The Effects of Pregestational Overweight and Obesity on Maternal Lipidome in Pregnancy: Implications for Newborns' Characteristics.

Obesity is an important risk factor for the development of pregnancy complications. We investigated the effects of pregestational overweight and obesity on maternal lipidome during pregnancy and on newborns' characteristics. The study encompassed 131 pregnant women, 99 with pre-pregnancy body mass index (BMI) < 25 kg/m2 and 32 with BMI ≥ 25 kg/m2. Maternal lipid status parameters, plasma markers of cholesterol synthesis and absorption and sphingolipids were determined in each trimester. Data on neonatal height, weight and APGAR scores were assessed. The results showed a higher prevalence (p < 0.05) of pregnancy and childbirth complications among the participants with elevated pregestational BMI. Levels of total cholesterol, HDL-cholesterol (p < 0.05) and LDL-cholesterol (p < 0.01) were significantly lower, and concentrations of triglycerides were higher (p < 0.05) in women with increased pre-gestational BMI. Lower concentrations of the cholesterol synthesis marker, desmosterol, in the 2nd trimester (p < 0.01) and the cholesterol absorption marker, campesterol, in each trimester (p < 0.01, p < 0.05, p < 0.01, respectively) were also found in this group. Markers of maternal cholesterol synthesis were in positive correlation with neonatal APGAR scores in the group of mothers with healthy pre-pregnancy weight but in negative correlation in the overweight/obese group. Our results indicate that gestational adaptations of maternal lipidome depend on her pregestational nutritional status and that such changes may affect neonatal outcomes.

Cholesterol Metabolic Profiling of HDL in Women with Late-Onset Preeclampsia.

A specific feature of dyslipidemia in pregnancy is increased high-density lipoprotein (HDL) cholesterol concentration, which is probably associated with maternal endothelium protection. However, preeclampsia is most often associated with low HDL cholesterol, and the mechanisms behind this change are scarcely explored. We aimed to investigate changes in HDL metabolism in risky pregnancies and those complicated by late-onset preeclampsia. We analyze cholesterol synthesis (cholesterol precursors: desmosterol, 7-dehydrocholesterol, and lathosterol) and absorption markers (phytosterols: campesterol and ß-sitosterol) within HDL particles (NCSHDL), the activities of principal modulators of HDL cholesterol's content, and major HDL functional proteins levels in mid and late pregnancy. On the basis of the pregnancy outcome, participants were classified into the risk group (RG) (70 women) and the preeclampsia group (PG) (20 women). HDL cholesterol was lower in PG in the second trimester compared to RG (p < 0.05) and followed by lower levels of cholesterol absorption markers (p < 0.001 for campesterolHDL and p < 0.05 for ß-sitosterolHDL). Lowering of HDL cholesterol between trimesters in RG (p < 0.05) was accompanied by a decrease in HDL phytosterol content (p < 0.001), apolipoprotein A-I (apoA-I) concentration (p < 0.05), and paraoxonase 1 (PON1) (p < 0.001), lecithin-cholesterol acyltransferase (LCAT) (p < 0.05), and cholesterol ester transfer protein (CETP) activities (p < 0.05). These longitudinal changes were absent in PG. Development of late-onset preeclampsia is preceded by the appearance of lower HDL cholesterol and NCSHDL in the second trimester. We propose that reduced capacity for intestinal HDL synthesis, decreased LCAT activity, and impaired capacity for HDL-mediated cholesterol efflux could be the contributing mechanisms resulting in lower HDL cholesterol.

Effects of Gestational Diabetes Mellitus on Cholesterol Metabolism in Women with High-Risk Pregnancies: Possible Implications for Neonatal Outcome.

Metabolic disorders in pregnancy, particularly gestational diabetes mellitus (GDM), are associated with an increased risk for adverse pregnancy outcome and long-term cardiometabolic health of mother and child. This study analyzed changes of serum cholesterol synthesis and absorption markers during the course of high-risk pregnancies, with respect to the development of GDM. Possible associations of maternal lipid biomarkers with neonatal characteristics were also investigated. The study included 63 women with high risk for development of pregnancy complications. Size and proportions of small low-density (LDL) and high-density lipoprotein (HDL) particles were assessed across trimesters (T1−T3), as well as concentrations of cholesterol synthesis (lathosterol, desmosterol) and absorption markers (campesterol, ß-sitosterol). During the study, 15 women developed GDM, while 48 had no complications (non-GDM). As compared to the non-GDM group, women with GDM had significantly higher triglycerides in each trimester, while having a lower HDL-C level in T3. In addition, they had significantly lower levels of ß-sitosterol in T3 (p < 0.05). Cholesterol synthesis markers increased across trimesters in both groups. A decrease in serum ß-sitosterol levels during the course of pregnancies affected by GDM was observed. The prevalence of small-sized HDL decreased in non-GDM, while in the GDM group remained unchanged across trimesters. Newborn's size in the non-GDM group was significantly higher (p < 0.01) and inversely associated with proportions of both small, dense LDL and HDL particles (p < 0.05) in maternal plasma in T1. In conclusion, high-risk pregnancies affected by GDM are characterized by altered cholesterol absorption and HDL maturation. Advanced lipid testing may indicate disturbed lipid homeostasis in GDM.

Antioxidant status in hypertensive disorders of pregnancy.

OBJECTIVE: Pregnancy can be associated with maternal hypertension leading to possible complications in pregnancy outcome. Antioxidant status may be proned to changes during pregnancy with hypertension. The aim of our study was to estimate antioxidant status through high-risk pregnancies. METHODS: Seventy-nine pregnant women with high-risk for preeclampsia development were included and 46 of them developed some hypertensive disorder in pregnancy. Superoxide-dismutase (SOD) and paraoxonase 1 (PON1) activities and relative proportion of PON1 activiity on different HDL subclasses were determined in 1st, 2nd, and 3rd trimester and prior to delivery. RESULTS: SOD activity was significantly lower in 2nd and 3rd trimesters when compared to 1st trimester (P˂0.001) whereas PON1 activity was significantly higher in 3rd than in 1st trimester (P˂0.05) in group of hypertensive women. This group had significantly higher SOD and PON1 activities and relative proportion of PON1 on HDL3c subclasses in the 1st trimester, significantly increased PON1 in the 3rd trimester and prior to delivery and significantly higher PON1 activity on HDL3c subclasses (P˂0.05) than nonhypertensive group. In 1st trimester and prior to delivery, total PON1 activity and relative proportion of PON1 on HDL3c subclasses exhibited significant ability to mark out hypertension in pregnancy (P˂0.05). CONCLUSIONS: SOD activity decreased whereas total PON1 activity increased during pregnancy with hypertension. Pregnant women with hypertension had higher activities of PON1 and SOD and relative proportion of PON1 on HDL3c subclasses than nonhypertensive ones. PON1 activity and relative proportion of PON1 on HDL3c subclasses exhibited significant association with hypertension in pregnancy.

Cholesterol homeostasis is dysregulated in women with preeclampsia.

INTRODUCTION: The link between preeclampsia and dyslipidemia has been established. Even though lipid profile parameters have been intensively investigated in the pathology of preeclampsia, their accurate molecular mechanisms of action have not been fully decoded. OBJECTIVES: We aimed to identify the specifics of cholesterol metabolism in women affected by late-onset preeclampsia and single out potential biomarkers associated with late-onset syndrome. PATIENTS AND METHODS: A total of 90 pregnant women with a priori risk for preeclampsia were monitored at 4 time points during gestation and, based on the outcome of pregnancy, they were classified into the high-risk group (70 women) and the preeclampsia group (20 women). Cholesterol metabolic profiling was done using liquid chromatography-tandem mass spectrometry. RESULTS: The only significant change in the preeclampsia group was an increase in the lathosterol level (P = 0.001). The first-trimester lathosterol level was higher in the preeclampsia group compared with the high-risk group (P = 0.02). Further, in the preeclampsia group, positive correlations were found between desmosterol and ß-sitosterol (ρ = 0.474; P = 0.03) in the third trimester, desmosterol and campesterol changes between the second and the first (ρ = 0.546; P = 0.02), and the third and first trimesters (ρ = 0.754; P <⁠0.001), as well as between the desmosterol and ß-sitosterol differences between the third and first trimesters (ρ = 0.568; P = 0.01). No similar correlations were found in the high-risk group. CONCLUSIONS: Late-onset preeclampsia could be associated with an altered lipid profile. By studying the quantitative metabolic signatures of cholesterol, we might assume that both cholesterol synthesis and absorption are increased, that is, there is an imbalance in the cholesterol homeostasis regulation in women affected by the disease.

The role of resistin in early preeclampsia prediction.

Resistin might be involved with general inflammation and endothelial dysfunction observed in preeclampsia. We aimed to investigate longitudinal changes in resistin concentrations during high-risk pregnancies and evaluate their significance in preeclampsia development. Ninety-one patients were recruited at 11-14 weeks of gestation. They were followed towards the end of each trimester and before their deliveries. Of the 91 pregnant women, 21 developed preeclampsia, while 70 women did not develop preeclampsia despite being at risk. Compared to the 1st trimester, resistin concentration significantly increased during the 2nd trimester (p<.001). When women were divided into groups of those who developed preeclampsia and those who did not develop preeclampsia, we noticed a significant difference only in women who did not develop preeclampsia (p<.001). Moreover, resistin concentration in the 1st trimester was statistically higher in women who developed preeclampsia when compared to those who did not develop preeclampsia (p<.001). The analysis of the Receiver Operating Characteristics (ROC) curves indicated that inclusion of triglycerides (TG), high-sensitivity C-reactive protein (CRP), and resistin (AUC = 0.870) improved diagnostic accuracy of the basic model including demographic and clinical parameters (AUC = 0.777) for preeclampsia prediction (p<.05). If the concentration of resistin is high in the 1st trimester, such pregnancy at risk is likely to develop preeclampsia as a complication, indicating that resistin concentration in the 1st trimester might contribute to existing predictive and prognostic models for preeclampsia. A multi-marker model, possibly including also resistin and other clinical, metabolic, and inflammatory parameters, seems to be the best approach in late-onset preeclampsia prediction.

Use of FMF algorithm for prediction of preeclampsia in high risk pregnancies: a single center longitudinal study.

OBJECTIVE: This study aimed to assess the accuracy of The Fetal Medicine Foundation (FMF) screening algorithm for the prediction of preeclampsia.METHODS: Out of 138 women with high-risk pregnancies prospectively followed, 30 developed preeclampsia. The clinical examination and biochemical measurements were performed at first, second, early and late third trimester.RESULTS: A lower PAPP-A levels were found in the first trimester, while sFlt/PlGF was increased in the second and early third trimester in preeclampsia (p>0.05). FMF algorithm presented higher specificity (>70%), but had a drawback of lower sensitivity (35-77%).CONCLUSION: FMF algorithm had modest performance in the prediction of preeclampsia for high-risk pregnancies.

Unraveling the role of oxidative stress and lipid status parameters in the onset of preeclampsia.

OBJECTIVE: The aim of the study was to assess the potential role of oxidative stress and lipid status in the onset of preeclampsia.METHODS: 138 high-risk pregnant women were prospectively followed. Assessment of oxidative stress (TAS, TOS, AOPP and SH groups) and lipid status (t-C, LDL-C, HDL-C, TGC, APO-A1, APO-B) was carried out during the pregnancy.RESULTS: 30 women developed preeclampsia. TGC, atherogenic index of plasma, TAS and SH levels were higher in women who subsequently developed preeclampsia (p<0.05).CONCLUSION: Oxidative stress and lipid status disturbance have a potential role in the onset of preeclampsia in high risk pregnancies.

Case report of persistent elevation of ßhCG in a nonpregnant woman: A diagnostic puzzle.

Detectable serum levels of beta subunit of human chorionic gonadotropin (ßhCG) in nonpregnant, perimenopausal women bring confusion in both clinician and patient and could lead to unnecessary diagnostic and therapeutic procedures. A 45-year-old woman with the continuous elevation of ßhCG underwent hysteroscopy, two laparoscopic surgeries, two explorative uterine cavity curettages and three cycles of cytostatic therapy. No ultrasonographic, macroscopic or histological signs of pregnancy, both uterine and ectopic or gestational trophoblastic disease were found. Both radiographic and computed tomography reports ruled out the presence of a nongynecological neoplasm. All recommended steps were taken for confirmation or ruling out the possibility of heterophile antibodies interference, but the results were not absolute. Finally, the referent laboratory confirmed the presence of the antibodies, but their exact type remains unknown. This case underlines the importance of the universally accepted protocol in the cases of persistent ßhCG elevation in nonpregnant, perimenopausal women.

Usefulness of human epididymis protein 4 in predicting optimal cytoreductive therapy in patients with advanced ovarian cancer.

PURPOSE: Human Epididymis Protein 4 (HE4) is a novel promising serum biomarker of high sensitivity and specificity for ovarian cancer (OC). We investigated the usefulness of HE4 in predicting the outcome of surgery of advanced OC. METHODS: Fifty patients with OC (FIGO stage III and IV) entered the study. Serum concentrations of HE4 and CA125 were evaluated preoperatively. All patients had been operated between January 2014 - January 2016. RESULTS: Preoperatively, the mean concentration of HE4 was 628pmol/L. Optimal cytoreduction was achieved in 44% of the patients, accompanied with decline of the mean values to HE4 478pmol/L, while in patients with suboptimal cytoreduction these values were 756pmol/L (p<0.001). Optimal cytoreduction was achieved in 52.9% of the patients with ascites ≤1,000 ml and in 48% of those with ascites >1,000 ml (p=0.023). These patients had preoperative values of HE4 405 and 713pmol/L, respectively (p=0.001). Optimal debulking was achieved in those patients with positive lymph nodes and ascites >1000ml, whose preoperative values of HE4 and CA125 were <413pmol/L and <500U/ mL, respectively. Our results indicated that the significant predictor of optimal cytoreduction was the value of HE4≤413pmol/L. In patients whose preoperative values HE4 were ≥413pmol/L the optimal cytoreduction was less probable (odds ratio 4.921, p=0.021). CONCLUSION: Preoperative concentrations of HE4 can be of predictive value for the achievement of optimal debulking of OC. Additional research in larger populations is necessary to prove the ability of preoperative values of HE4 in helping answer the question of whether or not optimal cytoreduction would be achieved.

The influence of maternal smoking habits before pregnancy and antioxidative supplementation during pregnancy on oxidative stress status in a non-complicated pregnancy.

BACKGROUND: As a physiological condition closely linked with increased susceptibility to oxidative stress, pregnancy can be further compromised by cigarette smoking. Inadequate nutrition and reduced intake of antioxidants can also disrupt the prooxidant/antioxidant relationship and contribute to oxidative stress. Increased oxidative stress during pregnancy may be involved in several complications of pregnancy, such as preterm labor, fetal growth restriction, preeclampsia and miscarriage. OBJECTIVES: The aim of this study was to investigate the influence of maternal smoking habits before pregnancy on the parameters of oxidative stress and the antioxidative defense system, lipid profile parameters and paraoxonase-1 (PON1) activity during the third trimester of uncomplicated pregnancies. MATERIAL AND METHODS: Healthy pregnant women (n = 86) were divided into non-smoking and smoking groups, and into groups taking vitamin supplements and not taking them. Oxidative damage was measured through the levels of thiobarbituric acid-reacting substances (TBARS) and plasma antioxidant status was evaluated by measuring total antioxidant capacity (TAC). RESULTS: TBARS concetration was significantly higher (p < 0.05) and PON1 activity was significantly lower (p < 0.05) in the smokers' group. No significant differences were found in the investigated parameters in relation to vitamin supplement intake. CONCLUSIONS: Habitual smoking before pregnancy is associated with increased oxidative stress. Vitamin supplementation has no effect on the oxidative stress status of healthy pregnant women.

Changes in LDL and HDL subclasses in normal pregnancy and associations with birth weight, birth length and head circumference.

Pregnancy is associated with alterations in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses, but the exact pattern of these variations remains controversial. This study investigates longitudinal changes of plasma LDL and HDL particles distributions during the course of normal pregnancy, as well as associations of maternal LDL and HDL subclasses distributions before delivery with parameters of newborn size. Blood samples were collected from 41 healthy pregnant women throughout entire pregnancy, before delivery and 7 weeks postpartum. LDL and HDL subclasses were determined by gradient gel electrophoresis, while other biochemical parameters were measured by standard laboratory methods. During gestation LDL size significantly decreased (P < 0.001), due to reduction in relative proportion of LDL I (P < 0.01) and increase of LDL II (P < 0.001) and IIIA (P < 0.05) subclasses. In the same time, HDL size and proportions of HDL 2a particles significantly decreased (P < 0.001), with concomitant increase of HDL 3b and 3c subclasses (P < 0.05). Observed alterations were associated with changes in serum triglyceride levels. Rearrangement in LDL subclasses distribution during gestation was transient, while postpartum HDL subclasses distribution remained shifted toward smaller particles. Higher proportion of LDL IVB in maternal plasma before delivery was an independent predictor of smaller birth weights and lengths, while higher proportions of LDL IVB and HDL 2a subclasses were independent determinants of newborns' smaller head circumferences. Routine gestational and prenatal care in otherwise normal pregnancy could be complemented with evaluation of LDL and HDL particles distribution in order to ensure an adequate size of the newborn.

Association of the atherogenic index of plasma and oxidative stress status with weight gain during non-complicated pregnancy.

BACKGROUND: Pregnancy is a stressful condition linked with altered lipid profile, increased oxidative stress and increased inflammation processes. The purpose of the present study was to determine the associations between those alterations with increased weight gain during pregnancy. METHODS: The atherogenic index of plasma (AIP) and oxidative stress status parameters were determinated in 50 healthy and 172 pregnant women with non-complicated pregnancy. Pregnant women were divided in four groups according to body mass index (BMI) values (BMI quartiles). RESULTS: Oxidative stress parameters were significantly lower in the control group compared with all the pregnant women quartiles. Unexpectedly, differences in oxidative stress parameters between BMI quartiles groups were not significant. The antioxidant defence parameters remained quite similar in the different BMI quartiles. Weight gain and paraoxonase-1 (PON1) activities were independently associated with increased AIP while weight gain and triglyceride concentration were found to be significant predictors of PON1 activities. CONCLUSIONS: The results of our current study indicate the association of maternal weight gain during pregnancy and altered lipid profile, elevated oxidative stress and changed antioxidative capacity of PON1. Taken together all these facts indicate possible increased risk of cardiovascular disease (CVD) development in later life if the weight gain during pregnancy is excessive.

Longitudinal changes in PON1 activities, PON1 phenotype distribution and oxidative status throughout normal pregnancy.

The purpose of the present study was to determine changes in plasma paraoxonase-1 activity (an indicator of paraoxonase phenotype) throughout normal pregnancy and its relationship with maternal oxidative stress status. The frequencies of the paraoxonase-1 phenotype in the studied population were determined using a two-substrate (paraoxon/diazoxon) activity method. As a parameter of oxidative stress status we measured the redox balance. Paraoxonase-1 activity significantly decreased at gestational week 32. In addition, the lipid profile was more atherogenic. Redox balance was significantly increased across gestational weeks. There were independent direct associations between maternal smoking habits before pregnancy, glucose concentrations and redox balance with PON1 activity in the third trimester. This study shows that pregnancy is followed by a decrease in PON1 activity and increased risk for development of cardiovascular diseases. We conclude that changes in paraoxonase-1 status during pregnancy are associated with maternal oxidative stress status and smoking habits.

[Tumor marker CA-125 in adnexal inflammatory tumors].

BACKGROUND/AIM: The glycoprotein of a high molecular weight CA-125, which is not a specific tumor marker of ovarian cancer, is secreted by the endothelial cells of most pelvic organs. Endometriosis, inflammatory processes in the pelvic cavity, as well as some nongynecoligical malignant diseases, could be followed by the increased values of CA-125. Serial assessment of the values of CA-125 makes it possible to avoid surgical treatment, and, by means of the used conservative treatment, to avoid malignant diseases not to be noticed. METHODS: The study included 57 female patients hospitalized due to inflammable adnexal tumors. Besides following the values of serum CA-125 during and after the therapy, also performed were the transvaginal Doppler ultrasonography and the determination of the values of resistance index (RI). RESULTS: In 27 patients (55.1%) the CA-125 values ranged from 38.8 U/ml to 794 U/ml, while in 30 of the patients they were within the range of normal. In this group of the patients, besides the increased values of CA-125, also increased were the values of leucocytes (11(9)/1-20(9)/1), as well as the sedimentation rates (65-120) within the first hour. In all the 57 patients, transvaginal Doppler ultrasonography revealed the presence of adnexal tumor of inflammatory kind. The measured values of RI were within the range of 0.539-0.681. Eight of the patients were treated by the conservative--triple antibiotic therapy, while in 49 patients explorative laparotomy was performed. Hystorectomy was done in 12 of the patients, and one-side adnexectomy in 37 of them. CONCLUSION: The method for the assessment of CA-125 is simple and available which facilitates the monitoring of surgical, conservative or the combined therapy that is particularly significant in younger patients with inflammable adnexal tumor developed on the basis of endometrosis.