الفهرس 
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Abstract
VI- Summary and Conclusion
Preeclampsia (PE) is a common complication of pregnancy associated with high maternal morbidity and mortality and intrauterine fetal growth restriction. PE is a multisystem disorder characterized by hypertension and proteinuria in pregnant women. Pre-eclampsia affects 2–8% of pregnancies worldwide.
The prevalence of PE In Egypt is 10.7% in a community based study. While, in hospital based studies it ranged from 9.1% to12.5% of all deliveries. Also, In Egypt PE was found among 16.0% and 5.0% of rural and urban pregnant residents, respectively.
There is extensive evidence that the reduction of uteroplacental blood flow in this syndrome results from the toxic combination of hypoxia, imbalance of angiogenic and antiangiogenic factors, inflammation, and deranged immunity. Women treated for preeclampsia also have an increased risk for cardiovascular and renal disease.
The etiology of preeclampsia remains obscure. Some studies suggested that in pregnancies destined to develop PE, the circulating levels of glucose ,insulin , and insulin resistance ,in the form of Homeostatic model assessments (HOMA-IR), are associated with later onset of preeclampsia .
Some studies suggested that in pregnancies destined to develop PE, the circulating levels of IGF-I decrease from the first trimester of pregnancy suggesting that IGF-I may be implicated in the pathogenesis of the disease.
Other studies found that the PAPP-A-related patient-specific risk for PE was strongly influenced by maternal characteristics. There was a significant association between PAPP- A and the detection rate of screening for PE by maternal variables .
Early detection of PE would allow for planning appropriate monitoring and clinical management, following the early identification of disease complications.
In our present study, we wanted to combine all these parameters for study, Insulin resistance, IGF-1, serum PAPPA and placental PAPPA gene expression, among groups of pregnant women with mild preeclampsia, severe preeclampsia and other healthy carriers of the disease, in order to predict the occurrence of the disease as well as their use as a means to prevent the disease before it occurs, as well as treatment if possible.
Case-control study included 60 women with preeclampsia, were collected from Medicine University Hospital, Mansoura University, Mansoura, Egypt, (mean age: 30.03± 5.5 years) diagnosed into Mild preeclampsia group (mean age: 30.03± 5.5years), 50 % for the patients (30/60) and 50% (30/60) severe preeclampsia (mean age: 31.83± 3. Years),and 30 pregnant women without preeclampsia as control (mean age: 29.53± 4.363 years) 33,3% (30/90 total number of participants).
The fasting plasma glucose was determined by using enzymatic colorimetric method , the fasting plasma insulin was determined by using a solid phase enzyme- linked immune sorbent assay, the Homeostatic model assessments [HOMA-IR] was calculated by specific equation from glucose and insulin concentrations, the serum IGF-1 level and serum PAPP-A were assayed by enzyme-linked immunosorbent assay and placental PAPP-A gene expression was done by total RNA extraction and RT-PCR.
Methods has been following in this study:
1- 3 ml venous blood sample were collected from each case and collected in EDTA tube.
2- 5 ml venous blood sample were collected from each case and collected in tube to separate serum from samples.
3- Placental biopsy samples were obtained during delivery from both normotensive patients and those with pre-eclampsia.
4- enzymatic colorimetric method for determination of glucose.
5- Immunospec Insulin Quantitive Test depending on A solid phase enzyme- linked immune sorbent assay.
6- A Sandwich Enzyme Immunoassay( ELISA) for detection of serum PAPPA level and serum IGF-1 level.
7 - Total RNA extraction,Reverse Transcriptase (RT)-PCR and Real-Time PCR System
Results :
Our results indicate no significant correlation between groups of preeclampsia and control group without preeclampsia in terms of average age, Weight and gestational age. There was statistically significant difference between the preeclampsia groups and control group as regards Body mass index, Diastolic blood pressure and Systolic blood pressure (P<0.001). The level of fasting glucose among people with preeclampsia was higher than that of control group with statistically significant difference (𝑃 < 0.05) . Changes in insulin level were significant for both groups of preeclampsia (𝑃 <0.001). HOMA-IR was higher in group with severe preeclampsia than in group with mild preeclampsia. There was lower level of the serum IGF-I in case of preeclampsia groups than that in control group. Mean PAPP-A levels were significantly lower in preeclampsia (MPE and SPE) compared to their matched control. PAPP-A was significantly lower in control group than in severe preeclampsia group(P<0.001) or mild preeclampsia (P= 0.001). There was no statistically significant difference between the groups of preeclampsia.
We must taken into consideration it is important to recognize that there are significant associations between all biochemical markers in PE and unaffected pregnancies and therefore when combining the six markers, fasting glucose, fasting insulin , HOMA-IR, serum IGF-1level , serum PAPP-A level and placental PAPP-A gene expression, in calculating the patient specific risk for PE the correlation factors are taken into account to provide accurate risk assessment for PE.
Conclusions :
1-Second-trimester maternal serum levels of PAPPA, fasting glucose, fasting insulin, HOMA-IR, serum IGF-1level, and placental PAPP-A gene expression together with maternal characteristics (MC), are predictive of development of subsequent PE. These markers, along with MC, form a suitable panel for predicting PE.
2-Our findings suggest that serum PAPPA level was significantly decreased in preeclamptic blood, which may be caused by increasing expression preeclamptic placentas of PAPPA gene.
3-The direct significant correlation between overexpressed of placental PAPPA and serum PAPPA levels ,we found in our study,may give the method to avoid the cost analysis of PAPP-A gene expression and the analysis of serum PAPP-A may be the enough analysis in prediction, diagnosis and treatment.
Recommendations:
1- Further research to design on different samples from the three trimesters of pregnancy.
2- The power calculation of the sample was low, suggesting that a larger sample is needed
3- We recommend that hospital laboratories in Egypt should investigate all samples of women with preeclampsia women and collect the samples to expand the field of study of genetic expression.
4- Larger groups are needed, healthy non pregnant women, healthy pregnant women, and women with preeclampsia.