title: Protein Z, protein S levels are lower in patients with thrombophilia and subsequent pregnancy complications.
abstract: OBJECTIVE
  We posit that low levels of protein S (PS) and protein Z (PZ) contribute to adverse pregnancy outcome (APO).
  
  
  METHODS
  We evaluated 103 women with subsequent normal pregnancy outcome (NPO), 106 women with APO, and 20 women with thrombophilia (TP).
  
  
  METHODS
  We compared first trimester (1st TRI) PZ levels in 103 women with NPO, 106 women with APO, and in 20 women with TP. We compared plasma levels of PZ and free PS antigen during the second (2nd TRI) and third trimesters (3rd TRI) of pregnancy in 51 women with APO and 51 matched women with NPO.
  
  
  RESULTS
  The mean 1st TRI PZ level was significantly lower among patients with APO, compared to pregnant controls (1.81 +/- 0.7 vs. 2.21 +/- 0.8 microg mL(-1), respectively, P < 0.001). Of patients with known TP, those with APO had a tendency for lower mean PZ levels compared to those TP women with NPO (1.5 +/- 0.6 vs. 2.3 +/- 0.9 microg mL(-1), respectively, P < 0.0631). There was a significant decrease in the PZ levels in patients with APO compared to NPO (2nd TRI 1.5 +/- 0.4 vs. 2.0 +/- 0.5 microg mL(-1), P < 0.0001; and 3rd TRI 1.6 +/- 0.5 vs. 1.9 +/- 0.5 microg mL(-1), P < 0.0002). Protein S levels were significantly lower in the 2nd and 3rd TRIs among patients with APO compared to patients with NPO (2nd TRI 34.4 +/- 11.8% vs. 38.9 +/- 10.3%, P < 0.05, respectively; and 3rd TRI 27.5 +/- 8.4 vs. 31.2 +/- 7.4, P < 0.025, respectively).
  
  
  CONCLUSIONS
  We posit that decreased PZ and PS levels are additional risk factors for APO.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA. michael.paidas@yale.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Paidas
authors.forename: D-H W
authors.initials: DH
authors.lastname: Ku
authors.forename: M-J
authors.initials: MJ
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Manish
authors.forename: A
authors.initials: A
authors.lastname: Thurston
authors.forename: C J
authors.initials: CJ
authors.lastname: Lockwood
authors.forename: Y S
authors.initials: YS
authors.lastname: Arkel
mesh_terms: D000328:Adult; D001798:Blood Proteins / Q000032:analysis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D021041:Placental Circulation; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D017293:Protein S / Q000032:analysis*; D012307:Risk Factors; D019851:Thrombophilia / Q000097:blood* / Q000150:complications
chemical_list: D001798:Blood Proteins; D017293:Protein S; C026080:plasma protein Z