Predictive value of biochemical and ultrasonographic parameters for developing preeclampsia

Tokom poslednje decenije, predložene su mnoge metode kako bi se poboljšala predikcija preeklampsije. Ipak, preeklampsija ostaje jedan od vodećih uzroka maternalnog i fetalnog morbiditeta i mortaliteta u svetu. Cilj studije bila je procena prediktivne vrednosti biohemijskih i angiogenih markera, povišenih parametara lipida i uloge oksidativnog stresa u proceni rizika od preeklampsije kod žena sa visokorizičnom trudnoćom. Takođe, urađena je procena performansi FMF algoritma za predikciju preeklampsije. METOD: Prospektivna kohortna studija (n = 138) sprovedena je u periodu od januara 2016. do avgusta 2018. godine na Odeljenju visokorizičnih trudnoća, Ginekološko-akušerske klinike „Narodni front“ u Beogradu. Merenje nivoa biohemijskih (PAPP-A) i angiogenih markera (PlGF, sFlt-1), parametara oksidativnog stresa (TAS, TOS, AOPP i SH) i lipidnog statusa (TC, LDL-C i subfrakcije, HDL-C, APO-A1 i APO-B) izvršeno je tokom prvog, drugog, ranog trećeg i kasnog trećeg trimestra. Aterogeni indeks plazme (AIP) izračunat je kao AIP = log (TG / HDL-C). Procena rizika za preeklampsiju analizirana je pomoću algoritma Fetal Medicine Foundation (FMF). REZULTATI: Od 138 visokorizičnih trudnica, njih 30 razvilo je preeklampsiju. U prvom trimestru nađene su značajno niže vrednosti PAPP-A kod žena koje su razvile preeklampsiju (p=0,002). U drugom i trećem trimestru, PlGF i sFlt/PlGF su bili značajno povišeni kod žena sa preeklampsijom (p=0,015 odnosno p=0,017), i njihovi nivoi su nastavili da se uvećavaju u kasnom trećem trimestru (p=0,012 i p=0,023). Nivoi triglicerida i aterogeni indeks plazme bili su viši kod žena sa preeklampsijom tokom cele trudnoće (p0,05). FMF algoritam korišćen za predikciju preeklampsije pokazao je specifičnost od preko 70%, ali je imao nižu senzitivnost (35-77%). Sveukupna tačnost FMF skora ostala je nepromenjena tokom čitave trudnoće i bila je između 70 i 80%. ZAKLJUČAK: Nalazi ove studije ukazuju na potencijalnu ulogu angiogenih markera PlGF i sFlt-1, poremećaja metabolizma lipida, posebno visokog nivoa triglicerida, kao i oksidativnog stresa tokom trudnoće kod žena sa visokim rizikom za razvoj preeklampsije. FMF algoritam ima višu specicifičnost, ali nižu senzitivnost u predikciji preeklampsije kod žena sa visokorizičnom trudnoćom.Over the last decade, many methods have been proposed to improve prediction of preeclampsia. Nevertheless, preeclampsia remains one of the leading causes of maternal and fetal morbidity and mortality worldwide. This study is aimed at assessing the predictive value of biochemical (PAPP-A) and angiogenic markers, abnormal lipid profile and oxidative stress status for developing preeclampsia in high-risk pregnancies/ high-risk pregnant women. In addition, the Fetal Medicine Foundation (FMF) algorithm for preeclampsia prediction was assessed. METHODS: A prospective cohort study (n=138) was conducted in the period January 2016 - August 2018, at the Department of High-Risk Pregnancies, Gynecology and Obstetrics Clinic "Narodni Front" in Belgrade, Republic of Serbia. Levels of biochemical (PAPP-A) and angiogenic markers (PlGF, sFlt-1), hormones (PAPP-A), oxidative stress parameters (TAS, TOS, AOPP and SH) and lipid status parameters (TC, LDL-C and subfractions, HDL-C, APO-A1 and APO-B) were assessed during the first, second, early third and late third trimester. The risk assessment for PE was analyzed using the FMF algorithm. RESULTS: Women developed preeclampsia in 30 out of 138 high-risk pregnancies. In the 1st trimester, significantly lower PAPP-A levels were found in PE group (p=0.002). In the 2nd and early 3rd trimester, PlGF and sFlt-1/PlGF were significantly increased in PE (p=0.015 and p=0.017, respectively), and their levels continued to increase in the late 3rd trimester (p=0.012 and p=0.023, respectively). Triglyceride levels and atherogenic index of plasma were higher in preeclamptic women throughout the whole pregnancy (p0.05) in terms of TOS and AOPP levels throughout all trimesters. The specificity of the used FMF algorithm is higher (above 70%); however, its lower sensitivity (35-77%) is a drawback. FMF score accuracy was 70-80% and it remained similar in all pregnancy trimesters. CONCLUSION: The findings of the present study suggest a potential role of angiogenic markers PlGF and sFlt-1, abnormal lipid metabolism, particularly high triglycerides levels, as well as oxidative stress during pregnancy, in women at a high risk for preeclampsia. FMF algorithm has a higher specificity, but lower sensitivity for prediction of preeclampsia in high-risk pregnancies

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. Patient s 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. Result s 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 β‑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 β‑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

Izmenjena struktura i antioksidativni kapacitet lipoproteinskih čestica visoke gustine u preeklampsiji

Background/Aim. One of the complications that can oc- cur during pregnancy is the development of preeclampsia (PE). The main characteristics of this condition are high blood pressure and very often signs of kidney damage or other organ damage. The condition affects 5–7% of all pregnant women and is one of the main factors of maternal and perinatal morbidity and mortality worldwide. The aim of this study was to investigate the structural and functional modifications of high-density lipoprotein (HDL) particles during high-risk pregnancies (HRP) for PE development. Methods. The longitudinal prospective study included a to- tal of 91 pregnant women with a HRP for developing PE. Out of this total number, 71 women did not develop PE until delivery, and this group was designated as the group without PE (WPE). The rest of the 20 HRP women devel- oped PE before delivery and were designated as the PE group. The blood was sampled toward the end of each tri- mester and before the delivery. The distribution of HDL particles was determined by the vertical 3–31% polyacryla- mide gradient gel electrophoresis method. The antioxidative capacity of HDL particles was measured by the activity of the HDL-associated enzyme – paraoxonase 1 (PON1). PON1 activity was determined by the method of kinetic spectrophotometry from serum samples. Results. The re- sults have shown that the proportions of HDL 2b particles significantly increased in the 2nd trimester (p ˂ 0.05) and remained increased until the end of pregnancy in the WPE group. PON1 activity was significantly higher in the 3 rd tri- mester (p < 0.05) of the WPE group. In the PE group, we found that the proportions of HDL 3a particles significantly decreased in the 2 nd trimester (p < 0.05) and remained de- creased until the end of pregnancy. PON1 activity has not changed in the PE group during pregnancy. Conclusion. Dyslipidemia in pregnancy could be associated with differ- ent modifications of HDL particles. The adaptive pregnancy mechanisms expressed as a functional modification of HDL particles in pregnant women who develop PE seem inade- quate and, therefore, lose their atheroprotective role.Uvod/Cilj. Jedna od komplikacija koja se može javiti tokom trudnoće je razvoj preeklampsije (PE). Glavne karakteristike ovog stanja su visok krvni pritisak i vrlo često znaci oštećenja bubrega ili drugih organa. Ovo stanje pogađa 5–7% svih trudnica i jedan je od glavnih faktora morbiditeta i mortaliteta trudnica i fetusa ili novorođenčadi. Cilj ovog rada bio je ispitivanje strukturnih i funkcionalnih modifikacija lipoproteinskih čestica visoke gustine (high- density lipoprotein – HDL) u trudnoćama sa visokim rizikom (TVR) za razvoj PE. Metode. U longitudinalnoj prospektivnoj studiji učestvovala je ukupno 91 trudnica sa TVR od razvoja PE. Od ukupnog broja trudnica, kod njih 71, PE se nije razvila do kraja trudnoće i ova grupa je označena kao grupa bez PE (BPE). Kod preostalih 20 žena sa TVR se razvila PE do porođaja, i one su svrstane u grupu PE. Krv je uzimana za analizu na kraju svakog trimestra i pred porođaj. Raspodela HDL čestica je određivana metodom vertikalne elektroforeze u 3–31% gradijentu poliakrilamidnog gela. Antioksidativni kapacitet HDL čestica je određivan na osnovu aktivnosti enzima paraoksonaze 1 (PON1) vezanog za HDL. Aktivnost PON1 u serumu je određivana metodom kinetičke spektrofotometrije. Rezultati. Rezultati su pokazali da se udeo HDL 2b čestica značajno povećao u drugom trimestru (p < 0,05) i ostao je povećan do kraja trudnoće u grupi BPE. Aktivnost PON1 bila je značajno veća u trećem trimestru (p < 0,05) kod ove grupe trudnica. Udeo HDL 3a čestica se značajno smanjio u drugom trimestru u PE grupi trudnica (p < 0,05) i ostao je snižen do kraja trudno će. Aktivnost PON1 enzima u PE gripi se nije menjala u toku trudnoće. Zaključak. Dislipidemija u trudnoći može biti posledica različitih modifikacija HDL čestica. Strukturne i funkcionalne modifikacije HDL čestica, kao jedan od adaptivnih mehanizama, kod trudnica kod kojih se razvila PE, nisu adekvatne i kao takve gube svoju ateroprotektivnu ulogu

Novi biomarkeri u procjeni rizika za razvoj preeklampsije

Despite significant progress in improving pregnancy outcomes in recent decades, predicting the risk and treatment of preeclampsia are still major challenges in clinical practice (1). The aim of this study was to examine non-routine biomarkers in preeclampsia risk assessment. The study involved 90 women with high-risk pregnancies, 20 of whom developed preeclampsia by the end of pregnancy. Biochemical parameters were determined between the 12th and 13 th weeks of gestation. The results of the study showed that women who later developed preeclampsia had higher concentrations of lathosterol, cholesterol synthesis marker (p <0.05), inflammatory proteins - monocyte chemoattractant protein-1 (MCP-1), and resistin (p <0.01, both), as well as paraoxonase-1 (PON1) activity (p <0.05). Binary logistic regression analysis showed that higher concentrations of lathosterol, MCP-1, resistin, and PON-1 were associated with preeclampsia development. To determine whether the parameters significant in univariate analysis, are independent predictors of preeclampsia, we applied multivariate regression analysis. Clinical markers commonly used in risk assessment (maternal age and body mass index, mean arterial pressure, and uterine blood flow), lathosterol, MCP-1, resistin, and PON-1 were included in the model. MCP-1 and resistin stood out as significant independent predictors of preeclampsia. The diagnostic accuracy of the investigated model was excellent (AUC=0.859). The study results indicated the importance of a multi-marker approach in risk assessment for preeclampsia development.Uprkos značajnom napretku u poboljšanju ishoda trudnoće poslednjih decenija, predviđanje rizika i terapija preeklampsije su još uvijek veliki izazovi u kliničkoj praksi (1). Cilj ove studije je bio ispitivanje biomarkera koji se ne koriste u rutinskoj praksi u proceni rizika za razvoj preeklampsije. U studiji je učestvovalo 90 žena sa visokorizičnim trudnoćama, od kojih je 20 razvilo preeklampsiju do kraja trudnoće. Biohemijski parametri su određivani između 12. i 13. nedelje gestacije. Rezultati studije su pokazali da su žene koje su razvile preeklampsiju imale više koncentracije latosterola, markera sinteze holesterola (p <0,05), inflamatornih proteina - monocitnog hemoatraktantnog proteina-1 (MCP-1) i rezistina (p < 0,01, oba), kao i aktivnost enzima paraoksonaze-1 (PON1) (p <0,05). Binarna logistička regresiona analiza je pokazala da su više koncentracije latosterola, MCP-1, rezistina i PON-1 povezane sa razvojem preeklampsije. Da bi se utvrdilo da su parametri koji su se u univarijantnoj analizi pokazali značajnim, nezavisni prediktori preeklampsije, primjenili smo multivarijantnu regresionu analizu. U model su ušli klinički parametri koji se uobičajeno koriste u procjeni rizika (starost i indeks tjelesne mase majke, srednji arterijski pritisak i protok krvi kroz matericu), latosterol, MCP-1, rezistin i PON-1. MCP-1 i rezistin su se istakli kao značajni nezavisni prediktori preeklampsije. Pokazana je odlična dijagnostička tačnost ispitivanog modela (AUC=0,859). Rezultati ove studije su ukazali na značaj multimarkerskog pristupa u procjeni rizika za razvoj preeklampsije.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

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, β-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 β-sitosterol in T3 (p < 0.05). Cholesterol synthesis markers increased across trimesters in both groups. A decrease in serum β-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

Predictive value of biochemical and ultrasonographic parameters for developing preeclampsia

Tokom poslednje decenije, predložene su mnoge metode kako bi se poboljšala predikcija preeklampsije. Ipak, preeklampsija ostaje jedan od vodećih uzroka maternalnog i fetalnog morbiditeta i mortaliteta u svetu. Cilj studije bila je procena prediktivne vrednosti biohemijskih i angiogenih markera, povišenih parametara lipida i uloge oksidativnog stresa u proceni rizika od preeklampsije kod žena sa visokorizičnom trudnoćom. Takođe, urađena je procena performansi FMF algoritma za predikciju preeklampsije. METOD: Prospektivna kohortna studija (n = 138) sprovedena je u periodu od januara 2016. do avgusta 2018. godine na Odeljenju visokorizičnih trudnoća, Ginekološko-akušerske klinike „Narodni front“ u Beogradu. Merenje nivoa biohemijskih (PAPP-A) i angiogenih markera (PlGF, sFlt-1), parametara oksidativnog stresa (TAS, TOS, AOPP i SH) i lipidnog statusa (TC, LDL-C i subfrakcije, HDL-C, APO-A1 i APO-B) izvršeno je tokom prvog, drugog, ranog trećeg i kasnog trećeg trimestra. Aterogeni indeks plazme (AIP) izračunat je kao AIP = log (TG / HDL-C). Procena rizika za preeklampsiju analizirana je pomoću algoritma Fetal Medicine Foundation (FMF). REZULTATI: Od 138 visokorizičnih trudnica, njih 30 razvilo je preeklampsiju. U prvom trimestru nađene su značajno niže vrednosti PAPP-A kod žena koje su razvile preeklampsiju (p=0,002). U drugom i trećem trimestru, PlGF i sFlt/PlGF su bili značajno povišeni kod žena sa preeklampsijom (p=0,015 odnosno p=0,017), i njihovi nivoi su nastavili da se uvećavaju u kasnom trećem trimestru (p=0,012 i p=0,023). Nivoi triglicerida i aterogeni indeks plazme bili su viši kod žena sa preeklampsijom tokom cele trudnoće (p0,05). FMF algoritam korišćen za predikciju preeklampsije pokazao je specifičnost od preko 70%, ali je imao nižu senzitivnost (35-77%). Sveukupna tačnost FMF skora ostala je nepromenjena tokom čitave trudnoće i bila je između 70 i 80%. ZAKLJUČAK: Nalazi ove studije ukazuju na potencijalnu ulogu angiogenih markera PlGF i sFlt-1, poremećaja metabolizma lipida, posebno visokog nivoa triglicerida, kao i oksidativnog stresa tokom trudnoće kod žena sa visokim rizikom za razvoj preeklampsije. FMF algoritam ima višu specicifičnost, ali nižu senzitivnost u predikciji preeklampsije kod žena sa visokorizičnom trudnoćom.Over the last decade, many methods have been proposed to improve prediction of preeclampsia. Nevertheless, preeclampsia remains one of the leading causes of maternal and fetal morbidity and mortality worldwide. This study is aimed at assessing the predictive value of biochemical (PAPP-A) and angiogenic markers, abnormal lipid profile and oxidative stress status for developing preeclampsia in high-risk pregnancies/ high-risk pregnant women. In addition, the Fetal Medicine Foundation (FMF) algorithm for preeclampsia prediction was assessed. METHODS: A prospective cohort study (n=138) was conducted in the period January 2016 - August 2018, at the Department of High-Risk Pregnancies, Gynecology and Obstetrics Clinic "Narodni Front" in Belgrade, Republic of Serbia. Levels of biochemical (PAPP-A) and angiogenic markers (PlGF, sFlt-1), hormones (PAPP-A), oxidative stress parameters (TAS, TOS, AOPP and SH) and lipid status parameters (TC, LDL-C and subfractions, HDL-C, APO-A1 and APO-B) were assessed during the first, second, early third and late third trimester. The risk assessment for PE was analyzed using the FMF algorithm. RESULTS: Women developed preeclampsia in 30 out of 138 high-risk pregnancies. In the 1st trimester, significantly lower PAPP-A levels were found in PE group (p=0.002). In the 2nd and early 3rd trimester, PlGF and sFlt-1/PlGF were significantly increased in PE (p=0.015 and p=0.017, respectively), and their levels continued to increase in the late 3rd trimester (p=0.012 and p=0.023, respectively). Triglyceride levels and atherogenic index of plasma were higher in preeclamptic women throughout the whole pregnancy (p0.05) in terms of TOS and AOPP levels throughout all trimesters. The specificity of the used FMF algorithm is higher (above 70%); however, its lower sensitivity (35-77%) is a drawback. FMF score accuracy was 70-80% and it remained similar in all pregnancy trimesters. CONCLUSION: The findings of the present study suggest a potential role of angiogenic markers PlGF and sFlt-1, abnormal lipid metabolism, particularly high triglycerides levels, as well as oxidative stress during pregnancy, in women at a high risk for preeclampsia. FMF algorithm has a higher specificity, but lower sensitivity for prediction of preeclampsia in high-risk pregnancies

Pelvic inflammatory diseases in perimenopause and menopause

Introduction: In the gynecological profession Pelvic Inflammatory Disease (PID) has a significant role due to its frequency, many complications and high costs of treatment Aim: The aim of this study was to investigate frequency and complications caused by these diseases, and used methods of treatment. Methods: The research was conducted in Clinic of Obstetrics and Gynecology 'Narodni Front', Belgrade, and included all consecutive patients diagnosed with PID during the period from year 2007 to 2010. The diagnosis of PID was set on the basis of: gynecological examination, test analysis (leucocytes, sedimentation, platelets, CRP, CA125), and ultrasound examination. A clinical criterion is divided into minimal and additional. The study included 112 patients. There were 33.93% of women in perimenopause/menopause (experimental group), while the control group consisted of 66.07% female subjects. Results: The frequency of surgically treated patients in experimental and control group was: 44.74% : 39.19% (χ2 test; p > 0.05). Women in experimental group used Intrauterine Device (IUD) more than other patients 57.89% : 13.15% (χ2 test; p = 0.0001). A link was established between the use of intrauterine devicela in (χ2 test; p = 0.0516), patients’ irregular control of IUD (χ2 test; p = 0.0114) and surgical treatments of women in experimental group. The conservative treatment usually applies dual antibiotic therapy. Costs of surgically treated patients are around 1300 and conservatively treated around 210 €. Conclusion: Women in perimenopause and menopause are not exposed to higher risks of contracting PID. Women in perimenopause and menopause which use intrauterine device and don’t have regular controls, have higher risk of surgical treatments in case of pelvic inflammatory disease. Costs of treatment are 6-7 times in lower with conservatively treated patients compared to operatively treated ones

Antioxidant status in hypertensive disorders of pregnancy

Free Radical Research Europe (SFRR-E) Annual Meeting Abstracts “Redox biology in the 21st century: a new scientific discipline” 15-18 June 2021, Belgrade, Serbi

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

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