[Association of homocysteine, vitamin and blood factors with preeclampsia in pregnant women]

Preeclampsia is a disease with worldwide importance to mothers and infants, where it accounts for 20-80% of the strikingly increased maternal mortality. The lack of enzymes added to the homocysteine metabolism or the cofactors necessary for its metabolism [folate, B6 vitamin, B12 vitamin] cause hyperhomocysteinemia. Abnormal serum lipid profiles such as cholesterol, LDL, HDL and triglyceride are associated with endothelial dysfunction. Recently high levels of B-HCG have been identified as a potential marker for developing preeclampsia. The purpose of this study was to identify the possible association of homocysteine, vitamin and some serum factors levels with preeclampsia in pregnant women. A case control study was performed prospectively on normotensive healthy pregnant women [80] and pregnant women diagnosed with preeclampsia [80] referring to Imam Sadjad hospital in Yasuj, between September 2004 to August 2005. in addition to the obstetric evaluation and laboratory examination in the 3rd trimester of gestation, blood samples were taken from all cases for homocysteine and vitamin B12, folic acid, triglyceride, cholesterol, LDL, HDL, B-HCG analysis. The samples were evaluated by Immunoassay [ELISA]. Univariant and logistic regression analyses were used to identify predictors of outcomes. The mean plasma level of total homocysteine was significantly higher in preeclamptic women compared with normal pregnancy [p<0/05]. No significant differences were observed in B12 concentrations and plasma folic acid [P>0.05]. Triglyceride and cholesterol levels were significantly higher in preeclamptic women compared with normal pregnant women [p<0/05]. LDL and HDL levels were not correlated with preeclampsia. There was no significant association between preeclampsia and B-HCG levels. Homocysteine, triglyceride and cholesterol concentrations increase in preeclampsia but decrease of vitamin B12 and folic acid levels was not observed in preeclampsia. LDL, HDL and B-HCG levels were not different preeclamptic women and women with normal pregnancy

[ randomised cohort trial comparing amoxicillin and erythromycin effect on the treatment of asymptomatic chlamydia trachomatis infection in pregnant women]

Introduction and Objective: chlamydia trachomatis infection is one of the most common sexual infections among childbearing women. Proper treatment of this infection in pregnant women is an important public health issue. Our goal was to compare the efficacy of amoxicillin and erythromycin on treatment of asymptomatic acute and chronic chlamydia trachomatis infection in pregnant women

Material and Methods: a randomized cohort trial of pregnant women with chlamydia trachomatis IgM and IgG positive serum receiving care at two inner city, university - based prenatal clinics were randomly assigned to receive either oral amoxicillin, 500 mg three times daily for 7 days [case group 1], erythromycin 400 mg four times for 7 days [case group2] or placebo 500mg three times for 7 days[control group]. Participants referred for retesting 4 weeks after initiation of treatment and the patients were followed till delivery. Patients with positive follow up blood tests were crossed over into the alternate treatment and retested at a later visit. Statitical analysis was performed by using McNemar, exact Fisher tests and chi square analysis

Results: 333 pregnant women were enrolled in this study and 92 chlamydia infected women [27.62%] completed the protocol. There was no significant difference between delivery gestational age of the groups [39.05, 38.72, 38.6 week] showing that chlamydia infection was not associated with preterm labor. Acute chlamydia infection rates before and after treatment in both amoxicillin and erythromycin groups were significantly different.The rates of acute chlamydia infection reduced from 83.87% before treatment to 35.48% after treatment [p<0.001] in group treated by amoxicillin. This change was 64.51% before treatment vs 29.03 after treatment [p<0.001] in erythromycin group. Chronic chlamydia infection rates in erythromycin group was significantly reduced in compare amoxicillin group after treatment. Based on the results of this study, the rates of chronic chlamydia infection in erythromycin group reduced from 41.93% before treatment to 19.35% after treatment [p=0.01]. The change in amoxicillin group was observed before treatment 19.35% vs 12.9% after treatment. In the amoxicillin group, 6 women [19.35%] were intolerant, compared with 10 women [32.25%] in erythromycin group

Conclusion: chlamydia infection was not associated with preterm labor. Two kinds of treatments used in this study had the similar effects on acute chlamydia infection but erythromycin was more effective than amoxicillin on chronic chlamydia infection. Women treated by amoxicillin had less gastrointestinal complications than those treated by erythromycin