losartan-potassium and Pre-Eclampsia

Oxidative stress is responsible for microvascular complications (hypertension, nephropathy, retinopathy, peripheral neuropathy) of diabetes, which during pregnancy increase both maternal and fetal complications. Chronic hypoxia and hyperglycemia result in increased oxidative stress and decreased antioxidant enzyme activity. However, oxidative stress induces also anti-oxidative reactions both in pregnant diabetes patients and in their fetuses. Not all type 1 diabetes patients with long-lasting disease develop microvascular complications, which suggests that some of these patients have protective mechanisms against these complications. Fetal erythropoietin (EPO) is the main regulator of red cell production in the mother and in the fetus, but it has also protective effects in various maternal and fetal tissues. This dual effect of EPO is based on EPO receptor (EPO-R) isoforms, which differ structurally and functionally from the hematopoietic EPO-R isoform. The tissue protective effects of EPO are based on its anti-apoptotic, anti-oxidative, anti-inflammatory, cell proliferative and angiogenic properties. Recent experimental and clinical studies have shown that EPO has also positive metabolic effects on hyperglycemia and diabetes, although these have not yet been fully delineated. Whether the tissue protective and metabolic effects of EPO could have clinical benefits, are important topics for future research in diabetic pregnancies.

Topics: Erythropoiesis; Erythropoietin; Female; Fetal Growth Retardation; Fetus; Humans; Hypoxia; Infant, Newborn; Oxidative Stress; Placenta; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Reactive Oxygen Species; Receptors, Erythropoietin

Topics: Blood Volume; Erythrocytes; Erythropoietin; Female; Hematocrit; Humans; Plasma Volume; Pre-Eclampsia; Pregnancy

Preeclampsia is a severe disease of late pregnancy. Etiological factors and a pathogenetic pattern of events still require significant clarification, but it is now recognized that a large role is played by placentation disorders and emerging endothelial dysfunction. The administration of short-chain peptides mimicking the spatial structure of the B erythropoietin chain may become one of the directions of searching for new drugs for preeclampsia prevention and therapy. Simulation of ADMA-like preeclampsia in Wistar rats was performed by the administration of a non-selective NOS blocker L-NAME from the 14th to 20th day of pregnancy. The administration of the pHBSP at the doses of 10 µg/kg and 250 µg/kg corrected the established morphofunctional disorders. The greatest effect was observed at a dose of 250 µg/kg. There was a decrease in systolic and diastolic blood pressure by 31.2 and 32.8%, respectively (

Topics: Animals; bcl-2-Associated X Protein; Blood Pressure; Disease Models, Animal; Endothelial Cells; Endothelium, Vascular; Erythropoietin; Female; Microcirculation; NG-Nitroarginine Methyl Ester; Oligopeptides; Placenta; Pre-Eclampsia; Pregnancy; Proto-Oncogene Proteins c-bcl-2; Rats; Rats, Wistar

The role of hepcidin in iron homeostasis in preeclamptic pregnant women is unclear. To test the hypothesis that increased serum iron in women diagnosed with preeclampsia results from decreased production of hepcidin, we performed an observational case-control study in which serum hepcidin concentration, dietary iron intake, hematological indices, iron status, liver function, and inflammatory markers in 18 preeclamptic women and 18 healthy normotensive pregnant women of similar age range were evaluated. Iron intake was established via a food frequency questionnaire, whereas hematological indices, iron status, liver function, and inflammatory markers were assessed using standard protocols. Hematocrit was significantly higher (P = .031) in the preeclamptic group compared with the control, whereas erythropoietin level was significantly lower (P = .003). The pronounced inflammatory status of preeclamptic women was confirmed by significantly higher concentrations of interleukin-6 (P = .001), tumor necrosis factor-α (P < .001), and ferritin (P < .001). Nonetheless, the preeclamptic group exhibited significantly higher serum iron (P = .012) and transferrin saturation (P = .006), and these alterations were accompanied by lower hepcidin levels (P = .047). No significant correlations between hepcidin concentration and iron status parameters were observed in either group. However, a positive and significant correlation between hepcidin concentration and C-reactive protein was observed in the preeclamptic group (r = 0.474; P = .047). We conclude that high serum iron in preeclamptic women is likely caused by low production of hepcidin, thus supporting the hypothesis originally stated.

Topics: Adolescent; Adult; C-Reactive Protein; Case-Control Studies; Diet Surveys; Erythropoietin; Female; Ferritins; Hematocrit; Hepcidins; Homeostasis; Humans; Inflammation; Interleukin-6; Iron; Iron Overload; Iron, Dietary; Nutritional Status; Pre-Eclampsia; Pregnancy; Transferrin; Tumor Necrosis Factor-alpha; Young Adult

To investigate the possible effect of abnormal placentation disorders such as preeclampsia (PE), pregnancy induced hypertension (PIH) and intrauterine growth restriction (IUGR) on erythropoietin (EPO) serum concentration in women in the first trimester of pregnancy.. A prospective study was performed in a group of pregnant women between 11 and 13⁺⁶ weeks' gestation. Serum concentration of EPO, beta HCG, PAPP-A and PlGF was measured. Mean arterial pressure (MAP) and uterine artery pulsatility index was calculated.. A group of 198 analyzed patients was divided into three groups depending on pregnancy outcome: abnormal placentation group (n=30), macrosomia (n=13) and control group (n=155). EPO concentrations between the three groups of patients revealed that they differ significantly (F=15.172, P<0.001). EPO concentration is significantly higher in abnormal placentation patients compared to the control group (P<0.001) and macrosomia group (P=0.004). The most significant increase in EPO concentration was detected within patients with PIH. Also the uterine artery pulsatility index was positively correlated with EPO concentration (P<0.01).. First-trimester maternal EPO concentration might be considered as a possible marker of abnormal placentation disorders and should be given more attention in future prospective studies.

Topics: Adult; Biomarkers; Erythropoietin; Female; Humans; Placentation; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Reference Values

Preeclampsia has been shown to be associated with an increased number of fetal and maternal erythroblasts in the maternal circulation, suggesting that preeclampsia involves increased leakage of fetal cells across the placental barrier, as well as increased erythropoiesis. We examined the relationship between circulatory erythroblast levels with maternal plasma concentrations of erythropoietin and activin A.. In a case-control study, we examined 15 pregnancies affected by preeclampsia and 10 matched controls. Erythroblasts were enriched from maternal blood samples by magnetic cell sorting, enumerated and correlated with corresponding plasma activin A and erythropoietin concentrations.. The proportion of erythroblast was elevated in preeclampsia (0.8 vs. 0.1%, p = 0.023). Erythropoietin and activin A concentrations were significantly elevated in preeclampsia (100.4 vs. 44.5 pg/ml, p = 0.023, and 7.4 vs. 1.85 ng/ml, p = 0.029, respectively). Circulatory erythroblast numbers were found to correlate with plasma activin A concentrations (r = 0.76, p = 0.01) in cases with preeclampsia. No such relationship existed for erythropoietin.. Our data suggest that increased concentrations of activin A promote enhanced levels of erythropoiesis in preeclampsia. As the placenta is one of the major sources of activin A in pregnancy, this increase in activin A-dependent erythropoiesis in preeclampsia may be a reflection of an underlying placental hypoxic condition.

Topics: Activins; Erythroblasts; Erythropoiesis; Erythropoietin; Female; Humans; Inhibin-beta Subunits; Placental Circulation; Pre-Eclampsia; Pregnancy

Controversy exists in the literature regarding the association between erythropoietin levels and preeclampsia. This study was aimed to compare serum erythropoietin concentrations among patients with and without preeclampsia.. A prospective study was designed and two groups were defined: 22 patients with preeclampsia (study group) and 19 normotensive patients (control group). Preeclampsia was defined as blood pressure higher than 140 mmHg systolic or 90 mmHg diastolic and proteinuria > 300/24 h or dipstick > 1. Women in the control group were matched for gestational age. Blood was collected in tubes containing EDTA, and centrifuged in 4 degrees C within 30 min of collection. Serum erythropoietin level was determined by ELISA (R&D Systems, Inc. Minneapolis, USA). Statistical analysis was performed using the SPSS package.. Erythropoietin concentration was higher among patients with preeclampsia, but did not reach significance (24.8 +/- 8.9 mU/ml vs. 19.9 +/- 9.9 mU/ml; P-0.19). Also, hemoglobin and hematocrit levels were similar in both groups (12.0 +/- 4.2 g/dl vs. 11.6 +/- 3.9 g/dl; P-0.16 and 36.5 +/- 10.8% vs. 35.3 +/- 11.4%; P-0.13, respectively).. A nonsignificant trend towards higher maternal serum levels of erythropoietin was demonstrated among patients with preeclampsia. Further prospective studies are needed to investigate the association between preeclampsia and erythropoietin.

Topics: Adult; Case-Control Studies; Erythropoietin; Female; Humans; Pre-Eclampsia; Pregnancy; Prospective Studies

Anemia is common in patients with chronic kidney disease (CKD) and those who have received a kidney allograft. Anemia is most prevalent in kidney transplant recipients before and immediately after transplantation, but also can occur months after transplantation if the donor kidney begins to fail. Replacement therapy for CKD-related and posttransplantation anemia is effective through the administration of exogenous erythropoiesis-stimulating proteins. Darbepoetin alfa (Aranesp; Amgen Inc, Thousand Oaks, CA) is a unique erythropoiesis-stimulating protein that can be administered at an extended dosing interval relative to recombinant human erythropoietin because of its approximately 3-fold longer serum half-life. Although darbepoetin alfa has been shown to be an effective treatment for patients with anemia of CKD and anemia after kidney transplantation, limited data have been published showing efficacy in treating women with anemia of these conditions during pregnancy. We report a case of successful darbepoetin alfa treatment for severe anemia in a pregnant transplant recipient.

Topics: Adult; Anemia; Cesarean Section; Contraindications; Cyclosporine; Darbepoetin alfa; Erythropoietin; Female; Ferrous Compounds; Humans; Hydronephrosis; Immunosuppressive Agents; Kidney Transplantation; Nephrostomy, Percutaneous; Postoperative Complications; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy, High-Risk; Puerperal Disorders; Seizures; Sirolimus; Stents; Treatment Refusal

The purpose of the present study was to compare fetal and neonatal outcomes with amniotic fluid erythropoietin (EPO) levels obtained in the antepartum period in pregnancies complicated by preeclampsia, pregnancy-induced hypertension or chronic hypertension.. Erythropoietin concentrations were measured in amniotic fluid within 2 days before delivery and in cord blood at birth in 75 hypertensive women and in 23 healthy controls delivered by cesarean section before labor contractions. Erythropoietin levels did not influence clinical decisions.. Amniotic fluid erythropoietin levels correlated highly significantly with cord plasma EPO levels and were significantly higher in pregnancies complicated by hypertension than in control pregnancies. Umbilical arterial pH, acid-base and blood gas values at birth were not different from controls. Both cord plasma and amniotic fluid erythropoietin levels correlated with cord blood pH, acid-base and blood gas values at birth in the study group. Newborn infants admitted to the newborn intensive care unit had significantly higher fetal erythropoietin levels and were more acidotic, hypoxemic and hypoglycemic than infants admitted to the normal care nursery.. Our findings suggest that elevated amniotic fluid erythropoietin levels are markers of chronic or subchronic fetal hypoxia and are associated with neonatal morbidity in pregnancies complicated by hypertension.

Topics: Adult; Amniotic Fluid; Biomarkers; Case-Control Studies; Erythropoietin; Female; Fetal Blood; Fetal Hypoxia; Gestational Age; Humans; Hypertension; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; ROC Curve

Management of renal anemia in pregnancy remains a major issue. We report the use of human recombinant erythropoietin (rhEPO) combined with parenteral iron sucrose in a pregnancy with chronic glomerulonephritis, progressive anemia and initially normal blood pressure. Therapy from 32 weeks gestation increased the hematocrit by 0.4% daily and the hemoglobin from 8.6 to 10.3 g/dL within 2 weeks. Despite the improvement of anemia, Cesarean section had to be performed at 34 weeks due to acute hypertension, preeclampsia and worsening renal function. Blood pressure remained elevated postpartum. Because of symptomatic postpartum anemia with a hemoglobin of 7.5 g/dL on the 5th postoperative day rhEPO in combination with parenteral iron sucrose was readministered over 3 following days. Blood pressure reached a maximum of 210/130 mm Hg 3 weeks later. Possible causes include advancing preeclampsia and renal disease, but also rhEPO (due to its intrinsic vascular effects and/or the rapid response of the hematocrit), and a combination of both.

Topics: Adult; Anemia; Erythropoietin; Female; Glomerulonephritis; Humans; Pre-Eclampsia; Pregnancy; Puerperal Disorders; Recombinant Proteins

To examine erythropoiesis in renal transplant pregnancies.. Retrospective cohort study of 30 renal transplant cases and 30 age, smoking and parity-matched healthy controls with normal index pregnancy. Retrospective chart review and assay of frozen antenatal serum (for serum erythropoietin concentration [serum EPO]), transferrin receptor protein [TfR], ferritin, folate and B12) were performed. The linear regression equation for normal pregnancy controls was used to calculate predicted [serum EPO] and the observed/predicted (O/P) log [serum EPO] was plotted. The relationship between [serum EPO] and haemoglobin (Hb) among transplant cases was considered to be different from that among controls if the slope of the O/P log [serum EPO] versus Hb regression was significantly different from zero.. The transplant (14 cadaveric) to conception interval was (median [range]) 33.5 [4, 189] months. Immunosuppressants were azathioprine (n = 25), cyclosporine (n = 22) and/or prednisone (n = 25). Cases were more often primiparous (20 vs. 7 [controls]; p = 0.01), had pre-existent hypertension (20 vs. 0 [controls]; p < 0.001), developed new/increased hypertension or pre-eclampsia (28 vs. 0 [controls]; p < 0.001) and an antenatal rise in creatinine (14 vs. 2 [controls]; p < 0.001). In early pregnancy, cases had similar EPO (15.2 [2.6, 84.6] vs. 15.7 [6.4, 41.0] [controls] U/L) but lower Hb (101 [65, 129] vs. 116 [106, 150] g/L; p < 0.001). Twenty-two (73%) cases had Hb < 100 g/L (vs. 4 [controls]; p < 0.0001); Hb was comparable at 6 wk postpartum. With advancing gestational age (GA), Hb remained stable and serum EPO increased in both groups. The slope of the O/P log [serum EPO] versus Hb for transplant cases was significantly different from zero within both the 17-28 wk (slope +/- SEM: 0.010 +/- 0.002; p < 0.0001) and the 29-42 wk GA categories (0.006 +/- 0.003; p = 0.02). Cases showed smaller rises in serum TfR (change 481 [- 1471, 2780]) vs. 1119 [- 698, 4195] [controls] ng/mL; p = 0.005).. Anaemia frequently complicates renal transplant pregnancies, in which serum EPO is inappropriately low and the rate of erythropoiesis blunted.

Topics: Adult; Anemia; Case-Control Studies; Cohort Studies; Creatinine; Erythropoiesis; Erythropoietin; Female; Ferritins; Folic Acid; Gestational Age; Hemoglobins; Humans; Hypertension; Immunosuppressive Agents; Kidney Transplantation; Linear Models; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Hematologic; Receptors, Transferrin; Retrospective Studies; Time Factors; Vitamin B 12

Our purpose was to evaluate and compare erythropoietin levels as related to obstetric conditions, including acute and chronic bleeding, preeclampsia, and multiple gestations.. During April 1999 all women in the labor and delivery unit with delivery expected to occur within 24 to 72 hours of admission had erythropoietin and hematocrit values obtained. First-trimester hematocrit values, obstetric problems, medications, and history of vaginal bleeding were obtained from patient interview, examination, and the prenatal record. Statistics were analyzed by the Student t test and chi(2).. During a 1-month period, 302 consecutive women were divided into 5 groups on the basis of obstetric events. Group 1 consisted of women with normal, uncomplicated term singleton gestations (n = 230); group 2, women with acute vaginal bleeding (n = 10); group 3, women with chronic vaginal bleeding (n = 29); group 4, women with multiple gestations (n = 13); and group 5, women with preeclampsia (n = 16). The mean erythropoietin level in group 1 (20. 2 +/- 10.3 mU/mL) was significantly different from values in the other 4 groups (group 2, 74.2 +/- 29.2 mU/mL; group 3, 65.0 +/- 33.0 mU/mL; group 4, 34.8 +/- 16.8 mU/mL; group 5, 43.4 +/- 11.4 mU/mL; P <.001). The admission hematocrit for group 1 (0.369 +/- 0.029) was significantly greater than for groups 2 and 3 (group 2, 0.323 +/- 0. 024; group 3, 0.321 +/- 0.023; P <.001) and significantly lower than for group 5 (0.384 +/- 0.022; P <.05).. The maternal serum erythropoietin level varies depending on the events occurring during gestation. Acute and chronic bleeding, multiple gestations, and preeclampsia are all associated with various serum erythropoietin levels.

Topics: Cesarean Section; Erythropoietin; Female; Gestational Age; Hematocrit; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Reference Values; Uterine Hemorrhage

The estimation of cord blood erythropoietin in subjects with pre-eclampsia and eclampsia.. Erythropoietin was measured, using ELISA, in the cord blood of infants born to 83 mothers with pre-eclampsia, and 7 with eclampsia. Another 90 subjects with no evidence of pre-eclampsia or eclampsia were taken as control subjects. Maternal parity, gestational age, blood pressures, 24-h urine protein and Apgar scores of the infants delivered were also noted.. Cord blood erythropoietin levels were statistically significantly higher (P<0.001) in infants born to mothers with pre-eclampsia and eclampsia. There was a significant positive correlation (P<0.01) between cord blood erythropoietin levels and maternal blood pressure (systolic and diastolic) and albuminuria. A negative correlation (P<0.01) was observed with the birth weights of infants.. Pre-eclampsia and eclampsia are associated with higher levels of cord blood erythropoietin.

Topics: Adult; Albuminuria; Apgar Score; Biomarkers; Birth Weight; Blood Pressure; Case-Control Studies; Eclampsia; Enzyme-Linked Immunosorbent Assay; Erythropoietin; Female; Fetal Blood; Gravidity; Humans; Hydrogen-Ion Concentration; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Uric Acid

This paper is a summary of results obtained in our studies on leptinemia in patients with chronic renal failure treated with recombinant human erythropoietin (rHuEPO), in kidney transplant patients, in patients with essential hypertension, and in pregnant women with preeclampsia. In this study, we found that rHuEPO treatment has a suppressive effect on leptinemia in patients with endstage renal failure. These results suggest that the appetite stimulating effect of rHuEPO may be mediated by a reduction of leptin synthesis and release. At the early stage of successful kidney transplantation, a significant decline of leptinemia was noticed, which was not related either to the excretory function of the graft or the kind and dose of immunosuppressants. In kidney transplant patients with grafts functioning well for 2.5 years, significantly elevated leptinemia was found. From these results, we may conclude that factors other than the excretory function of the graft and the kind and dosage of immunosuppressants may be involved in the pathogenesis of abnormal leptinemia in these patients. Both in normotensive subjects and patients with essential hypertension, a positive correlation was found between leptinemia and mean blood pressure, suggesting that leptin may be involved in the regulation of blood pressure. Both healthy and preeclamptic pregnant women show higher leptinemia than nonpregnant women. In preeclamptic women, leptin levels in maternal vein blood, umbilical cord blood, and amniotic fluid were significantly higher than respective values found in healthy pregnant women. In contrast to healthy pregnant and nonpregnant women, in women with preeclampsia, no correlation was found between the body mass index (BMI) and leptinemia. In preeclamptic women the abnormally elevated leptinemia was not related to blood pressure. Finally, no correlation was found between leptinemia in maternal and umbilical cord blood. From these studies, it follows that the elucidation of abnormal leptin secretion in the pathogenesis of preeclampsia needs further study.

Topics: Adipose Tissue; Amniotic Fluid; Appetite; Blood Pressure; Blood Proteins; Body Mass Index; Erythropoietin; Female; Fetal Blood; Humans; Hypertension; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Leptin; Pre-Eclampsia; Pregnancy; Proteins

Nonclassical sites of erythropoietin (EPO) and erythropoietin receptor (EPO-R) expression have been described that suggest new physiological roles for this hormone unrelated to erythropoiesis. The recent finding of EPO expression by trophoblast cells in the human placenta prompted us to consider whether these cells also express EPO-R. With use of immunocytochemistry, EPO-R was identified in villous and extravillous cytotrophoblast cells, as well as in the syncytiotrophoblast at all gestational ages. EPO-R was also expressed by cells within the villous core, including endothelial cells of fetoplacental blood vessels. Placental tissues and isolated and immunopurified trophoblast cells, as well as trophoblast-derived choriocarcinoma Jar cells, expressed immunoreactive EPO-R on Western blot. EPO-R mRNA was also detected in the same placental tissues and trophoblast cells by nested-primer reverse transcription-polymerase chain reaction. Finally, EPO-R was functional insofar as the receptor was phosphorylated on tyrosine residues in response to exogenous EPO treatment of cultured trophoblast or Jar cells. Thus, the present findings support the hypothesis that trophoblast cells of the human placenta express EPO-R. In view of these results, taken together with previous work demonstrating EPO expression by the same cells, an autocrine role for this hormone in the survival, proliferation, or differentiation of placental trophoblast cells is proposed.

Topics: Blotting, Western; Cells, Cultured; Erythropoietin; Female; Gene Expression; Gestational Age; Humans; Immunohistochemistry; Phosphorylation; Phosphotyrosine; Placenta; Pre-Eclampsia; Pregnancy; Receptors, Erythropoietin; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Trophoblasts

The fetal liver is the main hematopoietic organ during intrauterine life. Morphometrical studies were performed on liver sections to detect changes occurring with intrauterine growth retardation and preeclampsia. Compared with the controls (n = 10), fetuses from preeclamptic mothers showed a severe reduction of erythroid cells by 60% on average (n = 18). Closer examination revealed that the erythroid cells at early stages of differentiation were more affected (80% reduction) than at later stages (55%). Seven out of 18 fetuses from preeclamptic mothers did not show growth retardation but exhibited severely reduced hepatic erythropoiesis. We suggest that the prime factor for impaired red blood cell production is preeclampsia itself rather than intrauterine growth retardation. Regulation of erythropoiesis in utero might depend on the interaction of many hematopoietic growth factors, and preeclampsia might alter the balance. To test this notion, we quantitated erythropoietin in fetal blood and various cytokines in the amniotic fluid. An elevation of erythropoietin and interleukin (IL)-3 levels was seen in babies born under the conditions of preeclampsia, whereas the concentrations of granulocyte/macrophage-colony-stimulating factor (CSF), granulocyte-CSF, and IL-1 beta were reduced, and the levels of IL-6 and IL-8 remained constant. With preeclampsia, a discrepancy between elevation of erythrocyte numbers in peripheral blood and depression of hematopoiesis at the main production site, the fetal liver, is seen. Concomitantly, there is elevation of some but reduction of other hematopoietic cytokines. We envision that during the course of preeclampsia quantitation of hematopoietic growth factors might allow to predict the deterioration of in utero life conditions.

Topics: Amniotic Fluid; Case-Control Studies; Cytokines; Erythropoiesis; Erythropoietin; Female; Fetal Blood; Fetal Growth Retardation; Fetus; Hematopoietic Cell Growth Factors; Humans; Liver; Maternal-Fetal Exchange; Pre-Eclampsia; Pregnancy

To determine if diabetes and preeclampsia are independent stimulators of erythropoietin, distinct from hypoxia, we measured umbilical cord plasma erythropoietin in 239 deliveries from 24 to 40 weeks of gestation. Mean plasma erythropoietin levels were not different between normal, diabetic, and preeclamptic women when all deliveries were analyzed. When infants with suspected intrauterine hypoxia were excluded, the mean erythropoietin level was considerably lower within all three groups but there was no difference among the groups. In suspected hypoxia, the mean fetal erythropoietin was elevated, but there was no difference between control, diabetic, or preeclamptic pregnancies. These results provide further support that hypoxia remains the only known stimulator of erythropoietin production in the fetus.

Topics: Erythropoietin; Female; Fetal Hypoxia; Fetus; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics

Topics: Amniocentesis; Amniotic Fluid; Erythropoietin; Female; Fetal Hypoxia; Humans; Hypertension; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy Complications

To investigate the concentrations of amniotic fluid erythropoietin in normal and risk pregnancies.. The concentrations of erythropoietin were measured in 150 samples of amniotic fluid. The samples were obtained by amniocentesis and amniotomia and were analysed using an enzyme-linked immunosorbent assay (ELISA). Results were available within 6 hours. The intra-assay variation was 6.4%, the inter-assay variation 7.2%.. The range of erythropoietin concentration in all samples was between 0.23 and 80 U/L and in a defined group of normal pregnancies between 1.20 and 6.53 U/L (10%-90% percentile). Correlation was found between the concentration of erythropoietin and maternal hypertension (p = 0.0159), amnion infection syndrome in combination with premature birth (p = 0.0593), fetal growth retardation (p = 0.784), and base-excess (p = 0.0487). Elevated erythropoietin concentrations were found in a defined risk group with Apgar scores below 7 after 1 minute (p = 0.072) and after 5 minutes (p = 0.0037). There is a connection between postpartal transfer to the intensive-care unit and elevated erythropoietin concentrations (p = 0.073). No influence is exercised by the child's sex on the concentration of erythropoietin. No significant connection was found between the level of erythropoietin and smoking during pregnancy, volume of amniotic fluid and maturity at birth. A critical erythropoietin concentration could be postulated at 12 U/L. Children with higher levels showed heavy and severe disorders.. Elevated erythropoietin levels in amniotic fluid indicate prolonged fetal hypoxaemia. Using the ELISA-technique a rapid prepartal determination of such situations is possible and might be helpful in the clinical procedure.

Topics: Adolescent; Adult; Amniocentesis; Amniotic Fluid; Enzyme-Linked Immunosorbent Assay; Erythropoietin; Female; Fetal Growth Retardation; Fetal Hypoxia; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Pregnancy, High-Risk; Reference Values

Meticulous glucose control that begins long before conception is fundamental to protecting the fetus and mother. Maternal hypertension, retinopathy, renal disease, and neuropathy may lead to complications, but optimal education, care, and fetal monitoring can reduce the risks.

Topics: Adult; Algorithms; Antihypertensive Agents; Blood Glucose Self-Monitoring; Cesarean Section; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Erythropoietin; Female; Fetal Monitoring; Humans; Hypertension; Infant, Newborn; Insulin; Male; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Pregnancy, High-Risk; Prenatal Care

In this study we determine the erythropoietin levels and hematocrit in 22 women with preterm labor, 21 with insulin-dependent diabetes, 22 with preeclampsia, and 20 with normal gestation. The erythropoietin level was higher in the preeclamptic group than in the diabetic group compared with the normal and premature groups. There were no hypoxic fetuses. From this study, we found that the mechanism of increased erythropoietin levels in neonates can be different from fetal hypoxia. Further studies are needed on this subject.

Topics: Adult; Birth Weight; Diabetes Mellitus, Type 1; Erythropoietin; Female; Fetal Blood; Humans; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Prospective Studies

We have investigated the relationship between erythropoietin (Epo) and pH, PaO2 and haematocrit in 100 cord blood samples obtained at Caesarean section prior to labour. Of 82 term (> 37 weeks) infants, 64 were appropriately grown (10th-90th centiles), and their mean cord serum Epo and cord blood Epo was 23 +/- 8 mU/ml (mean +/- SD). Strong inverse correlations were found between cord serum Epo and cord blood pH (r = -0.74; p < 0.0001), and between cord serum Epo and cord blood PaO2 (r = -0.55; p < 0.0001), but not between cord serum Epo and cord haematocrit (r = 0.02; p < 0.9). For the 18 preterm babies (gestation 32.4 +/- 4.1 weeks, birth weight 1,820 +/- 476 g), the Epo level was 36 +/- 8 mU/ml, which was not significantly greater than for the term babies. Strong inverse correlations were again found between Epo and pH (r = -0.87; p < 0.0001) and Epo and PaO2 (r = -0.69; p < 0.002). Babies from complicated pregnancies (intra-uterine growth retardation, pre-eclampsia, antepartum haemorrhage, diabetes mellitus and fetal distress) tended to have higher Epo levels. Thirteen babies had Epo levels > 40 mU/ml, and 11 (85%) of these required neonatal intensive care. Cord serum Epo correlates better with oxygen tension and pH at birth than with fetal growth and haematocrit, which are measures of chronic stress to the fetus.

Topics: Cesarean Section; Cordocentesis; Diabetes Mellitus, Type 1; Erythropoietin; Female; Fetal Blood; Fetal Distress; Fetal Growth Retardation; Fetal Hypoxia; Hematocrit; Humans; Hydrogen-Ion Concentration; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Oxygen; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Uterine Hemorrhage

Topics: Adult; Anemia; Autonomic Nervous System; Blood Pressure; Dopamine beta-Hydroxylase; Erythropoietin; Female; Glomerulonephritis; Humans; Male; Middle Aged; Nephritis; Norepinephrine; Pre-Eclampsia; Pregnancy; Recombinant Proteins; Renal Dialysis

To investigate the possible effect of preeclampsia on erythropoietin metabolism, we measured plasma and urine erythropoietin concentrations and complete blood count in 19 women with preeclampsia and nine healthy gravidas. Hemoglobin concentration and hematocrit values in the preeclamptic patients did not differ significantly from those of the normal pregnant controls. However, the plasma erythropoietin concentration tended to be higher in the preeclamptic group than in the normal pregnant controls (26.9 +/- 31.2 versus 11.2 +/- 9.9 mU/mL), though the difference was not statistically significant. Plasma erythropoietin concentration correlated negatively with both hemoglobin concentration and hematocrit (r = -0.85, P less than .01). The pattern and magnitude of the erythropoietin response to anemia paralleled that previously reported in individuals with iron deficiency anemia. No significant correlation was found between urinary erythropoietin excretion and blood pressure, qualitative albumin excretion, hematocrit, hemoglobin concentration, or plasma erythropoietin concentration. Based on our results, the erythropoietin response to anemia appears to be intact in preeclampsia, at least in the absence of renal failure.

Topics: Adult; Albuminuria; Blood Cell Count; Blood Pressure; Creatine; Erythropoietin; Female; Humans; Pre-Eclampsia; Pregnancy; Proteinuria; Thrombocytopenia; Uric Acid

To assess the immediate postnatal changes of serum immunoreactive erythropoietin (EP) in infants born after acute or chronic fetal hypoxia, and to estimate the rate of EP disappearance, we studied EP concentration, measured by double-antibody radioimmunoassay, in cord venous plasma and in serum at a mean age of 8 hours in a control group (n = 9) and in three patient groups: (1) infants with polycythemia (n = 10), (2) infants born to mothers with preeclampsia of pregnancy, without (n = 22) or with (n = 11) acidosis at birth, and (3) infants with acute birth asphyxia (n = 19), seven of whom had postnatal hypoxia. In all patient groups, cord venous EP was elevated in comparison with values in control infants. No change was found in EP level between birth and 8 hours in control infants (geometric mean in cord and 8-hour sample: 20 and 16 mU/ml, not significant) or in acutely asphyxiated infants with postnatal hypoxia (122 and 72 mU/ml, not significant), whereas the EP level decreased in all other groups: infants with polycythemia (123 to 24 mU/ml, p less than 0.001), nonacidotic infants (78 to 26 mU/ml, p less than 0.001) and acidotic infants (176 to 38 mU/ml, p less than 0.001) of the preeclampsia group, and acutely asphyxiated infants without postnatal hypoxia (58 to 30 mU/ml, p less than 0.001). The mean (+/- SD) half-time of EP disappearance was 2.6 +/- 0.5 hours in infants with polycythemia and 3.7 +/- 0.9 hours in infants of the preeclampsia group.

Topics: Acidosis; Apgar Score; Asphyxia Neonatorum; Erythropoietin; Female; Fetal Blood; Fetal Hypoxia; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Polycythemia; Pre-Eclampsia; Pregnancy; Time Factors

To assess the value of cord plasma arginine vasopressin (AVP), erythropoietin (EP), and hypoxanthine (HX) as indices of asphyxia, we studied 62 infants of mothers with preeclampsia, 34 acutely asphyxiated infants, with 5-min Apgar score less than or equal to 6 and/or umbilical arterial pH less than or equal to 7.05, and 38 control infants. Umbilical arterial AVP in the asphyxia group (geometric mean; 95% confidence interval: 180; 92-350 pg/ml) was higher than in the control group (23; 8-66, p = 0.002) and correlated with umbilical arterial pH (r = -0.447, p = 0.028). AVP levels in the preeclampsia group did not differ from controls. Cord venous EP was higher in infants delivered by elective cesarean section from women with severe preeclampsia (115; 75-177 mU/ml, p less than 0.001) than in control infants (23; 18-27); in the whole group EP correlated with pH (r = -0.493, p less than 0.001). EP in the asphyxia group was similar (46; 35-65) to controls (40; 33-47) and did not correlate with pH. Cord arterial HX in the preeclampsia group was similar to controls (12.3; 9.5-16.0 mumol/liter), but elevated in the asphyxia group (23.7; 17.6-31.8, p = 0.001), in which HX correlated with pH (r = 0.558, p = 0.008) and AVP (r = 0.588, p = 0.005). EP did not correlate with AVP or HX in any group, nor did any of the variables correlate with the Apgar score. We conclude that cord plasma AVP and HX reflect acute asphyxia, whereas EP is elevated after more prolonged hypoxia.

Topics: Apgar Score; Asphyxia Neonatorum; Erythropoietin; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Hypoxanthine; Hypoxanthines; Infant, Newborn; Male; Pre-Eclampsia; Pregnancy; Vasopressins

For an assessment of whether cord plasma arginine vasopressin, erythropoietin, and hypoxanthine concentrations are predictors of perinatal brain damage, these concentrations were measured in 62 infants born after preeclampsia of pregnancy, 31 acutely asphyxiated infants, and 38 control infants. Follow-up at 2 years included neurologic examination and the determination of a Bayley mental score. Clear abnormality (death, cerebral palsy, or developmental delay) was found in four infants in the preeclampsia group and five in the asphyxia group; slight abnormality was found in 12 and 6 infants, respectively; and no abnormality was found in the remainder. Neither arginine vasopressin values nor hypoxanthine values predicted adverse outcome in either study group. A high erythropoietin level was found in infants born after preeclampsia regardless of outcome: normal outcome (geometric mean (GM), 102; 95% confidence interval [CI], 69 to 153 mU/ml), slightly abnormal outcome (GM, 100; 95% CI, 37 to 270 mU/ml) or clearly abnormal outcome (GM, 84; 95% CI, 19 to 378 mU/ml). However, asphyxiated infants with clearly abnormal outcome had higher erythropoietin values (GM, 67; 95% CI, 33 to 137 mU/ml; p less than 0.05) than the normal infants (GM, 37; 95% CI, 23 to 59 mU/ml). We conclude that a high erythropoietin level after normal pregnancy, but not after preeclampsia, indicates an increased risk for cerebral palsy or death.

Topics: Arginine Vasopressin; Asphyxia Neonatorum; Brain Damage, Chronic; Cerebral Palsy; Erythropoietin; Female; Fetal Blood; Humans; Hypoxanthine; Hypoxanthines; Infant, Newborn; Male; Pre-Eclampsia; Pregnancy; Prognosis

Topics: Erythropoietin; Female; Humans; Intestinal Absorption; Iron; Pre-Eclampsia; Pregnancy

Topics: Anemia, Hypochromic; Animals; Erythropoiesis; Erythropoietin; Female; Humans; Iron; Kidney; Mice; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic

Topics: Acute Kidney Injury; Adult; Anemia; Animals; Blood Platelets; Disseminated Intravascular Coagulation; Erythropoietin; Female; Folic Acid; Hemolysis; Humans; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Polycythemia; Pre-Eclampsia; Pregnancy; Rabbits; Renal Dialysis; Transplantation, Homologous

Topics: Amniotic Fluid; Anemia, Aplastic; Animals; Biological Assay; Erythroblastosis, Fetal; Erythrocytes; Erythropoietin; Female; Fetal Diseases; Hemoglobinometry; Humans; Hypoxia; Infant, Newborn; Iron; Iron Isotopes; Maternal-Fetal Exchange; Mice; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Uremia

Topics: Anemia; Animals; Erythropoiesis; Erythropoietin; Female; Humans; Injections, Intraperitoneal; Injections, Intravenous; Iron Isotopes; Mice; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Pyelitis