Recurrent pre-eclampsia in women with metabolic syndrome and low plasma volume: a retrospective cohort study.

OBJECTIVE: To determine the prevalence of recurrent pre-eclampsia in women with a history of pre-eclampsia with both metabolic syndrome and low plasma volume postpartum, as compared with women without either entity. DESIGN: Retrospective cohort study. SETTING: Three tertiary referral hospitals in the Netherlands. POPULATION: Women with a history of pre-eclampsia. METHODS: In 196 women with a history of pre-eclampsia we determined the presence or absence of metabolic syndrome using the World Health Organization criteria and measured plasma volume with the (125) I-human serum albumin indicator dilution technique. We compared the prevalence of recurrent pre-eclampsia in four groups, classified according to presence or absence of metabolic syndrome and low or normal plasma volume, calculating odds ratios (OR), adjusted for confounders. MAIN OUTCOME MEASURE: Recurrence of pre-eclampsia in the subsequent pregnancy. RESULTS: The prevalence of recurrent pre-eclampsia was 12% (12/99) in women without metabolic syndrome with normal plasma volume, versus 47% (8/17) in women with both metabolic syndrome and low plasma volume: OR 6.44 (95% CI 2.09-19.90), adjusted OR 7.90 (95% CI 2.30-27.16). Recurrent pre-eclampsia was present in 44% (10/23) and 25% (14/57) of women with isolated metabolic syndrome and low plasma volume, respectively. CONCLUSIONS: In the concomitant presence of metabolic syndrome and low plasma volume, the prevalence of recurrent pre-eclampsia was nearly 50%, which is four times as high as the prevalence in women without either entity. TWEETABLE ABSTRACT: Metabolic syndrome and low plasma volume raise the risk of recurrent pre-eclampsia to nearly 50%.

Metabolic syndrome and the risk for recurrent pre-eclampsia: a retrospective cohort study.

OBJECTIVE: To compare the prevalence of recurrent pre-eclampsia between women who have and do not have metabolic syndrome when non-pregnant. DESIGN: Retrospective cohort study. SETTING: Three tertiary referral hospitals in the Netherlands. POPULATION: Formerly pre-eclamptic women. METHODS: The presence or absence of metabolic syndrome was assessed in 480 women at least 6 months after their first pre-eclamptic pregnancy using World Health Organization criteria. We compared the prevalence of recurrent pre-eclampsia in the subsequent pregnancy, calculating odds ratios (OR), adjusted for confounders. MAIN OUTCOME MEASURE: Recurrence of pre-eclampsia in the subsequent pregnancy. RESULTS: Subsequent pregnancy outcome data were available for 197 women. Forty women had metabolic syndrome after previous pregnancy (20%). The prevalence of recurrent pre-eclampsia was 18/40 (45%) in women with metabolic syndrome versus 27/157 (17%) in women without metabolic syndrome; OR 3.94 (95% confidence interval [CI] 1.86-8.33, adjusted OR 3.77 (95% CI 1.61-8.81). The risk of recurrent pre-eclampsia increased with each extra component of the metabolic syndrome from 11.8% for absent components up to 43.9% for three or more (P for trend < 0.001). CONCLUSIONS: Interpregnancy metabolic syndrome predisposes to recurrent pre-eclampsia.

[A levonorgestrel-containing IUD for the treatment of endometriosis]. / Levonorgestrelhoudend IUD voor de behandeling van endometriose.

Endometriosis is a chronic condition that can cause severe pain and have a significant effect on the quality of life. The currently available hormonal treatments with analogues of gonadotrophin releasing hormone (GnRH) and oral progestational agents are effective in the short term, but the systemic side effects affect treatment compliance. Recurrence of the symptoms is therefore not uncommon. Recently, a few studies have assessed the effect of a levonorgestrel-releasing IUD on the pain associated with endometriosis. This treatment may have a positive effect on endometriosis, both on the symptoms, the measured extent of the lesions, and the serum levels of CA-125. However, the level of evidence of these studies is lower than that of the standard hormonal treatment options, since large randomised controlled trials are still lacking.

Ethene and other biomarkers of oxidative stress in hypertensive disorders of pregnancy.

OBJECTIVE: An increase in reactive oxygen species (ROS) and lipid peroxides and a comprised antioxidant status has been implicated in the pathophysiology of severe preeclampsia. This study investigates whether oxidative stress and impaired antioxidant systems also contribute to milder forms of hypertensive disorders in pregnancy. Furthermore, ethene in exhaled air, a noninvasive measure for oxidative stress, was evaluated and compared with two other more established biomarkers. METHODS: Ethene in exhaled air, plasma protein carbonyls, and the ratio of free glutathione/oxidized glutathione (GSHfree/GSHox) as markers for oxidative stress as well as the antioxidants vitamins C and E, uric acid, glutathione, and the oxygen radical absorbance capacity (ORAC) in plasma were measured in 30 healthy nonpregnant, 14 normal pregnant, 9 women with pregnancy-induced hypertension (PIH), and 14 preeclamptic women. Pregnant participants were measured during pregnancy and after delivery. RESULTS: Women suffering from PIH and preeclampsia showed higher levels of the antioxidants vitamin E and uric acid, and lower levels of vitamin C compared with normal pregnant and nonpregnant women. All markers for oxidative stress were comparable between groups. Ethene levels showed a positive correlation with protein carbonyls but no correlation could be demonstrated with the free glutathione/oxidised glutathione ratio. CONCLUSIONS: PIH and preeclampsia are associated with minor alterations in antioxidant levels without signs of oxidative stress. Detection of ethene in exhaled air seems a promising noninvasive method to study lipid peroxidation but further research in more severe preeclampsia is needed.