title: Could alterations in maternal plasma visfatin concentration participate in the phenotype definition of preeclampsia and SGA?
abstract: 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.
authors.affiliation: Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women's Hospital, Bethesda, MD, and Detroit, MI 48201, USA.
authors.forename: Shali
authors.initials: S
authors.lastname: Mazaki-Tovi
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Sun Kwon
authors.initials: SK
authors.lastname: Kim
authors.forename: Edi
authors.initials: E
authors.lastname: Vaisbuch
authors.forename: Juan Pedro
authors.initials: JP
authors.lastname: Kusanovic
authors.forename: Offer
authors.initials: O
authors.lastname: Erez
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
authors.forename: Francesca
authors.initials: F
authors.lastname: Gotsch
authors.forename: Pooja
authors.initials: P
authors.lastname: Mittal
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Nhan-Chang
authors.forename: Nandor Gabor
authors.initials: NG
authors.lastname: Than
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gomez
authors.forename: Jyh Kae
authors.initials: JK
authors.lastname: Nien
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Edwin
authors.forename: Percy
authors.initials: P
authors.lastname: Pacora
authors.forename: Lami
authors.initials: L
authors.lastname: Yeo
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
mesh_terms: 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
chemical_list: D016207:Cytokines; D054409:Nicotinamide Phosphoribosyltransferase; C085455:nicotinamide phosphoribosyltransferase, human