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Shenhav S, Harel I, Solt I, Shenhav A, Fytlovich S, Aharoni D, Rimler A, Anteby EY, Ovadia YS. Fetoplacental unit involvement in uric acid production in women with severe preeclampsia: a prospective case control pilot study. J Matern Fetal Neonatal Med 2024; 37:2399304. [PMID: 39287009 DOI: 10.1080/14767058.2024.2399304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 08/08/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE Preeclampsia (PE) is a common complication of pregnancy that carries significant risks for both the mother and the fetus, and is frequently accompanied by hyperuricemia, yet the exact source of elevated uric acid (UA) levels remains partially elucidated. Several potential origins for increased UA levels include abnormal renal function, increased tissue breakdown, and increased activity of the enzyme Xanthine Oxidase (XO). The aim of the study was to determine serum levels of UA and XO not only in maternal serum, but also in umbilical vein (UV) and umbilical artery (UA) and explore their possible role in PE development. METHODS A prospective case-control pilot study was conducted in women who were found positive for PE with severe features, and had elevated UA levels above 6 mg/dL, with normotensive pregnant women serving as controls. Renal function, UA and XO levels were measured in maternal, UV and UA serums immediately after delivery. They were then compared between PE (n = 21) and control (n = 18) groups, as well as across all mediums (maternal, UV and UA) among the total study sample (N = 39). Diastolic blood pressure (DBP) was also measured immediately following delivery. RESULTS The mean serum maternal creatinine levels did not differ significantly between groups (0.65 ± 0.03 vs 0.6 ± 0.07, p = 0.13). Both mean maternal serum UA and XO concentrations were higher in PE group than in control (7.3 ± 1.2 vs 4.2 ± 0.9, p < 0.01 and 3.6 ± 3.5 Vs 1.7 ± 0.8, p < 0.01, respectively). The mean UV and UA serum XO concentrations were significantly higher in PE group compared to control (4.2 ± 3.6 vs 2.2 ± 1.4, p < 0.01 and 4.2 ± 3.6 vs 2.1 ± 1.5, p < 0.01, respectively). Polynomial fit correlation test demonstrated a significant association between maternal DBP and UV XO concentration for all the total study participants (p = 0.03). CONCLUSION Despite preserved renal functions, UA and XO levels were elevated in women with PE. Importantly, this pattern was found to be applied to the feto-placental unit as well, which may indicate an active involvement of the fetus in the hypoxic process. Further study is needed to clarify the possible role of the feto-placental unit in pregnancies complicated by PE.
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Affiliation(s)
- Simon Shenhav
- Obstetrics and Gynecology Division, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Ashkelon, Israel
| | - Iris Harel
- Obstetrics and Gynecology Division, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
| | - Ido Solt
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Amit Shenhav
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Shlomo Fytlovich
- Laboratory of Clinical Biochemistry, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
| | - Dorit Aharoni
- Laboratory of Clinical Biochemistry, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
| | - Avi Rimler
- Laboratory of Clinical Biochemistry, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
| | - Eyal Y Anteby
- Obstetrics and Gynecology Division, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Ashkelon, Israel
| | - Yaniv S Ovadia
- Obstetrics and Gynecology Division, Barzilai University Medical Center Ashkelon, Ashkelon, Israel
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Gong Z, Zhang L, Shi Y. The potential role of uric acid in women with polycystic ovary syndrome. Gynecol Endocrinol 2024; 40:2323725. [PMID: 39718393 DOI: 10.1080/09513590.2024.2323725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 12/25/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age and is associated with a variety of multi-system complications. The prevailing treatment strategy for PCOS is to individualize the interventions based on individual symptoms and patient complaints. However, optimal efficacy in treatment necessitates a focus on addressing the underlying pathogenic mechanisms. Uric acid (UA), the end product of purine metabolism, has been suggested to be involved in the development of several diseases, including PCOS. However, the precise mechanisms by which UA may affect PCOS remain incompletely understood. This literature review aims to investigate the correlation between UA and the various clinical presentations of PCOS, such as hyperandrogenism, insulin resistance (IR), ovulation disorders, obesity, and other related manifestations, through the analysis of epidemiological and clinical studies. The purpose of this study is to improve our comprehension of how UA contributes to each aspect of PCOS and their interrelationship, thus identifying the potential role of UA as a facilitator of PCOS. Furthermore, we explore potential pathways linking UA and PCOS, and propose therapeutic interventions based on these findings to optimize the management of this condition.
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Affiliation(s)
- Zhentao Gong
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Medical College of Fudan University, Shanghai, China
| | - Lingshan Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yingli Shi
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Medical College of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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Li H, Wang Y, Zhang Q, Huang X, Tang Z, Liu Z. The association of maternal serum uric acid with the risk of small for gestational age newborn: a retrospective cohort study. J Matern Fetal Neonatal Med 2023; 36:2286738. [PMID: 38083844 DOI: 10.1080/14767058.2023.2286738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
PROBLEM Prior results on the association between serum uric acid (UA) levels in the early trimester and the risk of small for gestational age (SGA) remain unclear. This study evaluated the association of maternal first-, second-, and third-trimester UA levels with the risk of SGA infants. METHOD OF STUDY A total of 23, 194 singleton mothers from the International Peace Maternity and Child Health Hospital between January 2014 and January 2017 were included. Maternal UA levels were measured at 12.1 ± 1.08th (UA1) and 32.2 ± 1.03th (UA2) gestational weeks. △UA was calculated as the difference between UA2 and UA1. Logistic regression and restricted cubic spline (RCS) were performed to evaluate the association between maternal UA and △UA during pregnancy and SGA. Receiver operating characteristic (ROC) analysis was employed to assess the serum uric acid prediction value. RESULTS Women in the higher quartiles of UA1 had a significantly higher risk of SGA. A clear increased risk for SGA was observed with higher quartiles for UA2 (p for trend <0.05). An approximately "J-shaped" relationship was observed between UA2 and △UA, and the risk of SGA was observed. When compared with those with a lower level of UA in the first trimester, those with a higher level of UA1, the more increase in the later UA levels were associated with a higher risk of SGA [adjusted odds ratio (aOR) = 1.67, 95% CI:1.37-2.05]. The ROC curve areas were 0.525 for UA1, 0.582 for UA2 and 0.576 for △UA. CONCLUSIONS The findings suggested that non-preeclamptic and non-hypertensive women who experienced early pregnancy with high UA levels had an elevated risk of SGA. Moreover, a high maternal UA level in the earlier trimester may be an early predictor of SGA.
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Affiliation(s)
- Haiyuan Li
- Department of Neonatology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yi Wang
- Department of Neonatology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Qianqian Zhang
- Department of Neonatology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Xiaoyi Huang
- Department of Neonatology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Zheng Tang
- Department of Neonatology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Zhiwei Liu
- Department of Neonatology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
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Su S, Zhang E, Gao S, Zhang Y, Liu J, Xie S, Yue W, Liu R, Yin C. Serum uric acid and the risk of gestational diabetes mellitus: a systematic review and meta-analysis. Gynecol Endocrinol 2023; 39:2231101. [PMID: 37406646 DOI: 10.1080/09513590.2023.2231101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS Serum uric acid (SUA) is considered as a risk factor for gestational diabetes mellitus (GDM). However, current studies showed inconsistent results. This study aimed to explore the relationship between SUA levels and GDM risk. METHODS Eligible studies were retrieved from PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and Wanfang databases up to November 1, 2022. The pooled standardized mean difference (SMD) and 95% confidence interval (CI) were used to represent the difference in SUA levels between GDM women and controls. The combined odds ratios (OR) and 95% CI were applied to assess association between SUA levels and GDM risk. Subgroup analyses were conducted on study continents, design, and quality, detection time of SUA, and GDM diagnostic criteria. RESULTS Totally 11 studies including five case-control and six cohort studies, in which 80,387 pregnant women with 9815 GDM were included. The overall meta-analysis showed that the mean SUA level in GDM group was significantly higher than in controls (SMD = 0.423, 95%CI = 0.019-0.826, p = .040, I2 = 93%). Notably, pregnant women with elevated levels of SUA had a significantly increased risk of GDM (OR = 1.670, 95%CI = 1.184-2.356, p = .0035, I2 = 95%). Furthermore, subgroup analysis performed on the detection time of SUA showed a significant difference in the association between SUA and GDM risk within different trimesters (1st trimester: OR = 3.978, 95%CI = 2.177-7.268; 1st to 2nd trimester: OR = 1.340, 95%CI = 1.078-1.667; p between subgroups <.01). CONCLUSIONS Elevated SUA was positively associated with GDM risk, particularly in the 1st trimester of pregnancy. Further studies with high quality are required to validate the findings of this study.
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Affiliation(s)
- Shaofei Su
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Enjie Zhang
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Shen Gao
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Yue Zhang
- Department of Research Management, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Jianhui Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Shuanghua Xie
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Wentao Yue
- Department of Research Management, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Ruixia Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Chenghong Yin
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
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Corominas AI, Medina Y, Balconi S, Casale R, Farina M, Martínez N, Damiano AE. Assessing the Role of Uric Acid as a Predictor of Preeclampsia. Front Physiol 2022; 12:785219. [PMID: 35095555 PMCID: PMC8794766 DOI: 10.3389/fphys.2021.785219] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/13/2021] [Indexed: 12/31/2022] Open
Abstract
We assessed the diagnostic utility of uric acid for the prediction of preeclampsia. An observational prospective approach was carried out during 2014. Preeclamptic women were classified into 4 groups accordingly to the onset of preeclampsia and the presence of intrauterine growth restriction (IUGR). Serum uric acid levels, urea, and creatinine were measured. Receiver operating curves (ROC) of the uric acid levels ratio (UAr) between a dosage before and after the 20th week of gestation were performed. One thousand two hundred and ninety-third pregnant women were enrolled in this study. Eight hundred ten had non-complicated pregnancies, 40 preeclampsia, 33 gestational hypertension, and 20 IUGR without preeclampsia. Uric acid significantly raised after 20 weeks of gestation in women who develop preeclampsia before 34 weeks (Group A) or in those who develop preeclampsia after 37 weeks associated with IUGR (Group C). In women who develop preeclampsia after 34 weeks without IUGR (Groups B and D), uric acid increased after the 30th week of gestation. In all groups, UAr was greater than 1.5. In gestational hypertension, UAr was superior to 1.5 toward the end of gestation, while in IUGR without preeclampsia, the behavior of serum uric acid was similar to non-complicated pregnancies. In all cases, urea and creatinine showed normal values, confirming that patients had no renal compromise. ROC area was 0.918 [95% confidence interval (CI): 0.858–0.979) for the preeclampsia group and 0.955 (95% CI: 0.908–1.000) for Group A. UAr at a cut-off point ≥1.5 had a very low positive predictive value, but a high negative predictive value of 99.5% for preeclampsia and it reached 100% for Group A. Thus, a UAr less than 1.5 may be a helpful parameter with a strong exclusion value and high sensitivity for those women who are not expected to develop preeclampsia. Additionally, this low-cost test would allow for better use of resources in developing countries.
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Affiliation(s)
- Ana I. Corominas
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Yollyseth Medina
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Silvia Balconi
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Roberto Casale
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Mariana Farina
- Laboratorio de Fisiopatología Placentaria, Centro de Estudios Farmacológicos y Botánicos (CEFyBO) - CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nora Martínez
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alicia E. Damiano
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Departamento de Ciencias Biológicas, Cátedra de Biología Celular y Molecular, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
- *Correspondence: Alicia E. Damiano,
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Hu J, Xu W, Yang H, Mu L. Uric acid participating in female reproductive disorders: a review. Reprod Biol Endocrinol 2021; 19:65. [PMID: 33906696 PMCID: PMC8077923 DOI: 10.1186/s12958-021-00748-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/18/2021] [Indexed: 12/21/2022] Open
Abstract
Uric acid (UA) is the end metabolic product of purine metabolism. Early on, UA was considered to be a metabolite with a certain antioxidant capacity. As research has progressed, other properties of UA have been explored, and its association with many diseases has been found. The association between UA and kidney disease and cardiovascular disease is well established; however, there is still a paucity of reviews on the association between UA and the female reproductive system. An increasing number of epidemiological studies have shown elevated serum UA levels in patients with polycystic ovary syndrome (PCOS), endometriosis, etc. Additionally, serum UA can be used as a predictor of pregnancy complications and adverse foetal outcomes. An increasing number of animal experiments and clinical studies have revealed possible mechanisms related to the involvement of UA in certain female reproductive disorders: oxidative stress, chronic inflammation, mitochondrial dysfunction, etc. This article reviews the current mainstream mechanisms regarding the pathogenesis of UA and the role of UA in certain specific female reproductive disorders (direct involvement in the development of certain diseases or enhancement of other risk factors) in the hope of contributing to clinical prevention, diagnosis, treatment and improvement in prognosis.
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Affiliation(s)
- Junhao Hu
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, No.96 Fuxue Road, 325000, Wenzhou, People's Republic of China
| | - Wenyi Xu
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, No.96 Fuxue Road, 325000, Wenzhou, People's Republic of China
| | - Haiyan Yang
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, No.96 Fuxue Road, 325000, Wenzhou, People's Republic of China.
| | - Liangshan Mu
- School of Medicine, Zhejiang University, No.866 Yuhantang Road, 310058, Hangzhou, People's Republic of China.
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Medjedovic E, Suljevic A, Iglica A, Rama A, Mahmutbegovic E, Muftic A, Dzihic E. Uric Acid Values Along with Doppler Sonography Findings as a Tool for Preeclampsia Screening. Med Arch 2020; 73:408-411. [PMID: 32082010 PMCID: PMC7007614 DOI: 10.5455/medarh.2019.73.408-411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Preeclampsia is defined as hypertension (systolic pressure ≥140 mmHg or diastolic pressure ≥90 mmHg) after week 20 of gestation with one or more of the following symptoms: proteinuria, organ dysfunction (including renal, hepatologic, hematologic or neurological complications) and in case of stagnation of fetal development. So far, there are no valid clinical tools or tests that can tell with sufficient sensitivity and specificity in early pregnancy which pregnant woman will develop preeclampsia or have unwanted outcomes. Aim To present the properties of biochemical parameter, uric acid, in patients with signs of preclampsia, which was confirmed by Doppler sonography. Methods The study included 60 female subjects in the second trimester of pregnancy who were examined or were hospitalized at the Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo. Pregnant women who had normal Doppler sonography scan of the uterine arteries in the second trimester of pregnancy were included in the control group, while pregnant women with pathologic Doppler sonographic findings in the second trimester of pregnancy were included in the group of pregnant women at risk of preeclampsia, i.e. the study group. Results There is statistically significant difference between the average value of uric acid in the control and in the study group (213.36 ± 28.96 μmol / L vs 249.73 ± 47.06 μmol / L) (F = 12.991; p = 0.001). Applying the Wilcoxon non-parametric paired test to the average uric acid values during all measurements within the control group, no statistically significant difference was found. There was a statistically significant increase in the study group between all measurements, from 18.04 μmol / L between the first and second measurement (Z = -1.955; p = 0.043), 29.10 μmol / L between the second and third measurement (Z = -2.973; p = 0.003), 37.27 μmol / L between the third and fourth measurement (Z = -4.325; p = 0.001) and 109.87 μmol / L at the end of the study in comparison to values from the start of the study (Z = -4.309; p = 0.001). Conclusion Uric acid values should become part of a broad biochemical range in screening and optimizing the treatment of patients diagnosed with early preeclampsia.
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Affiliation(s)
- Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo Bosnia and Herzegovina
| | - Alma Suljevic
- Department of Gynecology and Obstetrics, General Hospital, Konjic, Bosnia and Herzegovina
| | - Amer Iglica
- Intensive Care Unit, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Admir Rama
- Bahceci IVF Center, Sarajevo, Bosnia and Herzegovina
| | - Emir Mahmutbegovic
- Department of Gynecology, Health Care Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amela Muftic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo Bosnia and Herzegovina
| | - Ema Dzihic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo Bosnia and Herzegovina.,Department of Gynecology and Obstetrics, General Hospital, Konjic, Bosnia and Herzegovina.,Intensive Care Unit, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Bahceci IVF Center, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, Health Care Center Sarajevo, Sarajevo, Bosnia and Herzegovina
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Pieczyńska J, Płaczkowska S, Sozański R, Orywal K, Mroczko B, Grajeta H. Is maternal dietary selenium intake related to antioxidant status and the occurrence of pregnancy complications? J Trace Elem Med Biol 2019; 54:110-117. [PMID: 31109600 DOI: 10.1016/j.jtemb.2019.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/02/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
Selenium (Se) is a trace element essential for the appropriate course of vital processes in the human body. It is also a constituent of the active center of glutathione peroxidase and other antioxidant compounds which play an important role in red-ox processes. Associations between lower blood selenium concentration and obstetric complications has been reported in many studies. The aim of this study was to determine the dietary selenium intake and serum selenium content in pregnant Polish women and relate this to antioxidant status as whole blood glutathione peroxidase (GPX) activity, serum uric acid (UA) content and serum total antioxidant status (TAS) and pregnancy complications occurrence. Ninety-four pregnant women at a mean age 30.6 ± 5.4 years from the Lower Silesia region of Poland were recruited to the study, 37% of studied group had pregnancy complications. The mean reported Se intake and serum selenium content for Polish pregnant women was in the first trimester - 53.99 μg/day and 44.36 μg/l, the second trimester - 58.93 μg/day and 43.16 μg/l and the third trimester - 62.89 μg/day and 40.97 μg/l, respectively. Selenium intake below or above recommended value hadn't significant effect on GPX activity, TAS and UA levels. There were no statistical differences in selenium intake, serum selenium content, GPX activity and TAS and UA level between physiological and complicated pregnancy, but a positive correlation between Se intake and serum selenium content was observed during all period of gestation as well as in the second trimester of pregnancy between Se intake and GPX activity in group with physiological pregnancy where selenium intake was below the recommended level. Selenium intake above the recommended level was positively correlated also with serum UA level in first and second trimester of pregnancy. Despite weak, positive correlations in the first two trimesters of pregnancy between selenium supply and GPX activity and UA concentration we concluded that selenium intake does not significantly affect during pregnancy, both: markers of the antioxidant status of pregnant women and the occurrence of pregnancy complications.
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Affiliation(s)
- Joanna Pieczyńska
- Department of Food Science and Dietetics, Wroclaw Medical University, Borowska 211, 50-556, Wroclaw, Poland.
| | - Sylwia Płaczkowska
- Diagnostics Laboratory for Teaching and Research, Wroclaw Medical University, Borowska 211a, 50-556, Wroclaw, Poland
| | - Rafał Sozański
- 1st Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, T. Chałubińskiego 3, 50-368, Wroclaw, Poland
| | - Karolina Orywal
- Department of Biochemical Diagnostics, Medical University of Białystok, Waszyngtona 15A, 15-269, Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Białystok, Waszyngtona 15A, 15-269, Bialystok, Poland; Department of Neurodegeneration Diagnostics, Medical University of Białystok, Waszyngtona 15A, 15-269, Bialystok, Poland
| | - Halina Grajeta
- Department of Food Science and Dietetics, Wroclaw Medical University, Borowska 211, 50-556, Wroclaw, Poland
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Biochemical Assessment of Renal and Liver Function among Preeclamptics in Lagos Metropolis. Int J Reprod Med 2018; 2018:1594182. [PMID: 30155474 PMCID: PMC6091329 DOI: 10.1155/2018/1594182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives Preeclampsia is a pregnancy specific syndrome. Studies have shown that preeclampsia has multiorgan dysfunction effects. This study evaluated biomarkers of renal and liver function among preeclamptic Nigerian women. Study Design This was a cross-sectional study conducted among 49 preeclamptic women and 50 normotensive healthy pregnant women. Method The baseline data comprising age, gestational age, and blood pressure were obtained. Venous blood and spot urine samples were collected from each participant. Plasma obtained from blood samples taken into lithium heparinized vacutainer bottles was assayed for electrolytes, urea, creatinine, total protein, albumin, and uric acid, while sera samples from blood samples taken into serum separation tube- (SST-) gel vacutainer were assayed for aspartate transaminase and alanine transaminase using ion selective electrode technique and Cobas autoanalyzer. Spot urine samples were assayed for protein and creatinine using Pyrogallol's reagent and Jaffe's methods, respectively. Microalbuminuria (protein/creatinine ratio) was generated from spot urine protein and creatinine data. Result The plasma sodium, total protein, and albumin in preeclamptic group were significantly decreased (p<0.05) when compared with control. There was statistically significant increase (p<0.05) in microalbuminuria, plasma potassium, urea, creatinine, uric acid levels, serum AST, and ALT activities in preeclamptic group. A positive association (p<0.05) between alanine aminotransferase and biomarkers of renal function was observed. Conclusion Preeclampsia has deleterious effects on renal and liver function as shown by alteration of these parameters.
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Müller-Deile J, Schiffer M. Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy. World J Nephrol 2014; 3:169-81. [PMID: 25374810 PMCID: PMC4220349 DOI: 10.5527/wjn.v3.i4.169] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/06/2014] [Accepted: 09/04/2014] [Indexed: 02/06/2023] Open
Abstract
Proteinuria is a frequently detected symptom, found in 20% of pregnancies. A common reason for proteinuria in pregnancy is preeclampsia. To diagnose preeclampsia clinically and to get new insights into the pathophysiology of the disease it is at first essential to be familiar with conditions in normal pregnancy. Animal models and biomarkers can help to learn more about disease conditions and to find new treatment strategies. In this article we review the changes in kidney function during normal pregnancy and the differential diagnosis of proteinuria in pregnancy. We summarize different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. We describe the current animal models and give a broad overview of different biomarkers that were reported to predict preeclampsia or have a prognostic value in preeclampsia cases. We end with a summary of treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia. Most of these novel biomarkers for preeclampsia are not yet implemented in clinical use. Therefore, we recommend using proteinuria (measured by UPC ratio) as a screening parameter for preeclampsia. Delivery is the only curative treatment for preeclampsia. In early preeclampsia the primary therapy goal is to prolong pregnancy until a state were the child has an acceptable chance of survival after delivery.
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Talaulikar VS, Shehata H. Uric acid: is it time to give up routine testing in management of pre-eclampsia? Obstet Med 2012; 5:119-23. [PMID: 27582868 PMCID: PMC4989702 DOI: 10.1258/om.2011.110075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 11/18/2022] Open
Abstract
Ever since it was first linked with the pathophysiology of pre-eclampsia, uric acid has been a routine test requested by many care-givers managing pregnant women with hypertensive disease of pregnancy for almost 100 years. Existing evidence however suggests that it has no definitive role in prediction, diagnosis or management of pre-eclampsia. We argue against routine uric acid testing in pregnancies complicated by hypertension not only because it has become a fruitless academic exercise but also because ceasing its routine use will ensure cost-savings for the health services.
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Affiliation(s)
- Vikram Sinai Talaulikar
- Department of Obstetrics & Gynaecology, St George's Hospital and Medical School, Cranmer Terrace, Tooting, London SW17 0RE
| | - Hassan Shehata
- Maternal Medicine Unit, Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Surrey SM5 1AA
- St George's Medical School, Blackshaw Road, London SW17 0QT, UK
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Hawkins TLA, Roberts JM, Mangos GJ, Davis GK, Roberts LM, Brown MA. Plasma uric acid remains a marker of poor outcome in hypertensive pregnancy: a retrospective cohort study. BJOG 2012; 119:484-92. [DOI: 10.1111/j.1471-0528.2011.03232.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wolak T, Sergienko R, Wiznitzer A, Paran E, Sheiner E. High uric acid level during the first 20 weeks of pregnancy is associated with higher risk for gestational diabetes mellitus and mild preeclampsia. Hypertens Pregnancy 2010; 31:307-15. [PMID: 20822424 DOI: 10.3109/10641955.2010.507848] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the association between uric acid (UA) level during the first 20 weeks of pregnancy and the development of gestational diabetes mellitus (GDM) and preeclampsia in the second half of pregnancy. METHODS The study population included registered births (n = 5507) between 2001 and 2007 in a tertiary medical center. The UA levels during the first 20 weeks of pregnancy were sorted by UA ≤ 2.4 mEq/L; UA = 2.5-4.0 mEq/L, UA = 4.1-5.5 mEq/L, and UA > 5.5 mEq/L. The linear-by-linear chi-square test and ROC curves were used to determine the association between UA level during the first 20 weeks and pregnancy complications. Multivariate analyses were performed to demonstrate whether UA level is an independent factor for the prevalence of preeclampsia and GDM. RESULTS Significant linear association was documented between UA level in the first 20 weeks and the prevalence of GDM and mild preeclampsia. The lowest and the highest prevalence of GDM were found in the UA ≤ 2.4 mEq/L group (6.3%) and in the UA > 5.5 mEq/L group (10.5%) (p < 0.001), respectively. Mild preeclampsia was diagnosed in 2.1% of the patients from the UA ≤ 2.4 mEq/L group, 3.3% from the UA = 2.5-4.0 mEq/L group, 5.3% from the UA = 4.1-5.5 mEq/L group, and 4.5% from the UA > 5.5 mEq/L group (p < 0.001). Three multiple logistic regression models controlling for maternal age showed that UA level is an independent risk factor for both GDM and mild preeclampsia. CONCLUSIONS UA levels in the highest quartile of the normal range during the first 20 weeks of pregnancy are associated with higher risk for the development of GDM and mild preeclampsia.
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Affiliation(s)
- Talya Wolak
- Hypertension unit, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
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14
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Bainbridge SA, Roberts JM. Uric acid as a pathogenic factor in preeclampsia. Placenta 2008; 29 Suppl A:S67-72. [PMID: 18093648 PMCID: PMC3319018 DOI: 10.1016/j.placenta.2007.11.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Revised: 10/30/2007] [Accepted: 11/01/2007] [Indexed: 11/18/2022]
Abstract
Hyperuricemia is a common finding in preeclamptic pregnancies evident from early pregnancy. Despite the fact that elevated uric acid often pre-dates the onset of clinical manifestations of preeclampsia, hyperuricemia is usually considered secondary to altered kidney function. Increased serum uric acid is associated with hypertension, renal disease and adverse cardiovascular events in the non-pregnant population and with adverse fetal outcomes in hypertensive pregnancies. We hypothesize that an elevated concentration of uric acid in preeclamptic women is not simply a marker of disease severity but rather contributes directly to the pathogenesis of the disorder. Using epidemiological and experimental evidence, gained largely outside of pregnancy, we will propose pathogenic roles for uric acid in preeclamptic pregnancies. Uric acid's ability to promote inflammation, oxidative stress and endothelial dysfunction will be highlighted with discussions of the potential impact on placental development and function and maternal vascular health.
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Affiliation(s)
- S A Bainbridge
- Lab 336A, Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA 15213, USA.
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15
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Kang DH, Finch J, Nakagawa T, Karumanchi SA, Kanellis J, Granger J, Johnson RJ. Uric acid, endothelial dysfunction and pre-eclampsia. J Hypertens 2004; 22:229-35. [PMID: 15076175 DOI: 10.1097/00004872-200402000-00001] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pre-eclampsia is strongly associated with hyperuricemia, and in some studies the increase in serum uric acid has been found to correlate with both maternal and fetal morbidity. The hyperuricemia is believed to result primarily from the decreased renal excretion that occurs as a consequence of the pre-eclampsia, and as such is widely viewed as a marker for pre-eclampsia as opposed to having a role in the pathogenesis. HYPOTHESIS We present the hypothesis that hyperuricemia may also have a contributory role in the development of hypertension and renal disease in these patients, and we review recent experimental data that would support this hypothesis. RECOMMENDATION We suggest that studies addressing the role of uric acid in pre-eclampsia may provide new insights into both the pathogenesis and treatment of this condition.
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Affiliation(s)
- Duk-Hee Kang
- Division of Nephrology, Ewha Women's University College of Medicine, Seoul, Korea.
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Barry CL, Royle GA, Lake Y. Racial variation in serum uric acid concentration in pregnancy: a comparison between European, New Zealand Maori and Polynesian women. Aust N Z J Obstet Gynaecol 1992; 32:17-9. [PMID: 1586327 DOI: 10.1111/j.1479-828x.1992.tb01889.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A prospective study was undertaken to measure serum uric acid levels in normal pregnant women of different races, to ascertain if there was any significant interracial variation. A total of 48 women were studied of which 13 were European, 11 New Zealand Maori, 22 Pacific Islanders and 2 Indian. In the second trimester, European, Maori and Cook Island women had similar uric acid levels and other Polynesian groups showed significantly higher levels. In the third trimester, both Maori and Cook Island women showed a marked rise so that their levels came to equal those of other Polynesian groups, all 3 having significantly higher levels than European women. The importance of these observations relates to the use of uric acid levels in the management of patients with gestational proteinuric hypertension. It is possible that in these cases unusually high results may alarm the clinician into hasty intervention.
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Affiliation(s)
- C L Barry
- Department of Obstetrics and Gynaecology, Middlemore Hospital, Auckland, New Zealand
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18
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Affiliation(s)
- R A Fay
- Nepean Hospital, Penrith, New South Wales
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