HLA-G polymorphism and in vitro fertilization failure in a Polish population.

To investigate whether human leukocyte antigen-G (HLA-G) gene polymorphism is associated with in vitro fertilization (IVF) failure, we sequenced exons 2-4 of the HLA-G gene in 50 couples with three or more IVFs (including 10 couples with five or more IVFs) and 58 control fertile couples from a Polish population. Of the 10 different HLA-G alleles identified in our study subjects, neither allele was found to be associated with IVF. We also genotyped 50 couples with IVF and 71 control couples for the -725C>G variant in the promoter region and the 14 bp insertion or deletion polymorphism in the 3' untranslated region of the HLA-G gene. The frequency of -725GG or GC genotype in women with IVF and in control fertile women was similar [26% vs 25.3%; odds ratio (OR) = 1.0; P = 1.0]. The 14 bp ins/ins or ins/del genotype was more common in women with IVF than in control women (76.9% vs 59.1%; OR 2.4; P = 0.03), but the difference was not significant after Bonferroni correction for multiple comparisons. The frequency of the ins/ins or ins/del genotype was particularly high (90%) in women who experienced five or more IVFs (OR = 6.2; P = 0.08), but again, the excess was not statistically significant, possibly because of small sample sizes. These results are in line with functional studies that show lower levels of HLA-G mRNA and protein related to the HLA-G allele including the 14 bp sequence and suggest that the insertion allele may be associated with an increased risk of IVF.

HLA-G polymorphism in a Polish population and reproductive failure.

To investigate whether human leukocyte antigen (HLA)-G gene polymorphism is associated with reproductive failure in a Polish population, we sequenced exons 2-4 of the HLA-G gene in 58 couples with three recurrent spontaneous abortions (RSAs) in the first trimester of pregnancy and 58 fertile control couples. We identified 12 different HLA-G alleles. Neither allele was found to be associated with an increased risk of RSA in the population. HLA-G allele sharing was similar in couples with RSA and in control fertile couples. All cases and controls were also genotyped for the -725C>G polymorphisms in the promoter region and the 14-bp insertion deletion in the 3' untranslated region of the HLA-G gene. The frequencies of both variants in RSA women and control fertile women were similar. These results suggest that HLA-G gene polymorphism does not influence the risk of RSA in the Polish population, but further studies are needed in this regard.

Soluble HLA-DR and soluble CD95 ligand levels in pregnant women with antiphospholipid syndromes.

Antiphospholipid syndrome (APS) is a severe complication in pregnancy that can lead to fetal death in the second or third trimester. As soluble HLA-DR (sHLA-DR) molecules are reported to be implicated in the etiology of pregnancy disorders and of autoimmune diseases, we studied sHLA-DR plasma levels in pregnant women with APS (n = 14) and in women with normal pregnancy (n = 15), in women with high-risk pregnancies such as preeclampsia (PE; n = 20) and intrauterine growth retardation (IUGR; n = 10) and in fertile non-pregnant women (n = 29). The sHLA-DR levels of pregnant women were assessed during the third trimester, at labor, in the first week, and in the third month of puerperium. The results obtained were compared with soluble CD95 ligand (sCD95L), an important signal molecule in the apoptosis pathway. The sHLA-DR levels in pregnant women with APS were approximately three times higher (mean 1.48 +/- 0.15 microg/ml) during the whole observation period than in fertile non-pregnant women (0.54 +/-.06 microg/ml) and nearly double in women with high risk (PE, 0.91 +/- 14 microg/ml; IUGR, 0.94 +/-.21 microg/ml) and in normal pregnancies (0.74 +/- 0.13 microg/ml). Furthermore, sHLA-DR levels of pregnant women with APS were positively correlated with the serum concentration of anti-anticardiolipin immunoglobulin G antibodies. For sCD95L plasma levels, no substantial variations were found among the different groups above. In pregnant women with APS, however, sHLA-DR levels were positively correlated with sCD95L levels. Further studies should clarify the functional involvement of sHLA-DR molecules in the induction of CD95/CD95L-mediated apoptosis pathway that may play a crucial role in the pathology of pregnancies complicated by APS.

[Violence towards pregnant women]. / Przemoc wobec kobiet w ciazy.

The aim of this work was the evaluation of the scale of violence towards pregnant women in the westpomeranian province, the definition of the social-biological profile of women exposed to violence and social-biological profile of their partners. The evaluation of the influence of violence on pregnant women's ending term and the weight of the newborns. 481 women were enrolled and an anonymous study was used in the form of questionnaires. A questionnaire was a modified form of a query-sheet proposed by WHO. 25% of the enrolled women were exposed to physical and psychological (emotional) abuse, 7.1% to psychical violence, women and men exposed to violence in their childhood more often become violent in their adult life. Men that physically abuse pregnant women are often of primary school education, are unemployed, drink alcohol and smoke. Physical abuse by a partner during pregnancy usually experience women with primary school education, who drink and smoke. Violence during pregnancy is usually associated with premature delivery as well as low birth weight of the newborns.

[Analysis of HLA class I and II antigens composition in high-risk pregnancy]. / Analiza wystepowania antygenów HLA klasy I i II w ciazy wysokiego ryzyka.

DESIGN: We have analyzed the frequency of HLA class I and II antigens in high-risk pregnancy. MATERIAL AND METHODS: Altogether, 22 gravida hospitalized at the Department of Pathology of Pregnancy and Labour, Pomeranian Medical University in Szczecin formed group I (PE) with 12 cases of preeclampsia and group II with 10 cases of the antiphospholipid syndrome (APS). The control group included 40 multigravida. Typing of HLA class I and II antigens was done using the two-stage microcytotoxic test (NIH) of Mittal. RESULTS: Antigen B35 was found more frequent in preeclampsia and antiphospholipid syndrome groups than in multigravida. Furthermore, a statistically significant difference in the frequency of homozygotes for the HLA-DR locus was noted between groups PE and APS on one hand, and controls on the other. CONCLUSIONS: Identical HLA-DR3, DR4 and DR5 antigens were found more frequently in preeclampsia, while identical DR4 and DR6 in the antiphospholipid syndrome.

[Antiphospholipid antibodies in high-risk pregnancy]. / Przeciwciala antyfosfolipidowe w ciazy wysokiego ryzyka.

UNLABELLED: Recently the connection of antiphospholipid antibodies (aPLs) presence with pregnancy loss and complications in pregnancy has been observed APLs related obstetric complications include: miscarriages after 10 weeks, IUGR, intrauterine foetal death, preeclampsia and severe preeclampsia. Our objective was to determine the aPLs prevalence in patients with recurrent pregnancy loss and/or complicated pregnancy. We examined 154 pregnant women aged 19-42 (average of 29.1) with recurrent pregnancy loss, current pregnancy complicated by preeclampsia and severe preeclampsia and/or IUGR, thrombotic episodes, thrombocytopenia or autoimmune disease. In all the patients anticardiolipin antibodies (aCL) were determined at least twice using ELISA and their coagulation system was tested including lupus anticoagulant (LA) test. In justified cases immunological examinations detecting connective tissue systemic diseases were conducted. Increased aCL titre was detected in 54 (34.4%) women. Statistically significant risk of increased aCL titre was observed in patients with autoimmunological diseases (RR = 4.3). Increased, but Statistically insignificant, risk of high aCL titre was observed in patients with venous thrombosis (RR = 2.45) as well as in patients with thrombocytopenia (RR = 2.45). LA prevailed significantly more often in patients with venous thrombosis episodes (RR = 6.33) and with autoimmunological diseases (RR = 17.4). Preterm deliveries were significantly more frequent in pregnant women with increased aCL titre and/or LA. Moreover, in this group foetal death and preterm stillbirth more often occurred. The above mentioned risks increased when aCL and LA coexisted. No relation between increased aPLs and miscarriage frequency was observed. CONCLUSIONS: 1) Increased aPLs titre prevail in multiparas with bad obstetrical anamnesis and with pathological course in present pregnancy, 2) increased aPLs titre prevail in patients with autoimmunological diseases, 3) increased aPLs titre are connected with pregnancy pathology manifested by frequent preterm deliveries and intrauterine foetal deaths.

Neuropathological changes within the brain of rabbits with experimental model of antiphospholipid syndrome in different time after immunization.

The post-mortem neuropathological investigations were carried out on 20 female New Zealand rabbits. Two main types of changes were found: inflammatory, including meningeal and perivascular infiltrates, and thrombotic within the nervous tissue. The findings revealed that active process within the CNS persists at least 3 months after APS was evoked, however its intensity, especially necrotic changes and vessel wall thickening evidently diminish. The active APS after experiment had been finished was also confirmed in blood samples.

[Respiratory distress syndrome in newborns of diabetic mothers in the years 1987-1998]. / Wystepowanie zaburzen oddychania u noworodków matek z cukrzyca w latach 1987-1998.

The aim of the study was to estimate which factors contribute to high frequency of RDS in our newborns of the diabetic mothers treated with intensive insulin therapy. The study material consisted of 574 newborns (394 from GDM and 180 from IDDM mothers) born in the years 1987-1998. In the analysed group there were compared: frequency of occurrence of RDS, severity of RDS as well as factors which can contribute to occurrence of RDS. That was found that, in the PGDM group prematurity, low Apgar score and delivery by caesarean section and in the GDM group--prematurity, low Apgar score and male sex are factors contributed the most to occurrence of RDS. That was also found that the risk of occurrence of RDS in the PGDM group was 5 to (transient tachypnoe) to 3 times (RDS) greater than in the GDM group. We conclude that PGDM and prematurity are factors the most connected with the occurrence of RDS in newborns born to diabetic mothers.

[Cord blood erythropoietin in relation to glycemic control in the last weeks of pregnancy]. / Stezenie erytropoetyny we krwi pepowinowej a stopien wyrównania gospodarki weglowodanowej w ostatnich tygodniach ciazy.

The relationship between cord blood erythropoietin (EPO) and maternal HbA1c and fructosamine levels were examined in the aim to answer a question, whether occurrence of prenatal hypoxia in newborns of diabetic mothers depends from maternal glycemic control during the last weeks of pregnancy. The study was performed in the group of 178 mothers and newborns divided into two groups: diabetic and control. The diabetic group consisted of 116 mothers (33 with IDDM and 83 with GDM) and newborns and the control group consisted of 62 healthy mothers and newborns. Maternal HbA1c (Micro Column Test BIORAD Prospecta) and fructosamine (Roche fructosamine Test) levels were estimated on the day of delivery. Cord blood to estimate EPO (radioimmunoassay) and fructosamine levels were drawing immediately after delivery the babies. The relationship between the study parameters were calculated on the basis of a covariance analysis test. In the diabetic group the significant positive correlation between EPO and maternal HbA1c and fructosamine levels was found as well as between EPO and fetal fructosamine levels. We conclude that higher levels of cord blood EPO are associated with poor maternal glycemic control during the last weeks of pregnancy.

[Cord blood insulin and erythropoietin levels in relation to the mode of delivery]. / Stezenie insuliny i erytropoetyny w krwi pepowinowej a sposób zakonczenia ciazy.

UNLABELLED: The aim of the study was evaluation, whether cord blood insulin (Ic) and erythropoietin (EPO) levels differ in accordance with mode of delivery: cesarean section (CS) or vaginal delivery (VD). MATERIAL AND METHODS: The study was performed in the diabetic group consisted of 148 newborns of diabetic mothers (NDM)--90 of them with GDM and 58 with IDDM as well as in the control group consisted of 100 newborns born to healthy mothers. 52.0% of NDM and 38.0% control subjects were delivered by cesarean section. The most frequent reason for performing CS in the diabetic group was fetal distress before labor and in the control group--fetal distress during labor. Cord blood Ic and EPO levels were compared in accordance with type of delivery: CS or VD. Into statistical analysis Mann-Whitney test was used. RESULTS: There were found that cord blood Ic and EPO levels in NDM born by CS are significantly higher than in those born by VD (Ic--38.2 +/- 41.5 versus 26.6 +/- 38.6 mIU/ml adequately and EPO--51.8 +/- 76.0 versus 26.8 +/- 29.9 mU/ml adequately). There were no such differences in the control group. CONCLUSIONS: 1. Fetal hyperinsulinemia in perinatal period is often connected with occurrence of indications for performing cesarean section in pregnant women with diabetes mellitus. 2. Cesarean section in diabetic pregnant women is often connected with previous fetal hypoxia.

Central nervous system involvement in pregnant rabbits with experimental model of antiphospholipid syndrome.

A postmortem neuropathological investigations were carried out on 23 female rabbits divided into 3 groups; pregnant animals with experimental antiphospholipid syndrome (APS), nonpregnant rabbits with antiphospholipid syndrome and nonpregnant animals without antiphospholipid syndrome. The aim of study was to analyze the CNS changes related to experimental model of APS in rabbits and to answer, whether pregnancy influences the intensity of CNS changes related to APS. The findings suggest that the experimental model of APS used in our study appeared to be effective in the development of the CNS involvement in rabbits. The extent thickening of CNS vessel wall is the most common feature of vasculopathy related to APS. In rabbits, pregnancy seems to be a factor facilitating the CNS damage related to APS.

[Estimated levels of fructosamine in venous blood of pregnant women and in cord blood]. / Wspólzaleznosc miedzy stezeniem fruktozaminy we krwi zylnej kobiet rodzacych oraz we krwi pepowinowej.

In the study there was estimated maternal (Fm) and cord blood (Fc) fructosamine levels in 151 diabetic (58 PGDM and 93 GDM) and 100 control subjects on the day of delivery. It was found that Fm and Fc levels in PGDM and GDM groups were significantly higher than in the control group. It was also found the significantly positive correlation between Fm and Fc levels in all study groups. It leads to the conclusion that pregnant diabetic women and their fetuses were hyperglycemic during the last 2 weeks of pregnancy. Our results indicate that on the basis of maternal fructosamine levels it is possible to apply on indirect estimation of metabolic status of the fetus.

Prevalence and forms of congenital anomalies in twins born in Pomeranian District during the period from 1.07.1997 to 31.12.1998. Polish Register of Congenital Anomalies.

The authors have analysed the frequency and structure of congenital anomalies in children born in the Pomeranian district in the period from 01.07.1997 to 31.12.1998. Among a total of 28.361 births in that area, 748 (2.64%) were affected by congenital anomalies. Among 28.361 births, 620 (2.18%) were from multiple pregnancies. 23 (3.71%) among births from multiple pregnancies were affected by congenital malformations. The prevalence rate of inborn anomalies in births from multiple pregnancy in our area were higher (3.71%) in comparison to births from singleton pregnancy (2.61%). It implies that children born from multiple pregnancy are at higher risk of developing congenital anomalies.

Placental alkaline phosphatase compared with human placental lactogen and oestriol in high-risk pregnancies.

Serum levels of placental alkaline phosphatase (PLAP), human placental lactogen (HPL) and oestriol (E3) were investigated in 33 women with high-risk pregnancies. In pregnancies complicated by intrauterine growth retardation (IUGR) low PLAP values were constantly recorded. HPL values showed a similar pattern while E3 levels were between normal mean and the lower limit of -2 SD. A clear differentiation between IUGR and pre-eclampsia was achieved by the simultaneous determination of PLAP and HPL. It is suggested that PLAP determinations may be more informative than E3 to detect placental insufficiency.