Estudio sobre la asociación de hipertrigliceridemia con los estados hipertensivos del embarazo / Study on the association of hypertriglyceridemia with hypertensive states of pregnancy

Resumen Antecedentes: La preeclampsia se presenta en el 8% de los embarazos y genera el 25% de las muertes perinatales. Aunque su etiología es multifactorial, algunas alteraciones metabólicas se asocian a la disfunción endotelial presente en la enfermedad, y su estudio podría identificar marcadores tempranos de daño. Objetivo: Determinar la relación existente entre concentración plasmática de triglicéridos en las pacientes embarazadas con enfermedad hipertensiva inducida por el embarazo. Método: Estudio prospectivo que incluyó 147 pacientes gestantes sanas y 120 mujeres con enfermedad hipertensiva inducida por el embarazo y se determinaron colesterol total, lipoproteínas de baja densidad (LDL), lipoproteínas de alta densidad (HDL), hemoglobina glucosilada (HbA1c), biometría hemática (BH), química sanguínea (QS), electrolitos séricos, nitritos séricos y pruebas de función hepática. Resultados: Se encontró una diferencia significativa en la concentración de triglicéridos entre las pacientes normotensas y con preeclampsia (261.22 ± 80.27 vs. 361.46 ± 135.17 mg/dl; p < 0.0008). Además, se observó una menor concentración sérica de nitritos en las pacientes con preeclampsia, que contribuye a explicar la vasoconstricción. Conclusiones: Se encontró una asociación entre la hipertrigliceridemia y la presencia de DM II con el desarrollo de la enfermedad hipertensiva inducida por el embarazo.

Abstract Background: Preeclampsia occurs in 8% of pregnancies and generates 25% of perinatal deaths. Although its etiology is multifactorial, some metabolic alterations are associated with the endothelial dysfunction present in the disease, and its study could identify early markers of damage. Objective: To determine the relationship between plasma concentration of triglycerides in pregnant patients with hypertensive disease induced by pregnancy. Methods: Prospective study that included 147 healthy pregnant women and 120 women with hypertensive disease induced by pregnancy. Total cholesterol, low-density lipoprotein, high-density lipoprotein, Hemoglobin A1c, triglycerides, BH, QS, serum electrolytes, serum nitrites and liver function tests were determined. Results: A significant difference was found in the concentration of triglycerides between normotensive and patients with preeclampsia (261.22 ± 80.27 vs. 361.46 ± 135.17 mg/dl, p < 0.0008). In addition, a lower serum concentration of nitrites was observed in patients with preeclampsia, which helps explain vasoconstriction. Conclusions: We found an association between hypertriglyceridemia and the presence of diabetes mellitus II with the development of hypertensive disease induced by pregnancy.

Asociación de nivel bajo de PAPP-A en primer trimestre con resultados obstétricos adversos / Association of low PAPP-A level in the first trimester with adverse obstetric outcomes

ANTECEDENTES: La PAPP-A es una proteína utilizada en obstetricia de forma rutinaria para el cribado de aneuploidías de primer trimestre. En los últimos años se está conociendo más acerca de su papel en la función placentaria. Diversos estudios están mostrando una asociación entre un nivel bajo de PAPP-A y distintos eventos obstétricos. OBJETIVO: Establecer una asociación entre PAPP-A baja y eventos obstétricos adversos. MÉTODO: Estudio retrospectivo de casos y controles anidado en una cohorte. Se han recogido las gestaciones únicas con PAPP-A inferior a percentil 5 en primer trimestre durante 2 años. Se ha recogido de la misma cohorte un grupo control, en proporción 2:1. Se compara mediante análisis estadístico la incidencia de eventos obstétricos adversos de cada grupo. RESULTADOS: Se incluyó un total de 285 pacientes en el grupo de casos y 570 pacientes en el grupo control. Se observó un aumento significativo en el grupo de casos de la incidencia de prematuridad, restricción del crecimiento, hipertensión gestacional y diabetes gestacional. Se ha correlacionado la PAPP-A baja con varios eventos obstétricos adversos, incluyendo prematuridad (OR 4,27), diabetes gestacional (OR 2,40), restricción del crecimiento (OR 2,36) e hipertensión gestacional (OR 2,22). No se observó relación con el resto de eventos obstétricos adversos. CONCLUSIÓN: Un nivel de PAPP-A bajo se asocia con aumentos significativos de prematuridad, diabetes gestacional, restricción del crecimiento e hipertensión gestacional.

BACKGROUND: PAPP-A is a placental protein used in obstetrics as a first trimester marker in aneuploidy screening. In the last few years we are knowing more about its placental function. Some studies are showing a association between low PAPP-A and obstetrical adverse events. AIM: Establish an association between low PAPP-A an obstetrical adverse events. METHOD: This is a retrospective nested case-control study. We identified each singleton pregnancy with a normal phenotype and a low PAPP-A (under percentile 5) in the last 2 years, and match it with a control group of the same population in a 2:1 proportion. It was compared the incidence of each obstetrical adverse outcomes with statistical analysis. RESULTS: We found 285 patients in the case group and match it with 570 patients from control group. It was observed a significative increase in the incidence of prematurity, intrauterine growth restriction, gestational hypertension and gestational diabetes. A low PAPP-A level was correlated with some obstetrical adverse events, like prematurity (OR 4.27), gestational diabetes (OR 2.40), intrauterine growth restriction (OR 2.36) and gestational hypertension (OR 2.22). We observe no correlation with the rest of outcomes. CONCLUSIONS: A low PAPP-A level is related with significative increases of prematurity, gestational diabetes, intrauterine growth restriction and gestational hypertension.

Resultados clínicos y perinatales de los embarazos con hipertensión arterial en un hospital de referencia de la VIII Región de Chile / Clinical and perinatal outcomes associated with hypertension syndrome in pregnancy

Objetivo: Conocer los resultados clínicos, bioquímicos y perinatales asociados al síndrome de hipertensión del embarazo (SHE) en el Hospital Herminda Martín de Chillan. Métodos: Se realizó un estudio retrospectivo de registros clínicos (n=416) con diagnóstico de SHE en el periodo 2006 a 2008. Los registros disponibles fueron divididos en tres grupos de acuerdo al nivel de presión arterial: Grupo I (n=124) <140/90 mmHg; Grupo II (n=98) ³ 140-159/³ 90-109 mmHg y Grupo III (n=41)³ 160/110 mmHg. Adicionalmente, un subgrupo (n=85) fue dividido considerando el percentil de distribución del nivel de ácido úrico materno en: SHE con niveles bajos (p75). Se analizaron y compararon los grupos estudiados y se correlacionó las variables estudiadas con los resultados perinatales. Resultados: La prevalence de SHE fue de 3,8 por ciento. Las mujeres del grupo II y III muestran peores resultados clínicos y neonatales que las mujeres del grupo I. El índice de masa corporal (IMC), la presión arterial materna y el nivel de ácido úrico están relacionados negativamente con la antropometría neonatal. Además, la antropometría neonatal fue menor en las mujeres con niveles más altos de ácido úrico, situación que no obedece a la severidad de la hipertensión o el IMC materno. Conclusión: La presencia de SHE esta asociada a mayor morbilidad materna y neonatal. Este estudio permitió detectar deficiencias (e.L, falta de cumplimiento en criterio diagnóstico) y hacer recomendaciones sobre probables marcadores de riesgo perinatal (e.L, nivel de ácido úrico).

Aims: To know the clinical and biochemical spectra and perinatal outcomes associated with syndrome of hypertension in pregnancy (HP) in the Herminda Martin Hospital from Chilian. Methods: It is a retrospective study using clinical records with HP diagnosis (N=416) during 2006 to 2008. The available records were divided in three different groups according with arterial blood pressure: Group I (n=124) <140/90 mmHg; Group II (n=98) ³ 140-159/³ 90-109 mmHg and Group III (n=41)³ 160/110 mmHg. Additionally, a subset (n=85) was divided considering the percentile of the uric acid level in the mother as: HP with low (p75th) uric acid levels. The studied groups were analyzed and compared each other and quantitative variables were correlated with perinatal outcomes. Results: The prevalence of HP was 3.8 percent. Women in the groups II and III showed worse clinical and neonatal outcomes compared with women in the group I. Body mass index (BMI), maternal blood pressure and uric acid levels were negatively correlated with neonatal anthropometry. Moreover, neonatal anthropometry was lower in women with high uric acid levels, a situation that was independent of maternal hypertension or BMI. Conclusion: Hypertension in pregnancy was associated with high maternal and neonatal morbidity. This study allowed identifies some weaknesses (e.i., lack of compliance in diagnosis criteria) as well as suggest the potential role of perinatal risk markers (e.i., uric acid levels).

Los niveles séricos de adenosin deaminasa y ácido úrico se correlacionan en pacientes gestantes con trastornos hipertensivos / Serum levels correlations of the enzyme adenosine deaminase (ADA) and uric acid in pregnant with hypertensive disorders

Objetivo: Evaluar los niveles séricos de la enzima adenosin-deaminasa (ADA) en pacientes gestantes normales y en pacientes con trastornos hipertensivos del embarazo, para determinar su relación con la gravedad del trastorno hipertensivo y con los niveles séricos de marcadores bioquímicos. Método: Se evaluaron pacientes con preeclampsia leve, preeclampsia grave, hipertensión gestacional y embarazadas sanas (n=10 por cada grupo). Se determinaron los niveles de ADA, ácido úrico, creatinina, amonio y enzimas hepáticas. Resultados: Se detectó una elevación en los niveles séricos de ADA en pacientes con preeclampsia y con hipertensión gestacional, en comparación con aquellas que cursaron con un embarazo normal. Los niveles ADA se correlacionaron positivamente con los niveles de ácido úrico y creatinina, más no con la severidad clínica. A su vez los niveles de ácido úrico se asociaron con la creatinina sérica y con la severidad clínica de los trastornos hipertensivos. Se encontró un incremento en los niveles de amonio en los pacientes con preeclampsia, el cual no se correlacionó con los otros marcadores bioquímicos, mientras que los niveles de TGO, TGP y LDH se encontraron significativamente elevados en la preeclampsia grave. Conclusión: Este estudio permite relacionar la actividad de ADA con los trastornos hipertensivos del embarazo, los niveles elevados de amonio con la preeclampsia y los niveles de ácido úrico, TGO, TGP y LDH con la severidad de los trastornos hipertensivos.

Objective: To evaluate serum levels of the enzyme adenosine deaminase (ADA) in normal pregnant and patients with hypertensive disorders induced by pregnancy, in order to determine their relationship with the severity of the hypertensive disorder and with serum biochemical markers. Method: We evaluated patients with mild preeclampsia, severe preeclampsia, gestational hypertension and healthy pregnancy (n=10 per group). We determined the serum levels of ADA, uric acid, creatinine, ammonia and liver enzymes. Results: In patients with preeclampsia and gestational hypertension we detected a rise in serum ADA as compared with those who had undergone a normal pregnancy. ADA levels were positively correlated with uric acid and creatinine serum levels, but not with clinical severity. Uric acid levels were associated with serum creatinine and the clinical severity of hypertensive disorders. We also found an increase in ammonia levels in patients with preeclampsia, which did not correlate with other biochemical markers, while the levels of SGOT, SGPT, and LDH were significantly elevated in severe preeclampsia. Conclusion: This study establishes a link between the activity of ADA with hypertensive disorders of pregnancy, high levels of ammonium with preeclampsia and uric acid, SGOT, SGPT and LDH levels with the severity of hypertensive disorders.

Cord blood leptin levels in normal pregnancies, pregnancy induced hypertension and gestational diabetes mellitus.

OBJECTIVE: To compare cord blood leptin concentrations between normal pregnancy, pregnancy induced hypertension (PIH), and gestational diabetes mellitus (GDM). DESIGN: Cross-sectional study. SETTING: Academic institutes and a tertiary care maternal hospital. METHOD: 48 newborns of normal pregnancies (N=18), pregnancy induced hypertension (N=16), and gestational diabetes mellitus (N=14) were studied. Cord blood samples were collected and newborn anthropometric indices recorded at delivery. Leptin concentrations were measured using an enzyme immunoassay. RESULTS: Cord blood leptin levels were significantly different between the 3 groups (Kruskal-Wallis ANOVA; P=0.0064), and the difference resulted mainly from higher levels in GDM than in PIH [geometric mean (95% CI) for GDM: 10.89 (6.30, 18.84) vs PIH: 3.49 (2.14, 5.69) ng/ml (Dunn's multiple comparison: P<0.01). This pattern persisted even when leptin levels were normalized to the ponderal index (Kruskal-Wallis ANOVA P=0.0035; Dunn's multiple comparison: P<0.01). Leptin levels significantly and positively correlated with the ponderal index in normal pregnancy (Spearman r=0.506, p<0.05) and with birth weight in PIH (r=0.5463, p<0.05). CONCLUSION: In GDM cord blood leptin levels are significantly higher, and a source other than fetal adipocytes appears to contribute to this.

Effect of pregnancy induced hypertension on mothers and their babies.

OBJECTIVE: To study the hematological profile of mothers with pregnancy induced hypertension and their infants. METHODS: The effects of maternal hypertension on the hematological profile of neonates were studied in 50 cases comparing the values with that of infants born to normotensive mothers. RESULTS: There was higher number of preterm, Intra-Uterine Growth Restriction (IUGR) and Small for Gestational Age (SGA) babies among the infants of hypertensive mothers. There was a significantly higher incidence of thrombocytopenia and nucleated RBCs seen in these babies. Significant neutropenia was not documented and there was no increased incidence of bleeding when compared to controls. CONCLUSION: Although there were significant changes in the hematological profile of infants born to hypertensive mothers, there was no significant increase in neonatal morbidity as a result of these changes.

Status of lipid peroxidation, glutathione, ascorbic acid, vitamin E and antioxidant enzymes in patients with pregnancy--induced hypertension.

The exact pro-oxidant and antioxidant status in pregnancy--induced hypertension patients is still not clear. To add a new insight to the question, changes in the erythrocyte lipid peroxidation products (malondialdehyde; MDA), levels of glutathione (GSH), ascorbic acid and plasma vitamin E (non enzymatic antioxidant parameters) and activities of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase in erythrocytes were studied in thirty five patients with pregnancy--induced hypertension and thirty five healthy pregnant normotensive cases. It was observed that there was a significant increase in erythrocyte MDA levels, activities of SOD, GPx and a significant decrease in erythrocyte GSH, ascorbic acid, plasma vitamin E levels and catalase activity in patients with pregnancy--induced hypertension when compared to controls. The results of our study have shown higher oxygen free radical production, evidenced by increased levels of MDA and decreased levels of GSH, ascorbic acid, vitamin E and Catalase activity supports the oxidative stress in pregnancy--induced hypertension. The increased activities of antioxidant enzymes may be a compensatory regulation in response to increased oxidative stress. The decreased concentrations of glutathione and antioxidant vitamin status supports the hypothesis that lipid peroxidation is an important causative factor in the pathogenesis of preeclampsia.

Platelet estimation: its prognostic value in pregnancy induced hypertension.

Thrombocytopenia is an associated phenomenon of Pregnancy induced hypertension (PIH). But the accurate count of platelets either by manual, (direct or indirect methods) or by automated cell counters is not feasible for all patients at all hospitals. Therefore we have adopted the method of platelet estimation, not platelet count as an alternate procedure to estimate the degree of thrombocytopenia in patients with PIH cases. We included 30 normal pregnant women and 90 pregnant women with varying degree of PIH. Blood platelets were estimated by an accepted manual method. Platelet numbers were found to be 2.38 lacs/mm3 +/- 0.33 in control group, 2.23 lacs/mm3 +/- 0.19 in mild PIH, 1.82 lakhs/mm3 +/- 0.45 in pre eclampsia and 1.21 lacs/mm3 +/- 0.49 in eclampsia. This indicated that there is an inverse relationship between the severity of PIH and platelet numbers. So this method of platelet estimation is useful as a rapid method of assessment in PIH. This method is not only rapid and cheap but can be done even in rural hospital settings.

Serum calcium level as a marker of pregnancy-induced hypertension

Regulation of intracellular calcium plays a key role in hypertension. Hypertension has been estimated to complicate 5% of all pregnancies and 11% of first pregnancies. Half of the pregnant women with hypertension have pre-eclampsia. Hypertensive disorders account for up to 40 000 maternal deaths annually. To compare total serum calcium levels in pregnant women complicated with pre-eclampsia with those in normotensive control. This is a case-control hospital based study carried out at Omdurman Maternity Hospital, Khartoum Teaching Hospital, and Khartoum North Teaching Hospital in Khartoum State, Sudan in the period from October 2006 to June 2007. One hundred thirty-five women were enrolled in this study. 90 women with pregnancy - induced hypertension [PIH] admitted after 20[th] week of pregnancy represented the study group. Forty five women with normal pregnancy, at same age; same gestational age were selected as control group. The mean [ +/- SD] serum calcium of the study group was 8.38 +/- 1.04 mg/dl, while that of the control group was 9.04 +/- 1.13mg/dl [P= 0.001]. Low level of maternal total calcium may have a role in the development PIH. Therefore calcium consumption in pregnancy should be encouraged. Calcium supplement is recommended for women who live in places of low socioeconomic status as well as for women who prefer to skip milk and milk products due to personal preference