Role of coagulation factor XII in unexplained recurrent abortions in the Greek population.

OBJECTIVE: To investigate the prevalence and clinical significance of congenital factor XII (FXII) deficiency in the South-European Caucasian (Greek) population in a cohort of women with recurrent spontaneous abortions (RSAs). STUDY DESIGN: One hundred women with a history of > or =2 RSAs of unexplained nature were compared to 100 age-matched, healthy controls with no history of thrombotic disease or adverse pregnancy outcomes, regarding FXII activity. Women were included in the RSA group if they had normal coagulation parameters and no congenital or acquired thrombophilia. RESULTS: Fifteen of 100 women with RSA had reduced FXII activity, whereas all controls had normal FXII activity. FXII activity was significantly lower in the RSA than in the control group (median 100.5, range 10-150 vs. median 104.2, range 58.3-143.2, p < 0.016 by Mann-Whitney test). FXII activity was positively correlated with age in both the RSA and the control groups (r = +0.1, p = 0.04 and r = +0.04, p = 0.2, respectively), but this correlation reached statistical significance in the RSA group only. A negative correlation between FXII activity and the number of abortions in the RSA group was found (r = -0.2, p = 0.03). CONCLUSION: Congenital FXII deficiency is strongly associated with RSA in the Greek population.

Antepartum and postpartum serum heme oxygenase-1 levels in preeclamptic and normotensive pregnant women.

AIM: To determine antepartum and postpartum serum heme oxygenase-1 (HO-1) levels in pre-eclamptic (PE) and normotensive pregnant women and to investigate the relationship between HO-1 levels and severity of PE. PATIENTS AND METHODS: Ten normotensive women were compared to 9 women with mild PE and 12 women with severe PE. Serum HO-1 levels were measured at 30-34 gestational weeks and 12-14 weeks postpartum. RESULTS: The severe PE group had significantly higher serum HO-1 levels antepartum compared to the mild PE and normotensive groups (5.50 ± 1.54 vs. 3.04 ± 0.72 ng/ml, p=0.0003, and 5.50 ± 1.54 vs. 3.12 ± 1.57 ng/ml, p=0.002, respectively). Serum HO-1 levels decreased significantly postpartum in the normotensive group only (3.12 ± 1.57 vs. 2.00 ± 0.97 ng/ml, p=0.0005). In the severe PE group, HO-1 levels antepartum were positively correlated to mean blood pressure (r=+0.79, p=0.004). CONCLUSION: Severe PE is associated with elevated serum HO-1 levels both antepartum and postpartum, suggesting a key role of chronic oxidative stress in the pathogenesis of PE and the endothelial dysfunction of these patients later in their life.

Maternal serum resistin concentrations in gestational diabetes mellitus and normal pregnancies.

AIM: To investigate changes in maternal serum resistin levels during pregnancy and postpartum and clarify their relationship to insulin resistance. METHODS: Thirty normal pregnant women were compared to 30 women diagnosed with gestational diabetes mellitus (GDM). Serum resistin levels were collected at the time of glucose challenge test (26-28 weeks), at 38 gestational weeks and at the third postpartum day and measured with enzyme immunoassay. Correlation of resistin to the homeostatic model assessment-insulin resistance (HOMA-IR) was performed. RESULTS: Maternal serum resistin levels at 38 weeks were significantly higher in pregnant women with GDM compared to the control group (0.28 vs 0.21 ng/mL, P = 0.02) and the same was true for the immediate puerperium (0.25 vs 0.19 ng/mL, P = 0.03). A significant increase in resistin levels was observed in GDM women from 26-28 weeks to 38 weeks (0.21 vs 0.28 ng/mL, P = 0.02), but not in controls. A decrease in serum resistin levels was noted in both the GDM and control groups, at 38 weeks and the immediate postpartum period, but this decrease did not reach statistical significance in either of the two groups. Resistin levels were positively correlated to HOMA-IR at 26-28 weeks of gestation (r = +0.253, P = 0.05). CONCLUSION: GDM is associated with increased resistin serum levels in term pregnancy as well as postpartum. Resistin is positively correlated to HOMA-IR at 26-28 weeks of gestation. A reduction in maternal resistin after delivery indicates a significant placental or fetal contribution in the production of resistin.

Serum adiponectin during pregnancy and postpartum in women with gestational diabetes and normal controls.

AIMS: To investigate changes in serum adiponectin during pregnancy and postpartum and assess its relationship with insulin resistance as measured by homeostasis model assessment (HOMA-IR). METHODS: Twenty-two normal pregnant women were compared with 22 women diagnosed with gestational diabetes mellitus (GDM). Serum adiponectin levels were measured at the time of the glucose challenge test as well as in the immediate postpartum period and the correlation of adiponectin to HOMA-IR was performed. RESULTS: Adiponectin was significantly lower in women with GDM than in controls during pregnancy (5381 vs. 8449 ng/dl, p = 0.004), as well as postpartum (3278 vs. 6958 ng/ml, p = 0.002). A significant reduction in adiponectin (3278 vs. 5381 ng/ml, p = 0.002) was observed postpartum in GDM women but not in controls. Using a lower cut-off value of 5253 ng/ml, maternal adiponectin could exclude GDM with a sensitivity of 86.4% and a specificity of 59.1% (area under the curve = 0.752, standard error = 0.77, 95% confidence interval 0.601-0.903, p = 0.004). Adiponectin levels during pregnancy were negatively correlated with HOMA-IR (r = -0.375, p = 0.012). CONCLUSION: GDM is associated with decreased serum adiponectin levels both in pregnancy as well as postpartum. Adiponectin is negatively correlated to HOMA-IR. A reduction in maternal adiponectin after delivery indicates a significant placental contribution to adiponectin production.

Randomized controlled trial comparing superovulation with letrozole versus recombinant follicle-stimulating hormone combined with intrauterine insemination for couples with unexplained infertility who had failed clomiphene citrate stimulation and intrauterine insemination.

OBJECTIVE: To compare the efficacy of letrozole to recombinant FSH for ovarian stimulation combined with IUI in a group of patients that had failed to conceive after clomiphene citrate (CC) and IUI. DESIGN: Prospective randomized trial with human subjects. SETTING: University-based fertility center. PATIENT(S): Fifty couples with unexplained infertility that failed to conceive after three cycles of CC combined to IUI. INTERVENTION(S): Couples were randomized to undergo superovulation either with letrozole or with recombinant FSH combined to IUI. MAIN OUTCOME MEASURE(S): Clinical pregnancy per cycle of treatment and clinical pregnancy per couple. RESULT(S): Pregnancy rate (PR) per cycle was 8.9% in the letrozole group as compared with 14% in the gonadotropin IUI group. This resulted in a cumulative PR per couple of 24% versus 36% and a take home baby rate of 20% versus 28%. Endometrial thickness was significantly lower in the letrozole group (7.1 +/- 2.3 vs 8.6 +/- 1.8). CONCLUSION(S): Ovarian stimulation with letrozole is associated with acceptable PRs compared with gonadotropin with significant less cost, risks, and patient inconvenience.