الفهرس 
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Abstract
Preeclampsia is a multisystem multifactorial disorder in the second
half of pregnancy. It affects about 3% of prim gravidae and is characterized
by widespread endothelial cell dysfunction.it is considered as a major cause
of maternal and perinatal mortality and morbidity.
Pre-eclampsia is defined as a syndrome characterized by
hypertension with or without edema and proteinuria manifested after 20
weeks of pregnancy.
Even-though the pathogenesis of the illness has been determined
after many studies. It‘s a etiology is still unknown certain theories have
been put forward in this regard :endothelial call damage, decreased
placental perfusion, changed vascular activity, instability between
prostacydin and threnboxane, genetic factors, increased newel system
irritability, and uterine ischemia.
Rennin-angiotensin-aldosterone system related vascular and
hemostatic hyperactivity, thrombocytes and eicosanoids have also been
blamed for this disease.
Several independent investigators have demonstrated through human
and animal studies the association of androgens, especially testosterone,
with hypertension.
Interestingly accumulating evidence indicates that androgens have
important effects on vascular reactivity, the renin-angiotensin system,
eicosanoids, and platelets, in ways that are strikingly similar to those
reported for preeclampsia.
Some studies have shown that women with polycystic ovary (PCO),
a disease associated with hyperandrogenemia, are at risk for pregnancy
induced hypertension independent of body mass index (BMI).
Summery
67
It has been suggested that overproduction of steroid hormones,
especially androgens, is the main factor for appearance of preeclampsia in
PCO patients.
Recently it has also been found that serum concentrations of inhibin
A were higher in patients with preeclampsia than in control subjects with
matched pregnancies and this finding was interpreted as further evidence
for Androgen levels in Preeclampsia trophoblastic dysfunction in
preeclampsia.
Additionally, inhibin was recently shown to increase androgen
production by ovarian theca cells, in turn increasing circulating androgen
levels in women. It is thus possible that effects of increased serum inhibin
in preeclampsia may be manifested through increased circulating androgen
levels.
We therefore hypothesized that levels of sex androgens, and more
specially that of testosterone, may be increased in pregnancies complicated
by preeclampsia.
We suspected that such an increase might be implicated in
pathogenesis of preeclampsia. Of course, there have been some studies that
have not demonstrated this correlation between androgens and
preeclampsia.
Consequently, this study was conducted and aimed to compare
between androgens level (serum total and free testosterone) in women with
preeclampsia and normal ones in the third trimester of pregnancy (28-40
weeks).
This prospective case control study was conducted at Obstetrics and
Gynecology Department, Faculty of Medicine, Menoufia University
Hospitals and Shebin Al Kom Teaching Hospital from February 2022 until
February 2023.
Summery
68
During this study, 80 pregnant women were enrolled, after
consenting each of them and divided into two groups; group A consisted of
40 women in the third trimester of pregnancy with preeclampsia at time of
admission and group B consisted of 40 healthy normotensive women in the
third trimester and they are control for group A with respect to maternal
age, gestational age and BMI.
Our study revealed that free and total testosterone levels were
significantly higher among pre-eclamptic cases compared with healthy
women with no differences between groups regarding maternal age,
gestational age and fetal sex.
In conclusion, serum androgen levels (free and total testosterones)
during third trimester of pregnancy are higher in pre-eclamptic women and
this may propose an effect of androgens in the pathogenesis of preeclampsia.
While the pathogenesis of preeclampsia in women remains unknown,
a role for androgens is emerging. The relationship between androgens and
maternal cardiovascular and placental function deserves particular
consideration because testosterone levels in the circulation of preeclamptic
women are elevated approximately two- to three-fold and are positively
correlated with vascular dysfunction.
Preeclampsia is also associated with elevated placental androgen
receptor (AR) gene expression.
Studies in animal models mimicking the pattern and level of increase
of adult female testosterone levels to those found in preeclamptic
pregnancies, replicate key features of preeclampsia, including gestational
hypertension, endothelial dysfunction, exaggerated vasoconstriction to
angiotensin II, reduced spiral artery remodeling, placental hypoxia,
decreased nutrient transport and fetal growth restriction.
Summery
69
Taken together, these data strongly implicate AR-mediated
testosterone action as an important pathway contributing to clinical
manifestation of preeclampsia.