[Metabolic syndrome after pregnancy complicated with gestational diabetes: four-year follow-up]. / Metabolikus szindróma gesztációs diabéteszt követôen: négyéves utánkövetés.

Although clustering of cardiovascular risk factors is unquestionable, the importance of the "metabolic syndrome" as a distinct cardiovascular risk marker has been debated recently. In the authors' previous report a high frequency of glucose intolerance was described 8 years after a pregnancy complicated by gestational diabetes, often associated with other unfavorable metabolic parameters. In the present study the objective was to estimate the prevalence of metabolic syndrome in a cohort of previously gestational diabetes women, using different diagnostic criteria, 4 years after delivery. Those data were compared to a control group of 39 women with normal glucose tolerance during pregnancy. Irrespective of the criteria used, metabolic syndrome was found more frequently among women with prior gestational diabetes. The prevalence of metabolic syndrome increased by degree of deterioration of glucose tolerance in the prior gestational diabetes group. Overweight women in both group had 10-fold increased risk of metabolic syndrome compared to normal-weight women. According to our results a clustering of cardiovascular risk factors might be observed in previous gestational diabetes women, 4 yrs after delivery. These data highlight the importance of regular follow-up of these women, and the possible advantage of early and aggressive treatment of each component of metabolic syndrome.

Lipid, haemostatic and inflammatory variables in relation to the estrogen receptor alpha (ESR1) PvuII and XbaI gene polymorphisms.

BACKGROUND: Estrogen is known to affect lipoprotein metabolism, the haemostatic system and inflammatory markers. Our aim was to determine whether estrogen receptor alpha (ESR1) PvuII and XbaI gene polymorphisms can influence lipid, haemostatic and inflammatory variables in healthy Caucasian women and men of reproductive age. METHODS: 58 healthy women (aged between 18 and 45 years) and 55 healthy men (aged between 21 and 45 years) of reproductive age were enrolled in our study. FSH levels, lipid (total cholesterol, triglyceride, HDL cholesterol, lipoprotein(a), apo A-I, apo B), haemostatic (prothrombin time, activated partial thromboplastin time (aPTT), thrombin time, fibrinogen, factor V, VII, VIII, protein C, protein S, antithrombin III) and inflammatory (CRP) variables were measured on autoanalyzers using commercially available kits. Serum VLDL and LDL cholesterol concentrations were calculated with the equation of Friedewald. The ESR1 PvuII and XbaI genotypes were determined with PCR-RFLP method. RESULTS: In the total group, the ESR1 XbaI GG genotype carriers had significantly higher serum lipoprotein(a) concentrations than the AA or AG genotype carriers. Serum total cholesterol concentrations were significantly higher in healthy women with the PvuII CC genotype than in those with the TT or TC genotypes, whereas healthy women with the GG genotype of the ESR1 XbaI polymorphism had significantly higher serum total cholesterol and LDL cholesterol levels compared to those with the AA or AG genotypes. No other effects of the ESR1 PvuII and XbaI polymorphisms were found on the investigated lipid, haemostatic and inflammatory variables either in the total group or in women and men separately. CONCLUSIONS: The ESR1 PvuII and XbaI gene polymorphisms seem to affect lipoprotein metabolism in healthy subjects of peak reproductive age. However, further studies are needed to determine the molecular mechanisms by which the two polymorphisms could influence serum lipid levels.

Serum heat shock protein 70 levels are decreased in normal human pregnancy.

Heat shock proteins (Hsps) are primarily known to be intracellular proteins with molecular chaperone and cytoprotective functions. However, Hsp60 and Hsp70 have been found in the serum and plasma of healthy non-pregnant individuals. We aimed to compare serum Hsp70 concentrations in healthy pregnant women with those of healthy non-pregnant women and to determine factors influencing serum Hsp70 levels in normal pregnancy. One hundred and seventy six healthy pregnant women with uncomplicated pregnancies (age, 17-44 years; gestational age, 20-41 weeks) and 81 healthy, age-matched non-pregnant women (age, 22-40 years) were enrolled in this cross-sectional study. Serum Hsp70 concentrations were measured using an enzyme-linked immunosorbent assay, and were significantly lower in healthy pregnant women than in healthy non-pregnant women (median (25-75 percentile): 0.29 (0.20-0.35)ng/ml versus 1.27 (0.86-1.72)ng/ml; p<0.001). In healthy pregnant women, there was a statistically significant negative correlation between maternal age and serum Hsp70 concentration (Spearman R=-0.35; p<0.001) and a significant positive correlation between gestational age and serum Hsp70 level (Spearman R=0.35; p<0.001). The capacity of extracellular Hsp70 to elicit innate and adaptive proinflammatory immune responses might be harmful in pregnancy and lead to immune rejection of the fetal semi-allograft. We hypothesize that decreased circulating Hsp70 levels are due to unknown regulatory mechanisms aimed at maintaining immune tolerance in pregnancy. In conclusion, serum Hsp70 concentrations are decreased in normal human pregnancy; however, further studies are needed to explain the observed differences between pregnant and non-pregnant women.

Intrauterine intestinal obstruction due to fetal midgut volvulus: a report of two cases.

Fetal midgut volvulus is quite rare, and few surviving infants--particularly cases with meconium peritonitis--have been reported in the literature. We report two cases of intrauterine intestinal obstruction due to fetal midgut volvulus associated with intestinal malrotation. In both cases, the infant survived after cesarean section delivery and appropriate surgical intervention, and they both continue to be in good overall condition. We discuss the prenatal signs and outcome of in utero intestinal volvulus. Close prenatal follow-up and appropriate timing of delivery in cases where ultrasound examination shows signs of fetal intestinal obstruction, as well as optimal postnatal treatment, are essential to reduce the morbidity and mortality associated with fetal midgut volvulus.

Association of increased serum heat shock protein 70 and C-reactive protein concentrations and decreased serum alpha(2)-HS glycoprotein concentration with the syndrome of hemolysis, elevated liver enzymes, and low platelet count.

The primary aim of this study was to determine serum Hsp70 concentrations in HELLP syndrome. We measured also the serum concentrations of three acute phase proteins: C-reactive protein (CRP), alpha(2)-macroglobulin (AMG) and alpha(2)-HS glycoprotein (AHSG). Ten severe preeclamptic patients with HELLP syndrome, 20 severe preeclamptic patients without HELLP syndrome and 20 normotensive, healthy pregnant women were included in this case-control study. Serum concentrations of Hsp70, CRP, AMG and AHSG were measured using an enzyme-linked immunosorbent assay (Hsp70), particle-enhanced immunoturbidimetric assay (CRP) and radial immunodiffusion (AMG, AHSG). The serum Hsp70 and CRP concentrations were significantly higher, whereas the serum AHSG concentration was significantly lower in the HELLP group (H) than the severe preeclamptic (P) and control (C) groups (median (25-75 percentile); Hsp70: 2.02 ng/ml (0.76-2.23) (H) versus 0.54 ng/ml (0.47-0.79) (P), p<0.01, and 0.30 ng/ml (0.27-0.33) (C), p<0.001; CRP: 43.9 mg/l (27.1-84.5) (H) versus 6.5 mg/l (2.7-10.7) (P), p<0.001, and 2.5 mg/l (1.1-6.7) (C), p<0.001; AHSG: 588 microg/ml (492-660) (H) versus 654 microg/ml (576-768) (P), p<0.05, and 738 microg/ml (666-804) (C), p<0.01, respectively). The serum AMG concentration did not differ between the study groups. In the HELLP group, there was a statistically significant negative correlation between serum Hsp70 concentration and platelet count (Spearman R=-0.69, p=0.026). In conclusion, serum Hsp70 and CRP concentrations are increased, whereas serum AHSG concentration is decreased, in HELLP syndrome. The maternal systemic inflammation seems to be more pronounced in HELLP syndrome than preeclampsia without HELLP syndrome, as suggested by the alterations in serum CRP and AHSG levels. However, it requires further investigation to determine whether these changes are causes or consequences of the disease.