RESUMO
Objective: To evaluate the usefulness of the serum concentration of nine matrix metalloproteinases (MMPs) as biomarkers of spontaneous abortion.Methods: A retrospective nested cohort case-control study was carried out in Zacatecas, Mexico. MMP-1-3, MMP-7-10, and MMP-12-13 were analyzed in serum from women who had spontaneous abortion of unknown causes (n = 7), who suffered abortions attributed to urinary tract infection (n = 7) and from those with healthy pregnancies without complications (controls; n = 20). Protein profiles were determined between 11 and 13 weeks of gestation (GW) using the Bio-Plex Pro Human MMP Panel. Differences in serum MMP concentrations between the study groups and their correlation with clinical findings were evaluated statistically.Results: There were differences in serum concentrations of MMP-9 between groups of spontaneous abortion of unknown cause (13.2 ± 7.5 ng/µL), abortion attributed to urinary tract infection (11.6 ± 5.8 ng/µL) and the controls (11.8 ± 16.5 ng/µL) (p = .022). Compared with controls, higher serum concentrations of MMP-8, MMP-9, and MMP-10 were observed in the group of spontaneous abortions of unknown causes (p value < .05). A negative correlation between MMP-8 and MMP-9 and urine density was also identified (r = -0.949, p value = .0167; and r = -0.947, p = .0167).Conclusions: Elevated serum concentrations of MMP-8, MMP-9, and MMP-10 were associated and preceded by the appearance of spontaneous interruption of pregnancy of unknown causes. Our results support the hypothesis that altered MMP modulation may be related with the pathogenesis of spontaneous abortion.
Assuntos
Aborto Espontâneo , Metaloproteinase 9 da Matriz , Aborto Espontâneo/sangue , Aborto Espontâneo/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Metaloproteinase 9 da Matriz/sangue , Metaloproteinase 9 da Matriz/metabolismo , México , Gravidez , Estudos RetrospectivosRESUMO
Cytokines are essential to maintain and coordinate the correct activity of immune cells during human pregnancy. IL-17 is a pro-inflammatory cytokine that induces the expression of many inflammatory mediators. The aim of this study was to compare the levels of Th1, Th2 and Th17 cytokines of women ongoing normal pregnancy with those found in women who suffered spontaneous abortion. IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α, and IFN-γ peripheral blood levels were measured in women who suffered spontaneous abortion (n = 13, blood collected up to 24 h after abortion), and were compared with healthy successful pregnancies (n = 16). Cytokine levels were measured using a cytometric bead array (CBA analysis). Similar cytokine levels were observed between spontaneous abortion and healthy pregnant women excepted to IL-17, which levels were increased in the healthy pregnant women (p = 0.0232). Our results show high IL-17 levels in the peripheral blood of women at late stages of healthy pregnancy, although low IL-17 levels were detected in the peripheral blood of women just after spontaneous abortion. In line with recent studies, this finding highlights IL-17 as a regulatory cytokine essential to the maintenance of a successful pregnancy.
Assuntos
Aborto Espontâneo/sangue , Interleucina-17/sangue , Gravidez/sangue , Adulto , Citocinas/sangue , Feminino , Humanos , Gravidez/imunologia , Células Th1/metabolismo , Células Th17/metabolismo , Células Th2/metabolismoRESUMO
OBJECTIVE: To investigate the association between mannose-binding lectin (MBL) serum level and MBL2 polymorphisms, and the frequency of spontaneous miscarriages in rheumatoid arthritis (RA) patients. METHODS: One hundred seventy seven women (mean age 50 years) with RA from Southern Brazil were studied and 4.5% had a history of abortion (8/177). The MBL levels were determined by ELISA. MBL2 polymorphisms in the promoter (-550H/L, -221X/Y), 5' untranslated region (4 P/Q) and exon 1 (p.Gly54Asp: B allele, p.Arg52Cys: D allele and p.Gly57Glu: C allele; collectively labelled O) were genotyped by sequencing. RESULTS: Mannose-binding lectin levels of RA patients ranged from ≤100 ng/mL to 6640 ng/mL (median 541.5 ng/mL). There was a significant difference in MBL median levels (100 ng/mL vs. 625 ng/mL, respectively, p = .001) and frequency of MBL deficiency (75.0% vs. 24.1%, p = .007, OR = 10.3, 95%CI = 1.9-55.4), in patients with a history of miscarriage vs those without it. Patients with RA and miscarriage had more frequently haplotypes related with low MBL levels (p = .007, OR = 10.5, 95%CI = 1.3-84) than high producers. Moreover, LYPB haplotype and O allele were significantly associated with the occurrence of miscarriage (p = .001, OR = 9.7, 95%CI = 2.4-39.1 and p = .009, OR = 5.9, 95%CI = 1.4-23.4, respectively). CONCLUSIONS: The results suggest that MBL deficiency and the presence of MBL2 gene polymorphisms that lead to MBL deficiency are risk factors for the occurrence of miscarriage in patients with RA.
Assuntos
Aborto Espontâneo/sangue , Aborto Espontâneo/etiologia , Artrite Reumatoide/complicações , Lectina de Ligação a Manose/sangue , Lectina de Ligação a Manose/deficiência , Erros Inatos do Metabolismo/complicações , Adulto , Alelos , Substituição de Aminoácidos , Biomarcadores , Feminino , Genótipo , Haplótipos , Humanos , Masculino , Lectina de Ligação a Manose/genética , Erros Inatos do Metabolismo/genética , Pessoa de Meia-Idade , Razão de ChancesRESUMO
OBJECTIVE: To investigate whether serum antimüllerian hormone (AMH) levels are independently related to miscarriage rates after in vitro fertilization-embryo transfer (IVF-ET). DESIGN: Cohort study. SETTING: University-affiliated IVF-ET center. PATIENT(S): A total of 1,060 patients who attained a clinical pregnancy after IVF-ET. INTERVENTIONS(S): Centralized serum AMH measurements were performed within the 12 months before IVF-ET. Binary logistic regression was used to verify whether serum AMH levels were associated with the occurrence of a miscarriage independently from confounding factors, such as age and intensity of ovarian response to controlled ovarian stimulation assessed by the number of oocytes retrieved. MAIN OUTCOME MEASURE(S): Miscarriage rates. RESULT(S): In patients displaying reduced serum AMH levels, miscarriage rates were significantly increased independently from age and the number of oocytes retrieved. CONCLUSION(S): The present data indicate that serum AMH levels are independently associated with the occurrence of a miscarriage after IVF-ET.
Assuntos
Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Hormônio Antimülleriano/sangue , Transferência Embrionária/estatística & dados numéricos , Fertilização in vitro/estatística & dados numéricos , Infertilidade Feminina/sangue , Infertilidade Feminina/terapia , Adulto , Distribuição por Idade , Biomarcadores/sangue , Terapia Combinada/estatística & dados numéricos , Comorbidade , Feminino , França/epidemiologia , Humanos , Incidência , Gravidez , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Falha de Tratamento , Adulto JovemRESUMO
PURPOSE: To analyze the serological, anatomopathological and parasitological results obtained from abortive material in order to detect infections with the risk of vertical transmission, with emphasis on toxoplasmosis. METHODS: A cross-sectional cohort study was conducted in order to determine the prevalence of infectoparasitic diseases. A total of 105 women who suffered spontaneous complete or incomplete abortion participated in the study. The women were interviewed, answered a questionnaire and had their blood and abortive material collected. Immunological tests were carried out in order to detect toxoplasmosis, Chagas disease, rubeola, cytomegalovirus and syphilis, and anatomopathological analysis of the ovular remains was performed. RESULTS: 55% of the women studied were 20 to 30 years old. Most of them (68%) presented a gestational age between the 7th and 14th week. 54.3% of the women had complete or incomplete high school education. Serological analysis showed cytomegalovirus (CMV) as the most common vertically transmitted infection with 97.1% positivity, followed by rubeola with 95.2%. Toxoplasmosis showed 54.3% positivity, Chagas disease 1.9% and syphilis 0.95%. Anatomopathological analysis showed inflammation in 63.1% of the cases and absence of inflammation in 34%. The results of the serological, anatomopathological and parasitological analysis of the 105 participants showed that 57 women were T. gondii positive. However, none showed positivity in the polymerase chain reaction (PCR) or in mouse inoculation. CONCLUSIONS: The prevalence of diseases with the risk of vertical transmission is important in women with spontaneous abortion, indicating the need for more research in order to investigate the etiology of abortion.
Assuntos
Aborto Espontâneo/sangue , Aborto Espontâneo/parasitologia , Transmissão Vertical de Doenças Infecciosas , Toxoplasmose/sangue , Toxoplasmose/transmissão , Aborto Espontâneo/microbiologia , Adolescente , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Prevalência , Adulto JovemRESUMO
OBJETIVO: Analisar os resultados sorológicos, anatomopatológicos e parasitológicos de material abortivo para infecções com risco de transmissão vertical, com ênfase na toxoplasmose. MÉTODOS: Foi realizado um estudo coorte-transversal tratando da prevalência das doenças infectoparasitárias. Participaram da pesquisa 105 mulheres que sofreram aborto espontâneo completo e/ou incompleto; elas foram entrevistadas por meio de um questionário, e foram coletadas amostras de sangue e material abortivo. Foram realizados testes imunológicos para toxoplasmose, doença de Chagas, rubéola, citomegalovírus e sífilis e análise anatomopatológica nos restos ovulares. RESULTADOS: 55% das mulheres tinham entre 20 e 30 anos de idade. A maioria (68%) apresentou idade gestacional entre a 7ª e a 14ª semanas. 54,3% das mulheres tinham o ensino médio completo ou incompleto. Pela análise da sorologia, a infecção com risco de transmissão vertical mais frequente foi o citomegalovírus (CMV) com 97,1% de positividade, e em seguida a rubéola, com 95,2%. A toxoplasmose teve um percentual de 54,3%, a doença de Chagas, de 1,9% e a sífilis, de 0,95%. A análise dos laudos de biópsia demonstrou que 63,1% apresentaram inflamação e 34%, ausência de inflamação. Das análises sorológica, anatomopatológica e parasitológica das 105 mulheres, 57 foram soropositivas para T. gondii, e nenhuma teve resultado positivo para a Reação em Cadeia da Polimerase (PCR) e para inoculação em camundongos. CONCLUSÕES: A prevalência de doenças com risco de transmissão congênita nas mulheres com abortamento espontâneo é importante, sendo necessárias pesquisas visando esclarecer a etiologia do aborto. .
PURPOSE: To analyze the serological, anatomopathological and parasitological results obtained from abortive material in order to detect infections with the risk of vertical transmission, with emphasis on toxoplasmosis. METHODS: A cross-sectional cohort study was conducted in order to determine the prevalence of infectoparasitic diseases. A total of 105 women who suffered spontaneous complete or incomplete abortion participated in the study. The women were interviewed, answered a questionnaire and had their blood and abortive material collected. Immunological tests were carried out in order to detect toxoplasmosis, Chagas disease, rubeola, cytomegalovirus and syphilis, and anatomopathological analysis of the ovular remains was performed. RESULTS: 55% of the women studied were 20 to 30 years old. Most of them (68%) presented a gestational age between the 7th and 14th week. 54.3% of the women had complete or incomplete high school education. Serological analysis showed cytomegalovirus (CMV) as the most common vertically transmitted infection with 97.1% positivity, followed by rubeola with 95.2%. Toxoplasmosis showed 54.3% positivity, Chagas disease 1.9% and syphilis 0.95%. Anatomopathological analysis showed inflammation in 63.1% of the cases and absence of inflammation in 34%. The results of the serological, anatomopathological and parasitological analysis of the 105 participants showed that 57 women were T. gondii positive. However, none showed positivity in the polymerase chain reaction (PCR) or in mouse inoculation. CONCLUSIONS: The prevalence of diseases with the risk of vertical transmission is important in women with spontaneous abortion, indicating the need for more research in order to investigate the etiology of abortion. .
Assuntos
Adolescente , Adulto , Feminino , Humanos , Adulto Jovem , Aborto Espontâneo/sangue , Aborto Espontâneo/parasitologia , Transmissão Vertical de Doenças Infecciosas , Toxoplasmose/sangue , Toxoplasmose/transmissão , Aborto Espontâneo/microbiologia , Estudos de Coortes , Estudos Transversais , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , PrevalênciaRESUMO
BACKGROUND: This study evaluated serum vascular endothelial growth factor (VEGF) concentrations in women with ectopic pregnancy (EP), miscarriage, and normal pregnancy (NP). MATERIALS AND METHODS: This was a case-control study comparing serum VEGF concentrations among 72 women with ectopic pregnancy (n = 35), miscarriage (n = 15), and normal pregnancy (n = 22) matched for gestational age. For the determination of serum VEGF concentration a solid phase sandwich enzyme-linked immunosorbent assay (ELISA) was used. Patients were stratified according to serum VEGF above or below 200 pg/ml. RESULTS: The serum level of VEGF was significantly higher in women with EP (median 211.1 pg/ml; range 5-1,017.0 pg/ml) than in women with normal pregnancy (median 5 pg/ml; range 5-310.6 pg/ml) p < 0.0001. Serum VEGF concentrations did not show any statistically significant difference between women with miscarriage (median 231.9 pg/ml; range 5-813.7 pg/ml) and EP (median 211.1 pg/ml; range 5-1,017.0 pg/ml). When threshold concentrations of serum VEGF level > 200 pg/ml were used, an EP could be distinguished from a normal pregnancy with a sensitivity of 51.4%, a specificity of 90.9%, and a positive predictive value of 90%. Between EP and miscarriage, the sensitivity was 51.4%, specificity 42.8%, and a positive predictive value of 69.2%. CONCLUSIONS: Serum VEGF could not distinguish an EP from a miscarriage. However, serum VEGF concentrations could discriminate a normal intrauterine pregnancy (IUP) from an unviable pregnancy (EP or miscarriage).
Assuntos
Idade Gestacional , Gravidez Ectópica/sangue , Fator A de Crescimento do Endotélio Vascular/sangue , Aborto Espontâneo/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Gravidez , Sensibilidade e EspecificidadeRESUMO
El manual, corresponde a una estrategia para reducir la tasa de mortalidad materna en relación a la hemorragia obstétrica y como indica el documento: "El comportamiento de la morbi-mortalidad materna en los últimos diez años, ha situado a la hemorragia obstétrica en el primer lugar del país. Por lo anterior se priorizan las acciones que impacten en la reducción de la muerte materna implementando la estrategia de "Código Rojo", la cual estandariza los lineamientos técnicos, normativos y clínicos para la prevención y manejo de la hemorragia obstétrica y choque hipovolémico, respondiendo así al derecho reproductivo que establece que ninguna mujer debe morir por causas relacionadas al embarazo, parto y post parto." Código rojo
Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez/prevenção & controle , Choque/terapia , Hemorragia Uterina/mortalidade , Transfusão de Sangue , Trabalho de Parto , Mortalidade Materna/tendências , Parto Obstétrico/mortalidade , Parto Obstétrico/estatística & dados numéricos , Saúde Reprodutiva/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Aborto Espontâneo/sangue , Estatísticas de Saúde , Emergências , Monitoramento Epidemiológico , GuatemalaRESUMO
BACKGROUND: The alpha-fetoprotein (AFP) is a glycoprotein, which is produced by the human fetus. Previous studies have shown associations between elevated AFP levels and an increased risk of adverse perinatal outcomes. OBJECTIVE: To determine if abnormal AFP levels are associated with adverse perinatal outcomes. The AFP concentrations were calculated as Multiples of the medians (MoM). PATIENTS AND METHOD: A prospective cohort study, including 283 pregnant women, the maternal serum concentration of AFP was determined between 15 and 20 weeks of pregnancy, and the pregnancy was followed until term, when we search for the perinatal outcomes. The study was made in the Instituto Nacional de Perinatología, in Mexico City, from August 2007 to January 2008. For the analyses, the AFP concentrations were calculated as Multiples of the medians (MoM). RESULTS: The threshold of 1.5 MoM increases the risk for preterm delivery (RR: 1.77, IC 95%: 1.04-3.03), abruption placentae (RR: 3.67, IC 95%: 1.59-8.49), placenta accreta (RR: 3.67, IC 95%: 1.59-8.49) and for intrauterine growth restriction (RR: 2.86, IC 95%: 1.74-4.68) There was a weak relation between AFP concentration and birth weight (r = -0.12, p = 0.047) and no correlation with pregnancy weeks at birth. CONCLUSIONS: There is a relation between adverse perinatal outcome and abnormal AFP levels. The evidence of an increase in the AFP concentration in fetuses without congenital defects should alert de clinician about the possibility of other adverse perinatal outcomes and those results must be included in the prenatal risk assessment.
Assuntos
Resultado da Gravidez , alfa-Fetoproteínas/análise , Aborto Espontâneo/sangue , Descolamento Prematuro da Placenta/sangue , Adulto , Biomarcadores , Peso ao Nascer , Estudos de Coortes , Feminino , Ruptura Prematura de Membranas Fetais/sangue , Idade Gestacional , Humanos , Placenta Acreta/sangue , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro , Estudos Prospectivos , Medição de RiscoRESUMO
To analyze immunomodulating effects related to parity status, we studied trophoblast invasion grade, placental expression and systemic concentration of VEGF and its receptor Flt-1 in normal fertile (CBA/JxBALB/c) mice and abortion-prone (CBA/JxDBA/2) H-2(d)xH-2(k) mice. BALB/c or DBA/2 mated CBA/J females were, respectively, divided into the following groups: primiparous young (3.0+/-0.5 months old); primiparous old (8.5+/-0.5 months old) and multiparous old (8.5+/-0.5 months old, with 4 pregnancies). Immunohistochemical analysis of term placentae from both multiparous groups revealed various layers of invasive trophoblast tissue, identified as cytokeratin+/vimentin- cells, in contrast to the single layer detected in the placentae of primiparous animals, indicating that multiparity increases trophoblast invasion regardless of the success of the pregnancy outcome. Invasive trophoblast tissue from primiparous CBA/JxDBA/2 placentae showed diminished VEGF expression in comparison with the normal fertile group, while both multiparous groups demonstrated high expression of VEGF in the invasive trophoblast tissue. Placental expression of Flt-1 was similar in all groups. However, the primiparous CBA/JxBALB/c group showed the highest plasma concentration of sFlt-1 at term, while both multiparous groups demonstrated low circulating levels. No differences in circulating VEGF levels were observed among the groups. These results demonstrate an increase in trophoblast invasion tissue and expression of VEGF in the maternal-fetal interface in multiparous mice compared to primiparous mice. Moreover, the placenta appears to be able to regulate the circulating levels of VEGF by releasing sFlt-1.