotensinogen gene single nucleotide polymorphism and preeclampsia/eclampsia].

Objective: To explore the association between preeclampsia/eclampsia and maternal and fetal angiotensinogen SNPs. Methods: From January 2008 to October 2015, a case-parents/mother-control designed study was conducted among 347 preeclampsia/eclampsia cases and 700 controls to collect related information on their demographic characteristics and to detect the related angiotensinogen SNPs' genotypes. Both log-linear and unconditional logistic regression methods were employed to investigate the genetic effects of maternal/fetal angiotensinogen SNPs on preeclampsia/eclampsia. Multivariate binary unconditional logistic regression model and covariance were used to analyze the relationship between BMI before pregnancy, weight gain during pregnancy and overweight and obesity in preschool children. Results: Both fetal angiotensinogen rs3789679 GA and AA genotype were associated with the reduced risks of preeclampsia/eclampsia, with ORs as 0.73 (95%CI: 0.55-0.96) and 0.62 (95%CI: 0.39-0.98), respectively. For fetal angiotensinogen rs2493132, individuals that carrying the TT genotype, presented a positive association with the risk of preeclampsia/eclampsia, with OR as 1.60 (95%CI: 1.08-2.37). However, these associations were not statistically significant after the correction of the false discovery rate. It was observed that fetal rs3789679 could reduce the risk of preeclampsia/eclampsia (OR=0.73, 95%CI: 0.55-0.96) under the dominant model (GA+AA/GG) while fetal rs2493132 increased the risk of preeclampsia/eclampsia (OR=1.66, 95%CI: 1.13-2.44) under the recessive model (TT/CC+CT). Maternal rs5051 presented an association with preeclampsia/eclampsia (OR=1.33, 95%CI: 1.01-1.76) under the dominant model (TC+CC/TT). Conclusions: Results from the dominant model showed that both fetal rs3789679 GA and AA genotype reduced the risk of preeclampsia/eclampsia and maternal rs5051 TC while CC genotype increased the risk of preeclampsia/eclampsia. Fetal rs2493132 TT genotype seemed to be associated with the risk of preeclampsia/eclampsia under the recessive model.

Liver enzyme patterns in maternal deaths due to eclampsia: A South African cohort.

Eclampsia is an obstetric emergency and a major cause of maternal mortality in low and middle-income countries such as South Africa. Despite years of research, there is no single test for the prediction of eclampsia, however liver function tests have been effective in monitoring the prognosis of this disorder. This was a retrospective study of patients in whom the final cause of death was eclampsia in South Africa between the years 2014-2016. Of 109 cases who died from eclampsia, the highest prevalence was found among primigravidae (42.1%: n = 45) of whom 26.6% (n = 29) were between 20 and 24 years of age. Twenty-six (23.9%) eclamptics did not receive antenatal care and of these 80.7% (n = 21) had the first eclamptic seizure at home. The first level of health care was used by 63.3% (n = 69) of patients; liver function test results were documented in 56.9% (n = 57). An association was found between eclampsia and elevated aspartate aminotransferase levels. Primigravidae especially teenagers are at risk of eclampsia. These women in particular must be informed of the warning signs of preeclampsia and requested to attend for antenatal care frequently especially in the third trimester so that early signs of preeclampsia are detected and timeous delivery is carried out to prevent eclampsia. Furthermore, liver function tests and platelet counts should be done in all women with the preeclampsia-eclampsia syndrome during antenatal and in the immediate postpartum period to prognosticate progression of the disorder and or timing of discharge from hospital.

Hypertensive disorders of pregnancy are associated with an inflammatory state: evidence from hematological findings and cytokine levels.

BACKGROUND: Abnormalities of blood cell counts and of cytokine profiles in women with hypertensive disorders of pregnancy (HDP) have been reported in several studies. Although their cause-effect relationships to HDP are not yet clear, detecting and monitoring these alterations can be of use for prognosis and management of HDP. This study aimed to determine hematological, coagulation and cytokine profiles in hypertensive as compared to normotensive pregnancy and to identify correlations between these profiles. METHODS: This was a hospital-based comparative cross-sectional study conducted from September 2017 to February 2018. There were two groups: the comparison group consisted of 77 normotensive pregnant women attending the antenatal clinic of Muhimbili National Hospital (MNH); the index group consisted of 76 hypertensive pregnant women admitted to the maternity block of the same hospital. Hematological and cytokine parameters were compared between the hypertensive and the normotensive group. We analyzed the data using Student's independent t-test when the data were normally distributed; and the Mann-Whitney U-test when the data were not normally distributed. Kruskal Wallis with Dunn's multiple comparison tests was run for subgroup analysis and correlation studies were done using Spearman ranking. RESULTS: Hemoglobin levels were slightly but significantly lower, (P < 0.01) in women with HDP compared to normotensive (N) women; the same was true for platelet counts (P < 0.001). The red cell distribution width (RDW) was slightly but significantly higher in HDP than in N. Neutrophil counts and Interleukin 6 (IL-6) levels were significantly (P < 0.001) higher in HDP than in N; and within HDP IL-6 levels increased with increasing severity of HDP. A novel remarkable finding was that eosinophil counts, normal in N, were lower and lower with increasing severity of HDP, to the point that they were nearly absent in women with eclampsia. CONCLUSION: There are significant changes in hematological, cytokine and coagulation parameters in pregnant women with hypertensive disorders compared to normotensive pregnant women. The picture that emerges is that of an inflammatory state associated with hypertensive disorders of pregnancy.

Maternal serum uric acid concentration and pregnancy outcomes in women with pre-eclampsia/eclampsia.

OBJECTIVES: To determine the relationship between maternal serum uric acid levels and fetal/neonatal complications in women with pre-eclampsia/eclampsia, and to establish a predictive threshold value. METHODS: A diagnostic test and historical cohort study conducted by prospective cross-sectional data collection on pregnant women with pre-eclampsia/eclampsia at Hue University Hospital, Vietnam, between March 2015 and July 2017. Pre-eclampsia was diagnosed based on ACOG criteria. Serum uric acid levels were measured by enzymatic colorimetric testing using a Cobas c 501 analyzer (Roche Diagnostics, Mannheim, Germany). Fetal complications included intrauterine growth restriction, preterm delivery, fetal death, and neonatal death. RESULTS: There were 205 women enrolled. Serum uric acid at a cutoff of 393 µmol/L is a good predictor of fetal/neonatal complications (AUC 0.752), with 64.4% sensitivity and 79.5% specificity. High uric acid level (≥393 µmol/L) resulted in increased risk of preterm birth (OR 6.367, 95% CI 3.009-13.084), low Apgar scores (OR 5.514, 95% CI 1.877-16.198), intrauterine growth restriction (OR 7.188, 95% CI 3.592-14.382), and neonatal death (OR 7.818, 95% CI 1.614-37.867). There was no relationship between uric acid level and fetal death (OR 1.803, 95% CI 0.355-9.168). CONCLUSIONS: Maternal serum uric acid concentration is a good predictor of fetal/neonatal outcomes in women with pre-eclampsia/eclampsia.

Prognostic value of serum soluble FMS-like tyrosine kinase (sFlt-1) levels in pre-eclampsia and eclampsia; a prospective cohort study.

OBJECTIVE: To evaluate the levels of circulating sFlt-1 in pre-eclampsia (PE) and eclampsia patients and to assess its prognostic value in detection of PE complications. METHODS: The present study was a prospective cohort study conducted in tertiary hospital between January and December 2016. Included patients were divided into two groups; (Group I) severe PE group and (Group II) eclampsia group. Age-, parity-, and gestational age-matched women had approached to participate in the study as a control group (Group III). Serum sFlt-1 levels were measured at inclusion and 2 days later with all basic investigations. Patients were followed up until delivery to record any complications. Correlation analysis was performed between the serum sFlt-1 levels and clinical, laboratory investigations. Receiver operating characteristic analysis was constructed for the evaluation of the area under curve (AUC) as well as the sensitivity and specificity regarding the cutoff point of sFlt-1 level that predict occurrence of complications. RESULTS: The study included 84 women. Women with complicated severe PE showed higher sFlt-1 levels than in non-complicated cases (120.2 ± 19.6 versus 72.2 ± 19.6, p < 0.001). Similarly, the mean serum level of sFlt-1 in complicated eclampsia was higher than in non-complicated cases (298.3 ± 75.2 versus 128.1 ± 36.5, p < 0.001) (OR = 1.119, 95% CI: 10.057-1.184, p < 0.001). SFlt-1 levels were strongly correlated with systolic blood pressure (r = 0.641) and diastolic blood pressure (r = 0.540) (p < 0.001 and p < 0.001, respectively). At cutoff point 102.60 ng/ml of sFlt-1 levels, the sensitivity was 90% and specificity was 80% with AUC = 0.923, 95% CI: 0.871-0.975. CONCLUSIONS: Serum sFlt-1 can be used as a prognostic marker to predict the occurrence of complications of preeclampsia.

Serum amyloid A, procalcitonin, highly sensitive C reactive protein and tumor necrosis factor alpha levels and acute inflammatory response in patients with hemolysis, elevated liver enzymes, low platelet count (HELLP) and eclampsia.

AIM: The aim of this study was to determine the relationship between serum amyloid A (SAA), procalcitonin (ProC), highly sensitive C reactive protein (hsCRP) and tumor necrosis factor (TNF) alpha activity in patients with pre-eclampsia, eclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP), and the pathogenesis and severity of the disease. METHOD: Ninety patients at ≥ 32 gestational weeks, according to the last date of menstruation and ultra-sonographic measurements, diagnosed with pre-eclampsia (30 patients), eclampsia (30 patients) or HELLP syndrome (30 patients) were included in the study. Thirty healthy pregnant women from the outpatient clinic during the same period were recruited as the control. The age, gravida, parity, gestational age, systolic and diastolic blood pressures, proteinuria, hemoglobin, thrombocyte count, liver function tests (aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, SAA, TNF alpha, ProC and hsCRP levels during pregnancy) were determined and recorded. RESULTS: No statistically significant differences were detected between the four groups in terms of age, gravida, parity, gestational age and hemoglobin parameters (P > 0.05). When compared to the control, systolic and diastolic blood pressures, spot and 24 h urine protein levels, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, SAA, ProC, hsCRP and TNF alpha levels were significantly high and thrombocyte levels were low in the pre-eclamptic, eclamptic and HELLP groups (P < 0.05). CONCLUSION: The investigated parameters were useful to gain an understanding of the maternal inflammatory profile of pre-eclampsia and might be beneficial as markers to predict complications such as HELLP and eclampsia and to provide the necessary preventive approach in these patients.

Effect of serum high molecular weight adiponectin level on the occurrence of eclampsia during subsequent pregnancy in patients with primary pregnancy induced hypertension.

OBJECTIVE: To analyze the effect of serum levels of high molecular weight adiponectin (HMWA) on the occurrence of eclampsia during subsequent pregnancy in patients with primary pregnancy-induced hypertension (PIH). PATIENTS AND METHODS: Thirty patients with primary PIH (observation group) and sixty patients without primary PIH (control group) were consecutively selected. ELISA was used to measure the serum levels of HMWA. The differences in the occurrence of eclampsia during subsequent pregnancy between the two groups were compared. RESULTS: The serum levels of HMWA in the observation group were significantly lower than in the control group, and they decreased with increased severity of PIH (p < 0.05). In the observation group, the gestational age was lower than that of the control group, and the occurrence of cesarean section and maternal complications were increased. The neonatal weight and Apgar scores were lower than those of the control group, and the occurrence of neonatal complications was increased. The difference was statistically significant (p < 0.05). There were no differences in the time intervals between pregnancies in the two groups. The occurrence of PIH and eclampsia during subsequent pregnancy in the observation group was significantly higher than that in the control group (p < 0.05). According to receiver operating curve analysis, the sensitivity, specificity, and accuracy of serum HMWA level in predicting the occurrence of eclampsia during subsequent pregnancy were 85.6%, 74.8%, and 0.824 (95% CI = 0.811-0.936, p = 0.015), respectively. The critical value was 2.4 mg/l. CONCLUSIONS: Decreases of serum levels of HMWA in patients with primary PIH are closely related to the severity of PIH and the outcome of pregnancy, which has important predictive value for the occurrence of eclampsia during subsequent pregnancy.

Hematocrit and plasma albumin levels difference may be a potential biomarker to discriminate preeclampsia and eclampsia in patients with hypertensive disorders of pregnancy.

BACKGROUND: We evaluated whether alterations of hemoglobin (HB), hematocrit (HCT), serum albumin level (ALB), and the difference of HCT and ALB can be used in the diagnosis of preeclampsia and eclampsia in patients with hypertensive disorders of pregnancy (HDP). METHODS: A total of 509 individuals were recruited and divided into 4 groups: Group 1, 170 healthy non-pregnant women; Group 2, 125 normal pregnant women; Group 3, 105 pregnant women diagnosed with gestational and chronic hypertension; Group 4, 109 pregnant women diagnosed as having preeclampsia and eclampsia. Data of HB, HCT, ALB, globulin (GLB) were collected at the time of a prenatal examination during the third trimester. RESULTS: Alterations in the HCT and the ALB levels in these groups were significantly different. Group 4 had a higher mean HCT-ALB value (P<0.01), but lower ALB and GLB values compared with the other three groups. We used Groups 2 and 3 as the respective reference to draw the receiver operating characteristic (ROC) curves of HCT-ALB in Group 4, and found that the threshold values of maximum index corresponding were 12.95 and 12.65 (sensitivity>57.0%, specificity>98.9%), respectively. CONCLUSIONS: The value of HCT-ALB>12.65 might be used as a potential biomarker for the auxiliary diagnosis of preeclampsia and eclampsia in HDP.

Circulating MicroRNAs as Potential Molecular Biomarkers in Pathophysiological Evolution of Pregnancy.

MicroRNAs represent nonprotein coding small RNA molecules that are very stable to degradation and responsible for gene silencing in most eukaryotic cells. Increased evidence has been accumulating over the years about their potential value as biomarkers for several diseases. MicroRNAs were predicted to be involved in nearly all biological processes from development to oncogenesis. In this review, we address the importance of circulating microRNAs in different conditions associated with pregnancy starting with the implantation period to preeclampsia and we shortly describe the correlation between placental circulating miRNAs and pregnancy status. We also discuss the importance of microRNAs in recurrent abortion and ectopic pregnancy.

Alanine Aminotransferase and Total Bilirubin Concentration in Preeclampsia and Eclampsia.

Eclampsia is an important cause of maternal mortality in developing countries. This cross-sectional comparative study was conducted in the Departments of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), and Obstetrics and Gynecology, BSMMU, and Dhaka Medical College Hospital, Dhaka, Bangladesh, from March 2012 to February 2013 and was designed to evaluate liver markers to predict preeclampsia. One hundred fifty (150) women with pregnancy of ≥28 weeks, 50 for each normal, preeclampsia and eclampsia group, were enrolled purposively. The protocol was approved by IRB of BSMMU. Consent was taken from each patient. Serum total Bilirubin and ALT were assessed. Data was collected in a questionnaire and analyzed by SPSS-16. Quantitative data were compared by ANOVA or 't' test and qualitative data by chi-square test. P value <0.05 was considered significant. The patients of all groups were similar in age and gravida. The mean±SD serum total bilirubin and ALT were significantly higher in preeclampsia and eclampsia groups than normal pregnancy. However they were similar in preeclampsia and eclampsia group.

Nucleated Red Blood Cell Count in Maternal Peripheral Blood and Hypertensive Disorders in Pregnant Women.

OBJECTIVE: We investigated the correlations of nucleated red blood cell (NRBC) counts with hypertensive disorders in pregnancy (HDP) and fetal umbilical blood flow velocity. MATERIALS AND METHODS: We recruited 282 patients with HDP as experimental group including 107 with mild pre-eclampsia (A1 group), 100 with severe pre-eclampsia (A2 group) and 75 with eclampsia (A3 group), and 215 normal pregnant women as control group. Maternal peripheral venous blood was collected and isolated cells were stained with Wright-Giemsa. We estimated NRBC counts according to laboratory routine and Doppler ultrasound examinations were employed to measure the systolic/diastolic (S/D) ratios of fetal ductus venosus, umbilical artery and middle cerebral artery. RESULTS: The NRBC counts in A1, A2 and A3 groups were higher than control group (all P < 0.01). The S/D ratios in control, A1, A2 and A3 groups increased orderly (P < 0.05). Receiver operating characteristic curve analysis demonstrated that the sensitivity and specificity of NRBC count and S/D ratios in diagnosing HDP were 96.50% and 96.28%; 93.60% and 98.14%; 94.30% and 94.88% 99.30% and 100%, respectively. Pearson and Spearman correlation analysis revealed that the NRBC and S/D ratios were correlated with gestational age at birth, amniotic fluid volume, premature birth, mechanical ventilation, neonatal intensive care unit admission, neonatal asphyxia, birth weight, fetal distress, APGAR score, pH value, arterial oxygenation tension, bicarbonate and base excess (all P < 0.05). The NRBC count was positively associated with the S/D ratios (all P < 0.05). CONCLUSIONS: Our results provide evidence that NRBC count in patients with HDP increased significantly, showing positive correlations with umbilical S/D ratios.

[The regulatory transport proteins in diagnostic and prognosis of preeclampsia].

The article considers the results of analysis of content of regulative transport proteins in blood serum and urine of pregnant women (term III) in case of uncomplicated pregnancy and pregnancy complicated by preeclampsia and eclampsia for elaborating their pathogenic role and evaluating prognostic significance. It is established that the more severe eclampsia is the higher is the level of a2-macroglobulin and the lower is the content of lactoferrin in blood. At that, excretion of a2-macroglobulin and albumin with urine increases with aggravation of severity of processes and in urine is detected a1-antitrypsin previously undetected. The excretion of lactoferrin reaches its peak values in case of preeclampsia and decreases in case of eclampsia. The alteration of levels of a2-macroglobulin and lactoferrin are uncharacteristic for classic inflammatory reaction and testify their active involvement into pathogenesis of eclampsia. The decreasing of in blood of levels of a1-antitrypsin lesser than 5 g/l and lactoferrin lesser than 0.8 mg/l at concentration of a2-macroglobulin higher than 3.5 g/l against the background of decreased levels of albumin and crude protein in blood and also increasing in urine of concentrations of a2-macroglobulin up to 0.0005 g/l and higher and occurrence of a1-antitrypsin and increasing of content of albumin up to 10 times can be recommended as criteria of high risk of development of eclampsia in regnant women with moderately expressed preeclampsia in term III.

Troponin I and D-Dimer levels in preeclampsia and eclampsia: prospective study.

OBJECTIVE: The aim of this study was to evaluate serum cardiac troponin I and D-Dimer (D-Di) levels in preeclampsia (PE), eclampsia (E), and normotensive healthy pregnant women in third trimester in order to define their diagnostic value. MATERIALS AND METHODS: The study group consisted of 42 preeclamptic patients and 16 eclamptic patient; 108 healthy normotensive pregnant women in third trimester who were chosen from outpatients clinic and examined regularly used as a control group. Serum cardiac troponin I and D-Di levels were measured using an immunoassay. RESULTS: The average levels of troponin I were 0.0134 ± 0.0091, 0.017 ± 0.0085, 0.180 ± 0.136 in control group, preeclamptic, and eclamptic patients, respectively. The levels of troponin in eclamptic patients were statistically higher than the normotensive and preeclamptic group (p = 0.016, p = 0.014). There were no differences in terms of troponin I level between preeclamptic group and normotensive pregnant women in third trimester (p = 0.089). The average D-Di levels were 634 ± 228 ng/ml, 1426 ± 430 ng/ml, 2067 ± 580 ng/ml in control group, preeclamptic, and eclamptic patients, respectively. The levels of D-Di in preeclamptic and eclamptic patients were found significantly higher than the control groups (p = 0.034, p = 0.020). CONCLUSION: Serum troponin I levels increased in eclamptic patient because of myocardial damage. An increased level of troponin was not detected in preeclamptic patients. However; D-Di level increased in preeclamptic and eclamptic patients.