Publications by authors named "Uwe Lang"

90 Publications

Androgen and Anti-Mullerian Hormone Concentrations at Term in Newborns and Their Mothers with and without Polycystic Ovary Syndrome.

J Clin Med 2019 Nov 1;8(11). Epub 2019 Nov 1.

Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria.

The aetiology of polycystic ovary syndrome (PCOS) is not particularly mapped; however, a complex interaction of various factors, such as genetic, environmental and intrauterine factors, can be assumed. Experimental animal studies and clinical observations support the hypothesis that developmental programming by excess intrauterine steroid is relevant. The aim of the study was to investigate whether mothers with and without PCOS exhibit different androgen and anti-Mullerian hormone (AMH) levels at the end of pregnancy and how maternal hormone levels are reflected in their offspring. Between March 2013 and December 2015, we performed a prospective cross-sectional study at the Medical University of Graz. We included 79 women with PCOS according to the ESHRE/ASRM 2003 definition and 354 women without PCOS, both with an ongoing pregnancy ≥37 + 0 weeks of gestation, who gave birth in our institution. Primary outcome parameters were the levels of maternal and neonatal androgens (testosterone, free testosterone, androstenedione) and AMH at delivery. Androgen levels in female offspring of PCOS and non-PCOS women at birth did not differ, while maternal hormone levels differed significantly. Androgen levels in PCOS boys were significantly higher when compared to levels in PCOS girls. Our findings do not support the hypothesis that maternal androgen excess contributes to elevated androgen concentrations in the female offspring. Nevertheless, the effects of the increased androgen concentrations in mothers on their offspring have to be investigated in future studies.
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http://dx.doi.org/10.3390/jcm8111817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912752PMC
November 2019

Changes of platelet count throughout pregnancy in women with antiphospholipid syndrome.

J Reprod Immunol 2019 11 16;136:102612. Epub 2019 Sep 16.

Medical University Graz, Auenbruggerplatz 14, 8036, Graz, Austria.

Objective: Antiphospholipid antibodies (aPL) activate several cell types, such as endothelial cells, monocytes, neutrophils, fibroblasts, trophoblasts and platelets, thus leading to thrombosis and obstetric complications in patients with antiphospholipid syndrome (APS). The aim of the present study was the longitudinal investigation of platelet count in women with APS. Additionally, platelet count in women with APS who developed preeclampsia during pregnancy were compared to women with APS and uncomplicated pregnancy for potential early detection of preeclampsia.

Material And Methods: This longitudinal study included 65 women with APS, 38 women with preeclampsia and 84 women with normal pregnancies, where platelet count was determined every four weeks, starting in early pregnancy.

Results: Platelet count was significantly lower in women with APS compared to women who developed preeclampsia and normal pregnancies starting at 12 weeks of gestation. The areas under the curve (AUC) for platelet count were 0.765 at 12 weeks of gestation (95% of CI of 0.634-0.896), 0.747 at 20 weeks (95% of CI of 0.600-0.894), 0.719 at 24 weeks (95% of CI of 0.555-0.882), respectively. The cut off points for platelets were 216 at 12-14 weeks of gestation, 226.5 at 20 weeks of gestation, and 163.5 at 24 weeks of gestation, respectively.

Discussion: We demonstrated a significant lower platelet count in women with APS throughout gestation. Additionally, platelet count is significantly decreased in women with APS who developed preeclampsia. According to our results, platelet count seems to have a predictive value for the development of preeclampsia in these women.
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http://dx.doi.org/10.1016/j.jri.2019.102612DOI Listing
November 2019

Effect of Low-Dose Aspirin on Soluble FMS-Like Tyrosine Kinase 1/Placental Growth Factor (sFlt-1/PlGF Ratio) in Pregnancies at High Risk for the Development of Preeclampsia.

J Clin Med 2019 Sep 10;8(9). Epub 2019 Sep 10.

Department of Obstetrics and Gynecology, Division of Obstetrics, Medical University of Graz, A-8036 Graz, Austria.

Background: Soluble FMS-like Tyrosine Kinase 1 (sFlt-1) and placental growth factor (PlGF) have been reported to be highly predictive several weeks before the onset of preeclampsia.

Objective: To investigate longitudinal changes of serum levels sFlt-1 and PlGF in pregnant women at high risk for the development of preeclampsia and to reveal an impact of aspirin on maternal serum concentrations of sFlt-1 and PlGF.

Methods: This was a prospective longitudinal study in 394 women with various risk factors for the development of preeclampsia (chronic hypertension, antiphospholipid syndrome/APS or systemic lupus erythematosus/SLE, thrombophilia, women with a history of preeclampsia, pathologic first trimester screening for preeclampsia) and 68 healthy women. Serum levels of sFlt-1 and PlGF were measured prospectively at 4-week intervals (from gestational weeks 12 until postpartum).

Results: The sFlt-1/PlGF ratio was significantly higher in women with an adverse obstetric outcome compared to women with a normal pregnancy, starting between 20 and 24 weeks of gestation. There was no effect of aspirin on sFlt-1/PlGF ratio in women with chronic hypertension, APS/SLE, thrombophilia and controls. The use of aspirin showed a trend towards an improvement of the sFlt-1/PlGF ratio in women with preeclampsia in a previous pregnancy and a significant effect on the sFlt-1/PlGF ratio in women with a pathologic first trimester screening for preeclampsia.

Conclusions: Our findings reveal an impact of aspirin on sFlt-1/PlGF ratio in women with a pathologic first trimester screening for preeclampsia, strongly supporting its prophylactic use.
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http://dx.doi.org/10.3390/jcm8091429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780316PMC
September 2019

Does third trimester cervical length predict duration of first stage of labor?

Wien Klin Wochenschr 2019 Oct 16;131(19-20):468-474. Epub 2019 Jul 16.

Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.

Objective: To examine the association between third trimester cervical length (CL) measurement and duration of the first stage of labor.

Methods: This prospective cohort study included women with a singleton pregnancy who had routine CL measurements taken by transvaginal ultrasonography between 37 and 39 weeks gestation. Subjective duration of the first stage of labor was defined as the duration of contractions that the women subjectively had from the onset of regular contractions to full effacement of the cervix. Objective duration of first stage of labor was defined as 3 cm cervical dilation independent of cervical effacement until full effacement of the cervix. Associations between variables were analyzed using nonparametric correlations coefficients. A model relating the duration of labor to predictors was built using linear regression.

Results: In this analysis a total of 129 women were included. There was no significant correlation between CL and subjective duration of labor (ρ = -0.037, p = 0.695); however, a reduction in CL increased the objective duration of the first stage of labor (ρ = -0.269, p = 0.013). In univariate analysis parity (p = 0.018), hypertensive disorders (p = 0.013) and induction of labor (p = 0.022) were significantly associated with subjective duration of the first stage of labor.

Conclusion: A long cervix in the third trimester is not associated with a prolonged first stage of labor. Induction of labor and multiparity were associated with a shorter first stage of labor while hypertension was associated with a longer duration of labor.
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http://dx.doi.org/10.1007/s00508-019-1527-0DOI Listing
October 2019

Comparison of mean platelet volume (MPV) and sFlt-1/PlGF ratio as predictive markers for preeclampsia.

J Matern Fetal Neonatal Med 2021 May 9;34(9):1407-1414. Epub 2019 Jul 9.

Department of Obstetrics, Medical University Graz, Graz, Austria.

Introduction: Preeclampsia is characterised by an increased platelet consumption with consecutive reduction of overall platelet count and a consecutive rise in mean platelet volume (MPV). MPV has therefore been suggested as a predictive marker for preeclampsia. We aimed to investigate MPV longitudinally in women with preeclampsia compared to healthy controls during pregnancy for potential early detection of preeclampsia and to compare potential MPV changes against the sFlt-1/PlGF ratio.

Study Design: This longitudinal study included 38 women with preeclampsia and 84 women with normal pregnancies, where MPV and sFlt-1 and PLGF levels were determined every 4 weeks, starting in early pregnancy.

Results: MPV was significantly higher in women who developed preeclampsia compared to women with normal pregnancies at 12, ( = .029), 24 ( = .011), 28 ( = .037), 32 ( = .002), and 36 weeks of gestation, respectively ( = .015). Further analysis revealed a cut-off point of 10.85 fl (sensitivity 65.6%, specificity 26.2%) for the prediction of preeclampsia. The sFlt-1/PlGF ratio was significantly higher in women who developed preeclampsia compared to women with normal pregnancies at the same time points ( = .001). The cut-off point for predicting preeclampsia was 10.3 (sensitivity 87.5%, specificity 11.9%). ROC curve analysis showed that MPV has a high predictive value for early-onset preeclampsia ( < .05) but not for late-onset preeclampsia.

Conclusion: MPV is significantly elevated even in early pregnancy in women who develop preeclampsia and seems, therefore, a valuable predictor for preeclampsia even at early gestation. However, according to our results, MPV seems reliable in predicting early onset preeclampsia.
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http://dx.doi.org/10.1080/14767058.2019.1638356DOI Listing
May 2021

Maternal Complications and Hemodynamic Changes Following Intrauterine Interventions for Twin-to-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies.

J Clin Med 2019 May 2;8(5). Epub 2019 May 2.

Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria.

Twin-to-twin transfusion syndrome (TTTS) is a challenging complication in monochorionic diamniotic (MCDA) twins. Intrauterine interventions, such as fetoscopic laser ablation and cord occlusion followed by amniodrainage, are established treatments. Little is known about maternal complications and hemodynamics following these interventions. We performed a retrospective analysis of maternal procedure-related complications and the impact of such procedures on maternal hemodynamics and blood characteristics. Within the study period, 100 women with severe TTTS treated by fetoscopic laser ablation (FLA) or cord occlusion (CO) were identified. Clinically relevant maternal complications were reported in four (4%) cases. There was a significant decrease in hemoglobin, hematocrit, and albumin between admission and postoperative measurements (all < 0.001). Systolic and diastolic blood pressure, as well as maternal heart rate, decreased from time of skin suture to postoperative measurements (all < 0.001). Within a 24 h interval, there was a positive correlation between hematocrit (Spearman's rho 0.325; = 0.003), hemoglobin (Spearman's rho 0.379; < 0.001), and albumin (Spearman's rho 0.360; = 0.027), and the amount of amniodrainage during the intervention. Maternal procedure-related complications are relatively rare. Significant hemodynamic alterations and maternal hemodilution are common clinical findings following intrauterine interventions.
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http://dx.doi.org/10.3390/jcm8050605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572341PMC
May 2019

Statement by the OEGGG with Review of the Literature on the Mode of Delivery of Premature Infants at the Limit of Viability.

Geburtshilfe Frauenheilkd 2018 Dec 14;78(12):1212-1216. Epub 2018 Dec 14.

Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria.

In 2017, the Austrian Society for Paediatric and Adolescent Medicine (ÖGKJ) published a guideline on the primary care of premature infants at the limit of viability. In this guideline, it is recommended that a Caesarean section be preferred as mode of delivery with regard to an early preterm birth (22 + 0 - 24 + 6 weeks of pregnancy) due to an allegedly lower perinatal risk of cerebral haemorrhage. In contrast to this, the Austrian Society for Gynaecology and Obstetrics (OEGGG) considers there to be no clinical and scientific basis for this recommendation and the mode of delivery in the case of early preterm birth must be adapted to the individual maternal and foetal clinical situation. The international data available from the generally retrospective investigations show heterogeneous results regarding the mode of delivery. The prospective and randomised data in this regard are insufficient. A Cochrane analysis does not show any advantage in favour of a Caesarean delivery. The German-language guidelines (AWMF and Switzerland) make analogous recommendations for adapting the mode of delivery with regard to an early preterm birth individually to the respective clinical situation. In the case of an early preterm birth and a singleton in cephalic presentation, the OEGGG therefore recommends individual management of the delivery which takes the maternal and foetal clinical situation into account and also includes vaginal delivery as a mode of delivery in the clinical decision process.
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http://dx.doi.org/10.1055/a-0669-1480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294639PMC
December 2018

Risk assessment for preterm preeclampsia in first trimester: Comparison of three calculation algorithms.

Eur J Obstet Gynecol Reprod Biol 2018 Dec 5;231:241-247. Epub 2018 Nov 5.

Department of Obstetrics and Gynaecology, Division of Obstetrics, Medical University of Graz, Austria.

Objective: To better adjust the risk for preeclampsia, multifactorial models in first trimester of pregnancy have found the way in clinical practice. This study compares the available test algorithms.

Study Design: In a cross-sectional study between November 2013 and April 2016 we compared the tests results of three first trimester testing algorithms for preeclampsia in 413 women. Risk for preterm preeclampsia was calculated with three different algorithms: Preeclampsia Predictor™ Software by PerkinElmer (PERK), ViewPoint® Software by GE Healthcare (VP) and the online calculator of the Fetal Medicine Foundation (FMF).We analyzed the data descriptively and determined Cohen's Kappa to assess the agreement among the algorithms.

Results: VP classified 89(21.5%) women, PERK 43(10.4%) women and FMF 90 (21.8%) women as having high risk for preterm preeclampsia (<34 weeks of gestation for VP and PERK and <37 weeks of gestation for FMF). Agreement between tests ranged from moderate to substantial (PERK/VP: κ = 0.56, PERK/ FMF: κ = 0.50, and VP/ FMF: κ = 0.72).

Conclusion: The three algorithms are similar but not equal. This may depend on chosen cut off, but also on test properties. This study cannot decide which algorithm is the best, but differences in results and cut offs should be taken into account.
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http://dx.doi.org/10.1016/j.ejogrb.2018.11.006DOI Listing
December 2018

A Modified Technique for Cord Transection in Monochorionic Monoamniotic Twin Pregnancies.

Fetal Diagn Ther 2018 8;44(3):236-240. Epub 2018 Aug 8.

Monochorionic monoamniotic (MA) twins are at increased risk for intrauterine demise (IUD) and discordant anomalies. Selective feticide by cord occlusion may be an option in case of unfavorable discordant problems. In MA pregnancies, however, the surviving co-twin still remains at serious risk for IUD due to progressive cord entanglement. Cord transection has therefore been recommended to protect the survivor. This procedure may turn out to be difficult. We herein describe a modified fetoscopic technique for laser transection using a grasping forceps. We present technical details and clinical outcome in 2 cases of cord transection: one following cord occlusion and the other following spontaneous IUD. Cord transection was performed at 19 and 26 weeks gestation, respectively. A 3 Fr grasping forceps with a working length of 35 cm was used for controlled manipulation of the umbilical cord during transection. There were no procedure-related complications and both surviving co-twins had favorable neonatal outcome. Cord transection using a grasping forceps facilitates easy and precise fetoscopic release of the umbilical cord. To the best of our knowledge, this is the first report on post mortem cord transection after spontaneous single IUD with favorable outcome for the survivor.
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http://dx.doi.org/10.1159/000489882DOI Listing
January 2019

Maternal cardiovascular and endothelial function from first trimester to postpartum.

PLoS One 2018 21;13(5):e0197748. Epub 2018 May 21.

Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.

Objective: To explore noninvasively the complex interactions of the maternal hemodynamic system throughout pregnancy and the resulting after-effect six weeks postpartum.

Methods: Eighteen women were tested beginning at the 12th week of gestation at six time-points throughout pregnancy and six weeks postpartum. Heart rate, heart rate variability, blood pressure, pulse transit time (PTT), respiration, and baroreceptor sensitivity were analyzed in resting conditions. Additionally, hemoglobin, asymmetric and symmetric dimethylarginine and Endothelin (ET-1) were obtained.

Results: Heart rate and sympathovagal balance favoring sympathetic drive increased, the vagal tone and the baroreflex sensitivity decreased during pregnancy. Relative sympathetic drive (sympathovagal balance) reached a maximum at 6 weeks postpartum whereas the other variables did not differ compared to first trimester levels. Postpartum diastolic blood pressure was higher compared to first and second trimester. Pulse transit time and endothelial markers showed no difference throughout gestation. However, opposing variables PTT and asymmetric dimethylarginine (ADMA) were both higher six weeks postpartum.

Conclusions: The sympathetic up regulation throughout pregnancy goes hand in hand with a decreased baroreflex sensitivity. In the postpartum period, the autonomic nervous system, biochemical endothelial reactions and PTT show significant and opposing changes compared to pregnancy findings, indicating the complex aftermath of the increase of blood volume, the changes in perfusion strategies and blood pressure regulation that occur in pregnancy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197748PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962097PMC
December 2018

Sex-specific associations of insulin-like peptides in cord blood with size at birth.

Clin Endocrinol (Oxf) 2018 Aug 29;89(2):187-193. Epub 2018 May 29.

Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.

Objective: Insulin-like peptides (insulin, IGF-1, IGF-2) are essential regulators of foetal growth. We assessed the role of these peptides for birth size in a sex-specific manner.

Design: Cross-sectional cohort analysis.

Patients And Measurements: In 369 neonates, cord blood insulin, C-peptide, IGF-1 and IGF-2 levels were measured. Outcomes were placenta weight, birthweight, length and ponderal index. In linear regression models, the association of insulin-like peptides with growth outcomes was assessed, adjusted for gestational age and delivery mode. Interaction between insulin-like peptides and neonatal sex was assessed.

Results: No sex differences in levels of insulin-like peptides were observed. Significant interactions were found of sex with IGF-1 for birthweight, and of sex with C-peptide for all outcomes, except ponderal index. The association of IGF-1 (ng/mL) with birthweight was stronger and only significant in males (beta coefficient 3.30 g; 95%CI 1.98-4.63 in males and 1.45 g; -0.09-2.99 in females). Associations of C-peptide (ng/mL) with growth outcomes were stronger and only significant in females (placenta weight females: 181.3 g; 109.3-253.3; P < .001, males: 29.8 g; -51.5-111.1; P = .47, birthweight females: 598.5 g; 358.3-838.7: P < .001, males: 113.7 g; -154.0-381.4; P = .40). Associations of IGF2 with birthweight were similar in males and females. No associations were found with ponderal index.

Conclusions: C-peptide and IGF-1 in cord blood associate with birthweight, length and placenta weight in a sex-specific manner, with stronger associations of C-peptide levels with placenta weight, birthweight and length in females and stronger associations of IGF-1 levels with birthweight in males.
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http://dx.doi.org/10.1111/cen.13739DOI Listing
August 2018

Angiogenic factors in pregnancies of women with antiphospholipid syndrome and systemic lupus erythematosus.

J Reprod Immunol 2018 06 18;127:19-23. Epub 2018 Apr 18.

Department of Obstetrics, Department of Internal Medicine and Endocrinology Lab Platform, Medical University Graz, Graz, Austria.

Objectives: An imbalance of angiogenic placental factors such as endoglin, soluble fms-like tyrosine kinase 1(sFlt-1) and placental growth factor (PlGF) has been implicated in the pathophysiology of preeclampsia. This study aimed to evaluate serum levels of sFlt-1, PlGF and endoglin in women with primary and secondary antiphospholipid Syndrome (APS) and systemic lupus erythematosus (SLE) longitudinally through pregnancy.

Material And Methods: Serum levels of sFlt-1, PlGF and endoglin were measured prospectively at 4-week intervals (from gestational weeks 12-36) in 17 women with primary APS (PAPS), 18 women with secondary APS (SAPS), and 23 women with SLE.

Results: 6/17 (35%) of women with PAPS, 3/18 (17%) of women with SAPS, and 2/23 (9%) of women with SLE developed early-onset preeclampsia. Women who developed preeclampsia had significantly higher mean sFlt-1 and endoglin levels, higher sFlt-1/PlGF ratios, and lower mean PlGF-levels than women who did not. These changes became statistically significant at 12 weeks for sFlt-1, PlGF and endoglin.

Discussion: Endoglin, sFlt-1 and PlGF are potential early screening parameters for the development of preeclampsia in pregnant women with autoimmune diseases like APS and SLE.
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http://dx.doi.org/10.1016/j.jri.2018.04.002DOI Listing
June 2018

Prenatal acupuncture: Women's expectations and satisfaction and influence on labor.

Birth 2018 06 1;45(2):210-216. Epub 2018 Feb 1.

Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.

Background: Use of prenatal acupuncture for labor preparation is common, but there is still conflicting evidence with respect to its objective obstetric benefits. There is little information on women's expectations and subjective experiences with acupuncture treatments.

Methods: In this retrospective cohort study, a validated questionnaire on women's treatment satisfaction was sent to women who had received prenatal acupuncture at the obstetric clinic of the Medical University of Graz, Austria within the last 3 years. The electronic obstetric database was used to extract detailed clinical and obstetric data of women who received acupuncture and delivered at the hospital. For comparison, obstetric data were matched with a control group of women without prenatal acupuncture, who had given birth at the hospital during the study period.

Results: The questionnaire was sent to 150 women, out of which 70 (46.7%) completed and returned the questionnaire. Analysis of the questionnaire indicated good overall satisfaction (mean sum score 26.22 ± 4.72) with acupuncture treatment-97.1% indicated that they were very or quite satisfied. Responders did not differ from nonresponders, except for the time between delivery and questionnaire (P = .015). Comparisons between the deliveries after prenatal acupuncture (n = 144) and the matched control deliveries (n = 576) showed no statistical significant differences in the length of labor and use of analgesics.

Conclusion: Prenatal acupuncture is likely to have positive effects on pregnant women, aside from an objective influence on labor duration and pain.
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http://dx.doi.org/10.1111/birt.12336DOI Listing
June 2018

Heart rate variability and baroreceptor reflex sensitivity in early- versus late-onset preeclampsia.

PLoS One 2017 20;12(10):e0186521. Epub 2017 Oct 20.

Department of Obstetrics and Gynecology, Clinical Center, Klagenfurt, Austria.

Objective: To determine whether there are differences in autonomic nervous system function in early- versus late-onset preeclampsia.

Methods: Matched case-control study. Cases were defined as singleton pregnancies with preeclampsia at < 34+0 weeks of gestation (early-onset preeclampsia) and ≥ 34+0 weeks of gestation (late-onset preeclampsia). For each case in each of the preeclampsia subgroups, three "control"uncomplicated singleton pregnancies were matched by maternal age, height, and week of gestation. Blood pressure and heart rate were measured continuously for 30 minutes in each participant. Baroreceptor reflex sensitivity (assessed using sequence technique), time and frequency domain heart rate variability measures, as SDNN, RMSSD, LFRRI, HFRRI and LF/HFRRI of R-R intervals, were compared between groups (p<0.05 significant).

Results: 24 women with preeclampsia (10 with early-onset and 14 with late-onset preeclampsia) and 72 controls were included in the study. SDNN, RMSSD and HFRRI were significantly higher in the late-onset preeclampsia group compared to gestational age matched controls (p = 0.033, p = 0.002 and p = 0.018, respectively). No significant differences in SDNN RMSSD and HFRRI between early-onset preeclampsia group and gestational age matched controls were observed (p = 0.304, p = 0.325 and p = 0.824, respectively). Similarly, baroreceptor reflex sensitivity was higher in late-onset preeclampsia compared to controls at ≥ 34 weeks (p = 0.037), but not different between early-onset preeclampsia compared to controls at < 34 weeks (p = 0.50).

Conclusions: Heart rate variability and baroreceptor reflex sensitivity are increased in late- but not early-onset preeclampsia compared to healthy pregnancies. This indicates a better autonomic nervous system mediated adaptation to preeclampsia related cardiovascular changes in late-onset disease.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186521PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650147PMC
November 2017

Maternal Gestational Diabetes Mellitus increases placental and foetal lipoprotein-associated Phospholipase A2 which might exert protective functions against oxidative stress.

Sci Rep 2017 10 3;7(1):12628. Epub 2017 Oct 3.

Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.

Increased Lipoprotein associated phospholipase A (LpPLA) has been associated with inflammatory pathologies, including Type 2 Diabetes. Studies on LpPLA and Gestational Diabetes Mellitus (GDM) are rare, and have focused mostly on maternal outcome. In the present study, we investigated whether LpPLA activity on foetal lipoproteins is altered by maternal GDM and/or obesity (a major risk factor for GDM), thereby contributing to changes in lipoprotein functionality. We identified HDL as the major carrier of LpPLA activity in the foetus, which is in contrast to adults. We observed marked expression of LpPLA in placental macrophages (Hofbauer cells; HBCs) and found that LpPLA activity in these cells was increased by insulin, leptin, and pro-inflammatory cytokines. These regulators were also increased in plasma of children born from GDM pregnancies. Our results suggest that insulin, leptin, and pro-inflammatory cytokines are positive regulators of LpPLA activity in the foeto-placental unit. Of particular interest, functional assays using a specific LpPLA inhibitor suggest that high-density lipoprotein (HDL)-associated LpPLA exerts anti-oxidative, athero-protective functions on placental endothelium and foetus. Our results therefore raise the possibility that foetal HDL-associated LpPLA might act as an anti-inflammatory enzyme improving vascular barrier function.
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http://dx.doi.org/10.1038/s41598-017-13051-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626711PMC
October 2017

Early skin-to-skin contact after cesarean section: A randomized clinical pilot study.

PLoS One 2017 23;12(2):e0168783. Epub 2017 Feb 23.

Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.

Objective: Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response.

Study Design: This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative ("early") SCC (n = 17) versus postoperative ("late") SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase.

Results: There was no evidence for differences in parameters reflecting neonatal transition or stress response between the 'Early SSC Group' and the 'Late SSC Group'. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group' (p = 0.004).

Conclusions: This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group', which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial.

Trial Registration: ClinicalTrials.gov NCT01894880.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168783PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322896PMC
August 2017

Comparison of two-risk assessment algorithms for preeclampsia in first trimester with consecutive intake of low-dose aspirin in the high-risk group - an observational study.

J Matern Fetal Neonatal Med 2018 Mar 3;31(5):549-552. Epub 2017 Mar 3.

a Division of Obstetrics, Department of Obstetrics and Gynaecology , Medical University of Graz , Graz , Austria.

We analyzed outcome of women screened for preeclampsia with two different multifactorial risk algorithms (PredictorSoftware by PerkinElmer, PerkinElmer, Waltham, MA; PERK-group: n = 214 and Viewpoint by GE Healthcare, Dornstadt, Germany; VIEW-group: n = 209) in first trimester. Women at high risk for developing preeclampsia were advised to take low-dose acetylsalicylic acid (LDA). Screening positive rates for early onset preeclampsia differed significantly between the two groups (7.9% versus 26.3%; p = 0.000). According the clinical use of screening test criteria, LDA was prescribed in 63 (29.4%) women in the PE-group and 55 (26.3%) in the VP-group (p = 0.516). There were no differences in onset of preeclampsia [4 (1.9%) versus 6 (2.9%); p = 0.540]. No early or severe preeclampsia occurred in the whole population.
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http://dx.doi.org/10.1080/14767058.2017.1291621DOI Listing
March 2018

Endothelin-1 down-regulates matrix metalloproteinase 14 and 15 expression in human first trimester trophoblasts via endothelin receptor type B.

Hum Reprod 2017 01 17;32(1):46-54. Epub 2016 Nov 17.

Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz 8036, Austria.

Study Question: Does endothelin-1 (ET-1) regulate matrix metalloproteinase (MMP) 14 and 15 production and invasion of human first trimester trophoblasts?

Summary Answer: ET-1 in pathophysiological concentrations down-regulates MMP14 and MMP15 expression via endothelin receptor (ETR) type B and decreases trophoblast migration and invasion.

What Is Known Already: MMP14 and MMP15 are involved in trophoblast invasion. Impairment of invasion has been linked to pregnancy complications such as pre-eclampsia (PE). ET-1 is up-regulated in PE.

Study Design, Size, Duration: In vitro study using primary human trophoblasts from 50 first trimester placentas (gestational week 7-12).

Participants/materials, Setting, Methods: Trophoblasts were cultured in the absence or presence of 10-100 nM ET-1. MMP14 and MMP15 mRNA and protein were quantified by RT-qPCR and Western blotting, respectively. Selective antagonists for ETRA (BQ-123) or ETRB (BQ-788) were used to identify ETR subtypes involved. Functional ET-1 effects were tested in first trimester chorionic villous explants and transwell invasion assays. The roles of tumor necrosis factor (TNF)-α (25 ng/ml) and oxygen (1%) in ET-1 regulation of MMP14 and 15 expression were assessed by Western blotting.

Main Results And The Role Of Chance: ET-1 down-regulated MMP14 and MMP15 mRNA (-21% and -26%, respectively, P < 0.05) and protein levels (-18% and -22%, respectively, P < 0.05). This effect was mediated via ETRB. ET-1 decreased trophoblast outgrowth in placental explants (-24%, P < 0.05) and trophoblast invasion (-26%, P ≤ 0.01). TNF-α enhanced ET-1 mediated MMP15 down-regulation (by 10%, P < 0.05), whereas hypoxia abolished the effect of ET-1 on both MMPs.

Large Scale Data: N/A.

Limitations, Reasons For Caution: Only primary trophoblasts were used in this study. Since trophoblast yield from first trimester placental material is limited, further aspects of MMP14 and 15 regulation could not be characterized. Other anti-invasive factors may be altered by ET-1 in trophoblasts and, thus, contribute to the reduced invasion, but have not been investigated. Oxygen levels similar to those found in the decidua (5-8% O) were not analyzed in this study.

Wider Implications Of The Findings: ET-1 modifies placental function already during the first trimester of pregnancy, the time-window when the placental changes implicated in PE occur. Thus, our results improve the understanding of the placental mechanisms underlying trophoblast invasion and PE.

Study Funding/competing Interests: The study was funded by the Oesterreichische Nationalbank (Anniversary Fund, project number: 14796) and the Herzfelder'sche Familienstiftung (to J.P.; number: 00685). AMM received funding from the Austrian Science Fund FWF (W1241) and the Medical University Graz through the PhD Program Molecular Fundamentals of Inflammation (DK-MOLIN). The authors have no conflict of interest.
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http://dx.doi.org/10.1093/humrep/dew295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165079PMC
January 2017

Serum bile acids in term and preterm neonates: A case-control study determining reference values and the influence of early-onset sepsis.

Medicine (Baltimore) 2016 Nov;95(44):e5219

Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.

Serum bile acids (BA) reference values are lacking for neonates. Therefore, this study aimed to determine serum BA reference values in term and preterm neonates. Furthermore, as serum BA concentrations are well-known to rise in septic adults, BA values were determined in early-onset neonatal sepsis (EOS), a common and serious disease in neonates.Using high-performance liquid chromatography-high-resolution mass spectrometry (HPLC-HRMS), we profiled serum BA in 236 infants, including healthy term neonates (n = 84), premature infants (n = 101), and both term infants (n = 35) and preterm infants (n = 16) with EOS. We examined the impact of prematurity and EOS on BA concentrations.The median reference values of serum BA were 8.0 μmol/L, interquartile range (IQR): 4.6 to 12.9, in healthy term neonates and 10.1 μmol/L, IQR: 5.7 to 15.7, in preterm neonates. Neonates with EOS had significantly lower median BA values, term (4.7 μmol/L, IQR: 2.7-7.6; P < 0.01) as well as preterm (6.4 μmol/L, IQR: 3.5-8.4; P < 0.01). Furthermore, primary and conjugated BA were most abundant in all groups. Taurine-conjugated BA were predominant in all neonates; glycine-conjugated BA were significantly lower in term neonates with EOS than in controls (P < 0.05). Multivariate regression analysis results obtained for BA and inflammatory parameters revealed that BA are an independent factor associated with EOS.This is the first study to determine standard value ranges of serum BA in neonates using HPLC-HRMS. In contrast to adults with sepsis, neonates suffering from EOS exhibit significantly lower BA values than do controls of the same gestational age. These data suggest BA as a supplementary parameter within a panel of biomarkers for EOS in the future.
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http://dx.doi.org/10.1097/MD.0000000000005219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591116PMC
November 2016

Pregnancy Outcome in Women with Obstetric and Thrombotic Antiphospholipid Syndrome-A Retrospective Analysis and a Review of Additional Treatment in Pregnancy.

Clin Rev Allergy Immunol 2017 Aug;53(1):54-67

Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036, Graz, Austria.

Antiphospholipid syndrome (APS) is associated with pregnancy complications such as recurrent early fetal loss (RFL), fetal death, preeclampsia (PE), and intrauterine growth restriction (obstetric APS/OAPS). Other clinical manifestations are venous and/or arterial thromboses (thrombotic APS/TAPS). The data of 37 pregnancies with OAPS and 37 pregnancies with TAPS were analyzed and compared. Overall, the most frequent APS antibodies (aPl) were LA as well as "triple-positivity"; LA antibodies were significantly more frequent in women with TAPS (67.6 % TAPS vs. 29.7 % OAPS, p < 0.010), whereas "triple-positivity" was significantly more seen in women with OAPS (40.5 % OAPS vs. 13.5 % TAPS, p < 0.010). Adequate therapy has been administered in nearly all pregnancies with TAPS, whereas in 18.9 % of pregnancies with OPS, no therapy has been given at all. One woman in OAPS and four women in TAPS were treated with plasmapheresis and immunoadsorption. There was no significant association between adverse obstetric outcome and therapy. The most frequent pregnancy complications were RFL in the OAPS group (32.4 vs. 13.5 % in TAPS) and PE in the TAPS group (18.9 % in OAPS and TAPS, respectively). The data of our study showed that pregnancies with OAPS and TAPS have a similar rate of pregnancy complications. However, pregnancies with OAPS tend to have rather RFL. Although we were not able to reveal a significant association with adverse obstetric outcome, it seems that the current adequate therapy for APS in pregnancy, consisting of LDA and LMWH, might rather prevent the development of RFL. Additionally, it might be considered to divide the obstetric APS into obstetric APS with early pregnancy complications and obstetric APS with late pregnancy complications. The division into two groups of obstetric APS might facilitate the choice of additional therapy in these women.
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http://dx.doi.org/10.1007/s12016-016-8569-0DOI Listing
August 2017

Going into labor and beyond: phospholipase A2 in pregnancy.

Reproduction 2016 06 23;151(6):R91-R102. Epub 2016 Feb 23.

Department of Obstetrics and GynecologyMedical University of Graz, Graz, Austria

The phospholipase A2 (PLA2) family is a very diverse group of enzymes, all serving in the cleavage of phospholipids, thereby releasing high amounts of arachidonic acid (AA) and lysophospholipids. AA serves as a substrate for prostaglandin production, which is of special importance in pregnancy for the onset of parturition. Novel research demonstrates that PLA2 action affects the immune response of the mother toward the child and is therefore probably implied in the tolerance of the fetus and prevention of miscarriage. This review presents data on the biochemical and enzymatic properties of PLA2 during gestation with a special emphasis on its role for the placental function and development of the fetus. We also critically discuss the possible pathophysiological significance of PLA2 alterations and its possible functional consequences. These alterations are often associated with pregnancy pathologies such as preeclampsia and villitis or pregnancy complications such as obesity and diabetes in the mother as well as preterm onset of labor.
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http://dx.doi.org/10.1530/REP-15-0519DOI Listing
June 2016

Placental membrane-type metalloproteinases (MT-MMPs): Key players in pregnancy.

Cell Adh Migr 2016 03 8;10(1-2):136-46. Epub 2016 Jan 8.

a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria.

Membrane-type matrix metalloproteinases (MT-MMPs) are a sub-family of zinc-dependent endopeptidases involved in the degradation of the extracellular matrix. Although MT-MMPs have been mainly characterized in tumor biology, they also play a relevant role during pregnancy. Placental MT-MMPs are required for cytotrophoblast migration and invasion of the uterine wall and in the remodeling of the spiral arteries. They are involved in the fusion of cytotrophoblasts to form the syncytiotrophoblast as well as in angiogenesis. All these processes are crucial for establishing and maintaining a successful pregnancy and, thus, MT-MMP activity has to be tightly regulated in time and space. Indeed, a de-regulation of MT-MMP expression has been linked with pregnancy complications such as preeclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM) and was also found in maternal obesity. Here we review what is currently known about MT-MMPs in the placenta, with a focus on their general features, their localization and their involvement in pregnancy disorders.
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http://dx.doi.org/10.1080/19336918.2015.1110671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853033PMC
March 2016

Response to Plasmapheresis Measured by Angiogenic Factors in a Woman with Antiphospholipid Syndrome in Pregnancy.

Case Rep Obstet Gynecol 2015 27;2015:123408. Epub 2015 Aug 27.

Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.

An imbalance of angiogenic and antiangiogenic placental factors such as endoglin and soluble fms-like tyrosine kinase 1 has been implicated in the pathophysiology of preeclampsia. Extraction of these substances by plasmapheresis might be a therapeutical approach in cases of severe early-onset preeclampsia. Case Report. A 21-year-old primigravida with antiphospholipid syndrome developed early-onset preeclampsia at 18 weeks' gestation. She was treated successfully with plasmapheresis in order to prolong pregnancy. Endoglin and sflt-1-levels were measured by ELISA before and after treatment. Endoglin levels decreased significantly after treatment (p < 0.05) and showed a significant decrease throughout pregnancy. A rerise of endoglin and sflt-1 preceded placental abruption 4 weeks before onset of incident. Conclusion. Due to the limited long-term therapeutical possibilities for pregnancies complicated by PE, plasmapheresis seems to be a therapeutical option. This consideration refers especially to pregnancies with early-onset preeclampsia, in which, after first conventional treatment of PE, prolongation of pregnancy should be above all.
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http://dx.doi.org/10.1155/2015/123408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564609PMC
September 2015

Clinical-Pathological Conference Series from the Medical University of Graz Case No 155: 26-year-old woman in third trimester of pregnancy with epigastric pain and thrombocytopenia.

Wien Klin Wochenschr 2015 Sep 7;127(17-18):707-14. Epub 2015 Aug 7.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.

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http://dx.doi.org/10.1007/s00508-015-0829-0DOI Listing
September 2015

Placenta praevia: incidence, risk factors and outcome.

J Matern Fetal Neonatal Med 2016 4;29(9):1395-8. Epub 2015 Jun 4.

a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria.

Objective: Aim of this study was to evaluate the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia.

Methods: Data were prospectively collected from women diagnosed with placenta praevia in 10 Austrian hospitals in in the province of Styria between 1993 and 2012. We analyzed the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia. Differences between women with major placenta praevia (complete or partial placenta praevia) and minor placenta praevia (marginal placenta praevia or low-lying placenta) were evaluated.

Results: 328 patients with placenta praevia were identified. The province wide incidence of placenta praevia was 0.15%. Maternal morbidity was high (ante-partum bleeding [42.3%], post-partum hemorrhage [7.1%], maternal anemia [30%], comorbid adherent placentation [4%], and hysterectomy [5.2%]) and neonatal complications were frequent (preterm birth [54.9%], low birth weight <2500 g [35.6%], Apgar-score after five minutes <7 [5.8%], and fetal mortality [1.5%]. Women with major placenta praevia had a significant higher incidence of preterm delivery, birthweight <2500 g and Apgar-score after five minutes <7.

Conclusions: Placenta praevia was associated with adverse maternal (34.15%) and neonatal (60.06%) outcome. The extent of placenta praevia was not related with differences regarding risk factors and maternal outcome.
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http://dx.doi.org/10.3109/14767058.2015.1049152DOI Listing
December 2016

Has there been a change in peripartal maternal mortality in a tertiary care obstetric European center over the last five decades?

Eur J Obstet Gynecol Reprod Biol 2015 Feb 29;185:145-50. Epub 2014 Dec 29.

Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.

Objective: Maternal mortality still remains a significant problem in obstetrics worldwide. Unchanged or even rising maternal mortality has been reported in several countries. The present study analyzed whether the pattern of maternal mortality has changed over the last five decades at the Department of Obstetrics and Gynecology of the Medical University of Graz.

Study Design: Starting in 1981, a registry of maternal deaths was established and regularly updated at our institution based on retrospective data. Between 1963 and 2012, a total of 187,917 women delivered. Thirty-five consecutive maternal deaths were observed and subdivided into 10 year cohorts.

Methods: The registry of maternal deaths included deliveries after 28+0 weeks of gestation. Puerperal deaths were defined as deaths up to day 42 post partum.

Main Outcome Measures: Clinical data from maternal deaths were extracted from hospital records and autopsy reports.

Results: Maternal mortality rates declined from 35.0, 29.0, 2.4, 13.1 to 3.6 per 100,000 deliveries in the five subsequent periods, respectively. Sixty-six percent of women who died were 30 years or older. The cesarean section rate was 49%. Ninety-one percent of the 35 maternal deaths occurred in women with no significant medical history or risk factors. Seventy-five percent of deaths occurred after the 37+0 weeks of gestation. During all study periods, the prevalence of infections and hemorrhage was highest. The main causes of bleeding were uterine rupture and placental abruption, respectively.

Conclusion: Even nowadays, peripartal maternal deaths occur mainly due to infections and hemorrhage and also in women with no significant medical history.
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http://dx.doi.org/10.1016/j.ejogrb.2014.12.015DOI Listing
February 2015

Are there differences in the health outcomes of mothers in Europe and East-Asia? A cross-cultural health survey.

Biomed Res Int 2014 27;2014:856543. Epub 2014 Nov 27.

Graduate School of Education, Hiroshima University, 1-1-1 Kagamiyama, Higashihiroshima, Hiroshima 739-8524, Japan.

The aim of the current study was to investigate differences in quality of life outcomes and depression of mothers in East-Asia and Central Europe. 170 women in Japan and 226 women in Austria with children between 3 and 5 answered the same cross-culturally validated questionnaires. The Quality of Life Questionnaire from the WHO (WHOQOL-Bref), the Patient Health Questionnaire (PHQ-2), the Sense of Coherence Scale (SOC-13), a Social Support Scale (MSPSS), and questions on gender orientation were used. In all dimensions of QOL (physical, psychological, social, and environmental) Japanese women had lower QOL scores compared to Austrian mothers (P < 001). Seven percent of women in both countries experienced major depression. In both countries sense of coherence, experienced stress level, satisfaction with income, social support, and gender roles had an influence on QOL and depressive symptoms. Mothers in Japan consider life events less comprehensible, manageable, and meaningful and experience less support. Consequently, creating an environment where fathers could be more involved in child rearing and mothers have more opportunities to choose between life styles and working and social environments would improve QOL not only in Japanese mothers but also in other countries all over the world.
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http://dx.doi.org/10.1155/2014/856543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265512PMC
August 2015

Gestational diabetes mellitus modulates neonatal high-density lipoprotein composition and its functional heterogeneity.

Biochim Biophys Acta 2014 Nov 12;1841(11):1619-27. Epub 2014 Aug 12.

Department of Obstetrics and Gynecology, Medical University of Graz, Austria. Electronic address:

Gestational diabetes mellitus (GDM) is related to neonatal macrosomia and an increased risk of vascular events. We hypothesized that GDM exerts qualitative effects on neonatal high-density lipoprotein (HDL). HDL was isolated from control (n=11) and GDM maternal/neonatal donors (n=9) and subjected to shotgun proteomics. Differences in HDL mobility were assessed by FPLC and native gel-electrophoresis. Paraoxonase (PON1) activity, cholesterol ester-transfer protein (CETP) mass and activity, phospholipid, triglyceride and cholesterol concentrations were quantified with commercial kits. Total anti-oxidative capacity and cholesterol efflux capability of HDLs were measured. Four proteins involved in lipid metabolism, inflammation and innate immunity were differentially expressed between controls and GDM neonates. ApoM (decreased, p<0.05) and SAA1 (increased, p<0.05) showed the same differences on both, maternal and neonatal GDM HDL. Lower PON1 protein expression was corroborated by lower activity (p<0.05) which in turn was associated with attenuated anti-oxidant capacity of GDM HDL. Protein changes were accompanied by increased levels of triglycerides and decreased levels of cholesterol esters, respectively. The observed differences in GDM HDL lipid moiety may be related to CETP mass and activity alterations. The rate of cholesterol efflux from term trophoblasts to maternal and from placental endothelial cells to neonatal GDM HDL was impaired (p<0.05). In conclusion, GDM causes changes in HDL composition and is intimately associated with impaired cholesterol efflux capability as well as diminished anti-oxidative particle properties. Remodeling of neonatal GDM HDL in utero supports the hypothesis that maternal conditions in pregnancy impact neonatal lipoprotein metabolism.
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http://dx.doi.org/10.1016/j.bbalip.2014.07.021DOI Listing
November 2014

Validation of a point-of-care (POC) lactate testing device for fetal scalp blood sampling during labor: clinical considerations, practicalities and realities.

Clin Chem Lab Med 2014 Jun;52(6):825-33

Background: Although fetal blood sampling for pH is well established the use of lactate has not been widely adopted. This study validated the performance and utility of a handheld point-of-care (POC) lactate device in comparison with the lactate and pH values obtained by the ABL 800 blood gas analyzer.

Methods: The clinical performance and influences on accuracy and decision-making criteria were assessed with freshly taken fetal blood scalp samples (n=57) and umbilical cord samples (n=310). Bland-Altman plot was used for data plotting and analyzing the agreement between the two measurement devices and correlation coefficients (R²) were determined using Passing-Bablok regression analysis.

Results: Sample processing errors were much lower in the testing device (22.8% vs. 0.5%). Following a preclinical assessment and calibration offset alignment (0.5 mmol/L) the test POC device showed good correlation with the reference method for lactate FBS (R²=0.977, p<0.0001, 95% CI 0.9 59-0.988), arterial cord blood (R²=0.976, p<0.0001, 95% CI 0.967-0.983) and venous cord blood (R²=0.977, p<0.0001, 95% CI 0.968-0.984).

Conclusions: A POC device which allows for a calibration adjustment to be made following preclinical testing can provide results that will correlate closely to an incumbent lactate method such as a blood gas analyzer. The use of a POC lactate device can address the impracticality and reality of pH sample collection and testing failures experienced in day to day clinical practice. For the StatStrip Lactate meter we suggest using a lactate cut-off of 5.1 mmol/L for predicting fetal acidosis (pH<7.20).
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http://dx.doi.org/10.1515/cclm-2013-0732DOI Listing
June 2014
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