Severe Superimposed Preeclampsia with Obesity, Diabetes and a Mild Imbalance of Angiogenic Factors

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1 Severe Superimposed Preeclampsia with Obesity, Diabetes and a Mild Imbalance of Angiogenic Factors *

2 ʼ ʼ Laboratory data at admission WBC ml Hb 9.2 g dl Plt ml RBC ml Ht 25.1 % PT 1.8 sec APTT 27.6 sec AT III 82 % D dimer 5.2 mg ml Fibrinogen 832 mg dl FDP 7.7 mg ml TP 5.5 g dl ALP 17 IU l Ca 8.3 mg dl Alb 2.5 g dl LAP 86 IU l Mg 1.6 mg dl TTT 1.5 KU GTP 5 IU l BUN 7.5 mg dl ZTT 4.3 KU CHE 271 IU l Cr.55 mg dl T bil.39 mg dl LDH 248 IU l UA 4.4 mg dl D bil.4 mg dl Na 138 mmol l T chol 261 mg dl AST 13 IU l K 3.7 mmol l TG 278 mg dl ALT 6 IU l Cl 17 mmol l HDL chol 69 mg dl CRP.95 mg dl Hp 6 mg dl Urinary protein 4383 mg day 24hCCR mi min egfr 9.3 ml min 1.73m 2 ANA 5. index Anti cardiolipin ab.1 U ml Anti cardilipin 2 ab 1.2 U ml

3 Clinical course and maternal concentrations of adipocytokines. Summary of adipocytokine levels during pregnancy Patient Normal pregnancy with obesity Preeclampsia Patients with obesity 22w 36w early control late control early onset late onset Adiponectin (μg ml) ( ) 8.8 ( ) 12.4 ( ) 15.8 ( ) Leptin (ng ml) ( ) 23.7 ( ) 56.9 ( ) 42.3 ( ) median (interquartile range) Summary of angiogenic factor levels during pregnancy Patient Normal pregnancy with obesity Preeclampsia Patients with obesity 22w 36w early control late control early onset late onset sflt 1 (pg ml) , ( ) 1,52.3 ( ,899.2) 6,27.2 (3,98.4 8,3.5) 3,324. (2,69. 4,122.2) PlGF ( ) ( ) 64.2 ( ) ( ) seng (ng ml) ( ) 1.4 ( ) 9.7 ( ) 42.2 ( ) median (interquartile range)

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5 1. Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC and Wenstrom KD: Hypertensive Disorders in Pregnancy. Williams Obstetrics. 21st ED, McGraw Hill, New York (21): Sibai B, Dekker G and Kupferminc M: Pre eclampsia. Lancet (25) 365: Seely EW and Solomon CG: Insulin resistance and its potential role in pregnancy induced hypertension. J Clin Endocrinol Metab (23) 88: Duckitt K and Harrington D: Risk factors for pre eclampsia at antenatal booking: systematic review of controlled studies. BMJ (25) 33: Masuyama H, Segawa T, Sumida Y, Masumoto A, Inoue S, Akahori Y and Hiramatsu Y: Different profiles of circulating angio genic factors and adipocytokines between early and late onset preeclampsia. BJOG (21) 117: Masuyama H, Nakatsukasa H, Takamoto N and Hiramatsu Y: Correlation between soluble endoglin, vascular endothelial growth factor receptor 1 and adipocytokines in preeclampsia. J Clin Endocrinol Metab (27) 92: Masuyama H, Inoue S and Hiramatsu Y: Retinol binding protein 4 and insulin resistance in preeclampsia. Endocrine J (21) 58: Steegers E, von Dadelszen P, Duvekot JJ and Pijnenborg R: Pre eclampsia. Lancet (21) 376: Davison JM, Homuth V and Jeyabalan A: New aspects in the pathophysiology of preeclampsia. J Am Soc Nephrol (24) 15: Huppertz B: Placental origins of preeclampsia: challenging the current hypothesis. Hypertension (28) 51: Masuyama H and Hiramatsu Y: Angiogenic proteins and adipocy tokines as markers for prediction of preeclampsia. Expert Rev Obstet Gynecol (21) 5: Gil Campos M, Canete RR and Gil A: Adiponectin, the missing link in insulin resistance and obesity. Clin Nutr (24) 23: Mise H, Sagawa N, Matsumoto T, Yura S, Nanno H, Itoh H, Mori T, Masuzaki H, Hosoda K, Ogawa Y and Nakao K: Augmented placental production of leptin in preeclampsia: possible involvement of placental hypoxia. J Clin Endocrinol Metab (1998) 83: Anim Nyame N, Sooranna SR, Steer PJ and Johnson MR: Longi tudinal analysis of maternal plasma leptin concentrations during normal pregnancy and pre eclampsia. Hum Reprod (2) 15: Teppa RJ, Ness RB, Crombleholme WR and Roberts JM: Free leptin is increased in normal pregnancy and further increased in preeclampsia. Metabolism (2) 49: Nakatsukasa H, Masuyama H, Takamoto N and Hiramatsu Y: Circulating Leptin and Angiogenic Factors in Preeclampsia Patients, Endocrine J (28) 55: Suwaki N, Masuyama H, Nakatsukasa H, Masumoto A, Sumida Y, Takamoto N and Hiramatsu Y: Hypo adiponectinemia and circulat ing angiogenic factors in overweight patients complicated with preeclampsia. Am J Obstet Gynecol (26) 195: Ramsay JE, Jamieson N, Greer IA and Sattar N: Paradoxical ele vation in adiponectin concentrations in women with preeclampsia. Hypertension (23) 42: Naruse K, Yamasaki M, Umekage H, Sado H, Sakamoto Y and Morikawa H: Peripheral blood concentrations of adiponectin, an adipocyte specific plasma protein, in normal pregnancy and preec lampsia. J Reprod Immunol (25) 65: Tan KC, Xu A, Chow WS, Lam MC, Ai VH, Tam SC and Lam KS: Hypoadiponectinaemia is associated with impaired endothe lium dependant vasodilatation. J Clin Endocrinol Metab (24) 89: Shimabukuro M, Higa N, Asahi T, Oshiro Y, Takasu N, Tagawa T, Ueda S, Shimomura I, Funahashi T and Matsuzawa Y: Hypo adiponectinaemia is closely linked to endothelial dysfunction in man. J Clin Endocrinol Metab (23) 88: Iwashima Y, Katsuya T, Ishikawa K, Ouchi N, Ohishi M, Sugimoto K, Fu Y, Motone M, Yamamoto K, Matsuo A, Ohashi K, Kihara S, Funahashi T, Rakugi H, Matsuzawa Y and Ogihara T: Hypoadiponectinemia is an independent risk factor for hyperten sion. Hypertension (24) 43: Caminos JE, Nogueiras R, Gallego R, Bravo S, Tovar S, García Caballero T, Casanueva FF and Diéguez C: Expression and regu lation of adiponectin and receptor in human and rat placenta. J Clin Endocrinol Metab (25) 9: