Could alterations in maternal plasma visfatin concentration participate in the phenotype definition of preeclampsia and SGA?
OBJECTIVE
Women with preeclampsia and those who delivered a small-for-gestational-age (SGA) neonate share several mechanisms of disease, including chronic uteroplacental ischemia and failure of physiologic transformation of the spiral arteries. However, the clinical manifestation of these obstetrical syndromes is remarkably different. It has been proposed that an altered maternal metabolic state, as well as a unique circulating cytokines milieu, predispose women to develop either preeclampsia or SGA. Compelling evidence suggests that adipose tissue orchestrates both metabolic pathways and immunological responses via the production of adipokines. Visfatin is a novel adipocytokine with metabolic and immunomodulating properties. The objective of this study was to determine whether preeclampsia and SGA are associated with alterations in maternal circulating visfatin concentrations.


METHODS
This cross-sectional study included pregnant women in the following groups: (1) normal pregnancy (n = 158); (2) patients with preeclampsia (n = 43) of which 32 had an AGA and 11 had an SGA neonate; (3) patients without preeclampsia who delivered an SGA neonate (n = 55). Maternal plasma visfatin concentrations were measured by ELISA. Nonparametric tests and multiple linear regression analysis were used.


RESULTS
(1) Women who delivered an SGA neonate had a higher median maternal plasma visfatin concentration than those with a normal pregnancy (20.0 ng/ml, interquartile range: 17.2-24.6 vs. 15.2 ng/ml, 12.1-19.2, respectively; P < 0.001) and than those with preeclampsia (14.5 ng/ml, 12.5-18.7; P < 0.001); (2) the median maternal plasma visfatin concentration did not differ significantly between patients with preeclampsia and those with a normal pregnancy (P = 0.8); (3) among patients with preeclampsia, there was no significant difference in the median maternal plasma visfatin concentration between those with or without an SGA neonate (P = 0.5); (4) in a linear regression model, delivery of an SGA neonate and pregestational body mass index were independently associated with increased visfatin concentration after adjustment for confounding factors (maternal age, smoking, gestational age at blood collection and the presence of preeclampsia or SGA).


CONCLUSIONS
(1) Patients with SGA, but not those with preeclampsia, had a higher maternal plasma visfatin concentration than those with a normal pregnancy; (2) this finding suggests differential involvement of visfatin in SGA and preeclampsia; (3) we propose that changes in circulating maternal visfatin concentration may be implicated in the phenotypic definitions and distinction of preeclampsia and SGA.
Mazaki-Tovi
Shali
S
Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women's Hospital, Bethesda, MD, and Detroit, MI 48201, USA.
Romero
Roberto
R
Kim
Sun Kwon
SK
Vaisbuch
Edi
E
Kusanovic
Juan Pedro
JP
Erez
Offer
O
Chaiworapongsa
Tinnakorn
T
Gotsch
Francesca
F
Mittal
Pooja
P
Nhan-Chang
Chia-Ling
CL
Than
Nandor Gabor
NG
Gomez
Ricardo
R
Nien
Jyh Kae
JK
Edwin
Samuel S
SS
Pacora
Percy
P
Yeo
Lami
L
Hassan
Sonia S
SS
D000328:Adult; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood*; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood / Q000201:enzymology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D054409:Nicotinamide Phosphoribosyltransferase / Q000097:blood*; D010641:Phenotype; D011225:Pre-Eclampsia / Q000097:blood* / Q000201:enzymology / Q000235:genetics; D011247:Pregnancy; D055815:Young Adult
D016207:Cytokines; D054409:Nicotinamide Phosphoribosyltransferase; C085455:nicotinamide phosphoribosyltransferase, human