Preeclampsia: síndrome metabólico del embarazo

Introducción: La preeclampsia aún es de etiología incierta, pero con distintas alteraciones metabólicas que se presentan en la mujer embarazada, tiene como común denominador el daño endotelial multiorgánico. La tarea del obstetra es identificar embarazos de alto riesgo causantes de la alta morbilidad y mortalidad materna y neonatal. Objetivo: Plantear una nueva denominación de la preeclampsia de acuerdo con la fisiopatología y los criterios del síndrome metabólico. Metodología: Se realizó un estudio de casos y controles anidados en una cohorte retrospectiva en el Hospital Materno Perinatal “Mónica Pretelini Sáenz” en el periodo de enero 2011 a diciembre 2012. Se formaron dos grupos de pacientes uno con síndrome de preeclampsia y otro con embarazo normal, a los cuales se les aplicaron los criterios de síndrome metabólico. Resultados: De la cohorte de 640 pacientes se incluyeron a 90 pacientes que correspondieron al 14.06%, el grupo I se conformó por 30 pacientes que fue considerado como casos, y grupo II por 60 pacientes considerado como controles. Los resultados de las variables antropométricas al comparar cintura, peso, talla mostraron diferencias estadísticas (OR= 8, p= 0.001), mostrando mayor obesidad en la población estudiada. En relación con los valores de triglicéridos, TA, y glucosa, se observaron diferencias estadísticas entre los grupos (OR de 1.8 y p=0.03, OR= 9 y p= 0.001, OR= 10 y p= 0.001 respectivamente). Conclusiones: El síndrome de preeclampsia cuenta con factores de riesgo como obesidad, dislipidemia aterogénica, hipertensión arterial, resistencia a la insulina con intolerancia a la glucosa o diabetes, estado proinflamatorio y protrombóticos. Por lo tanto, la preeclampsia puede ser considerada como un síndrome metabólico del embarazo y ser el factor desencadenante del desorden hipertensivo y sus complicaciones

Predictors of hyperlipidemia during the first half of pregnancy in Mexican women

Objective: To determine the predictors of hypercholesterolemia and of hypertriglyceridemia during the first half of pregnancy in Mexican women. Methods: Cross-sectional comparative study of pregnant women with less than 21 weeks of gestational age. Measurements: Demographic information, obstetric history, prepregnancy body mass index, cholesterol and triglycerides. Cross tabulations and multiple logistic regression were used for statistical analysis. Results: 230 participants; 61 women with normal prepregnancy body mass index, 108 with overweight, and 61 with obesity. Dyslipidemia was defined as elevated cholesterol (>180 mg/dL) or triglycerides (>170 mg/dL). After adjusting by potential confounders, independent predictors of hypercholesterolemia included being overweight (OR=2.8, 95% CI 1.4-5.9), being obese (OR=3.7 95% CI 1.6-8.4) or being on the second trimester of pregnancy. The same predictors were found for hypertriglyceridemia, respectively OR=2.8, 95% CI 1.4-5.6, OR=2.9, 95% CI 1.3-6.5, OR=2.6, 95% CI 1.4-4.7. Conclusion: Mexican women with prepregnancy overweight or obesity have greater risk of suffering hypercholesterolemia and hypertriglyceridemia during pregnancy. Women in the second trimester had higher levels of both lipids as compared to the first one. This is the first Mexican study that confirms the increase of lipids as gestational age progresses

Hyperleptinemia as a prognostic factor for preeclampsia: a cohort study

Summary: Introduction: Leptin is an adipokine which has a direct relationship to obesity. Our aim was to measure this hormone in pregnant women at three months intervals throughout their pregnancies to determine the serum value of those who developed preeclampsia. Material and Methods: We followed 19 women (median age 24.8 ± 5.7 years) with pre-gestational Body Mass Index (BMI) less than 25 kg/m2, 21 (median age 26.1 ± 4.6 years) with BMI higher than 25 kg/m2 and 16 (median age 30.9 ± 5.8 years) with Gestational Diabetes Mellitus (GDM) (median age 30.9 ± 5.8 years), recruited in the 1st trimester of pregnancy. Serum levels of leptin were measured with radioimmunoassay (RIA) technique. Results: In the first trimester of pregnancy leptin levels showed statistically significant differences between normal weight and overweight-obese women (p < 0.001), diabetic women (p < 0.05) and the subgroup of preeclamptic women (p < 0.001). For those women with PGBMI ≥ 40 kg/m2 and leptin ≥ 40 ng/ml in the second trimester, the Odds Ratio (OR) to develop preeclampsia was of 47.95% CI (4.1–527.2). Analyzing leptin values with ROC curves, the greatest area under the curve (AUC) was for leptin in the second trimester (0.773, CI: 0.634–0.911). Conclusion: Women with morbid obesity (BMI ≥ 40 kg/m2) had significantly higher levels of serum leptin (p < 0.01) and a value of 40 ng/ml of this hormone seems to be predictive of developing preeclampsia in this group of patients

Pregnancy weight gain limitation by a supervised nutritional program influences placental NF-κB/IKK complex expression and oxidative stress

Objective: Nuclear factor kappa B (NF-κB) pathway and oxidative stress participate in endothelial dysfunction, which is one of the causes of preeclampsia. Among the human antioxidant mechanisms there are the enzymes catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD). Our aim was to measure NF-κB, its inhibitor (IKK) and oxidative stress in placenta and umbilical cord of pregnant women submitted to a supervised nutritional program. Methods: Two groups were conformed: A) 14 pregnant women with individualized nutritional counseling and B) 12 pregnant women without nutritional guidance. NF-κB and IKK were assessed by real time PCR (RT-PCR). Enzymatic activity of CAT, GPx, lipoperoxidation (LPO) and SOD were also evaluated. Results: Pregnant women that followed-up a supervised nutritional program had lower level of systolic (p=0.03) and diastolic pressure (p=0.043) although they were heavier than a control group (p=0.048). Among all women, the Spearman correlation was positive between weight gain and placental NF-κB expression (1, p≤0.01). In placenta, women with nutritional advice had lower enzymatic activity of GPx (p≤0.038) and showed a tendency of IKK to be higher than in women without a nutritional supervised program. Conclusion: A supervised nutritional program in pregnancy offers a proven option to control weight gain, hypertension, NF-κB/IKK complex expression and oxidative stress reactions in placenta