Comparison of maternal serum and umbilical cord concentrations of nitric oxide and asymmetric-dimethyl-arginine in pre-eclamptic and uncomplicated pregnancies

Mustafa ALBAYRAK, Mahmut ÖNCÜL, Seyfettin ULUDAĞ, Hafize UZUN, Ali BENİAN, Onur GÜRALP, Rıza MADAZLI
1.732 502


The aim of this study was to compare maternal serum and umbilical cord levels of asymmetric-dimethyl-arginine (ADMA) and nitric oxide (NO) in pre-eclamptic and non-pre-eclamptic women and the possible effects of ADMA and NO on fetal outcome. Mean umbilical cord and maternal serum NO and ADMA levels of 29 women with preeclampsia (PE) and 24 randomly selected healthy pregnant women were compared. Maternal venous blood samples were collected before delivery and umbilical cord venous blood samples were obtained after delivery. Birth weight, apgar score, cord blood pH, duration of stay in the neonatal intensive care unit (NICU), and maternal and neonatal complications were recorded. Umbilical cord ADMA and maternal NO levels were significantly higher in women with pre-eclampsia compared to women without pre-eclampsia. There were no significant differences between means of maternal serum ADMA levels and cord blood NO levels in women with and without pre-eclampsia. Maternal and cord serum NO and ADMA levels in the pre-eclampsia group did not show a significant correlation with cord blood pH, umbilical artery pulsatility index (PI). In conclusion, umbilical cord ADMA and maternal NO levels were significantly higher in
women with pre-eclampsia compared to women without pre-eclampsia.


Asymmetric dimethyl arginine; cord blood; maternal serum; nitric oxide; pre-eclampsia

Full Text:




Ahmad, S., Ahmed, A,. 2004. Elevated placental soluble vascular endothelial growth factor receptor-1 inhibits angiogenesis in preeclampsia. Circ. Res. 95, 884-891.

Cunningham, F.G., Gant, N.F., Leveno, K.J., Gilstrap, L.C., Hauth, J.C., Wenstrom, K.D., 2001. Hypertensive Disorders in Pregnancy. Williams Obstetrics. 21st ED, McGraw-Hill., New York. 568-573.

Egerman, R.S., Andersen, R.N., Manejwala, F.M., Sibai, B.M., 1999. Neuropeptide Y and nitrite levels in preeclamptic and normotensive gravid women. Am. J. Obstet. Gynecol. 181, 921-923.

Garcia, R.G.,Celedón, J., Sierra-Laguado, J., Alarcón, M.A., Luengas, C., Silva, F., Arenas-Mantilla, M., López-Jaramillo, P., 2007. Raised Creactive protein and impaired flow-mediated vasodilation precede the development of preeclampsia. Am. J. Hypertens. 20, 98-103.

Gude, N.M., King, R.G., Brennecke, S.P., 1990. Role of endothelium-derived nitric oxide in maintenance of low fetal vascular resistance in placenta. Lancet. 336, 1589-1590.

Holden, D.P., Fickling, S.A., Whitley, G.S., Nussey, S.S., 1998. Plasma concentrations of asymmetric dimethylarginine, a natural inhibitor of nitric oxide synthase, in normal pregnancy and preeclampsia. Am J Obstet Gynecol. 178, 551-556.

Laresgoiti-Servitje, E., Gómez-López, N., Olson, D.M., 2010. An immunological insight into the origins of pre-eclampsia. Hum. Reprod. Update.16, 510-524.

Maeda, T., Yoshimura, T., Okamura, H., 2003. Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, in maternal and fetal circulation. J. Soc. Gynecol. Investig. 10, 2-4.

Moncada, S., Palmer, R.M., Higgs, E.A., 1991. Nitric oxide: Physiology, pathophysiology, and pharmacology. Pharmacol. Rev. 43, 109-142. Mutlu-Türkoglu, U., Aykaç-Toker, G., Ibrahimoglu, L., Ademoglu, E., Uysal, M., 1999. Plasma nitric oxide metabolites and lipid peroxide levels in preeclamptic pregnant women before and after delivery. Gynecol. Obstet. Invest. 48, 247-250.

Myatt, L., Brewer, A., Brockman, D.E. 1991. The action of nitric oxide the perfused human fetal-placental circulation. Am. J. Obstet. Gynecol. 164, 687-92.

Myatt, L., Brockman, D.E., Eis, A.L., Pollock, J.S., 1993. Immunohistochemical localization of nitric oxide synthase in the human placenta. Placenta. 14, 487-495.

Myatt, L.,Webster, R.P., 2009. Webster Vascular biology of preeclampsia. J. Thromb. Haemost. 375-384.

Pinheiro, M.B., Gomes, K.B., Dusse, L.M., 2013. Fibrinolyticsysteminpreeclampsia. Clin. Chim. Acta. 1, 416, 67-71.

Roberts, J.M., Taylor, R.N., Musci, T.J., Rodgers, G.M., Hubel, C.A., McLaughlin, M.K.,1989. Preeclampsia: An endothelial cell disorder. Am.J.Obstet. Gynecol. 161, 1200-1204.

Rudherford, R.A., McCarty, A., Sullvian, M.H., Elder, M.G., Polak, J.M., Warton, J., 1995. Nitric oxide synthase in human placenta and umbilical cord from normal, intrauterine growth-retarded and pre-eclamptic pregnancies. Br. J. Pharmacol. 116, 3099-3109.

Savvidou, D.M., Hingorani, A.D., Tsikas, D., Frölich, J.C., Vallance, P., Nicolaides, K.H., 2003. Endothelial dysfunction and raised plasma concantrations of asymmetric dimethyl arginine (ADMA) in pregnant woman who subsequently developed pre-eclampsia. Lancet. 361, 1511-1517.

Seligman, S.P., Buyon, J.P., Clancy, R.M., Young, B.K., Abramson, S.B., 1994. The role of nitric oxide in the pathogenesis of preeclampsia. Am. J. Obstet. Gynecol. 171, 944-948.

Shaamash, A.H., Elsonosy, E.D., Zakhari, M.M., Radwan, S.H., El-Dien, H.M., 2001. Placental nitric oxide synthase (NOS) activity and nitric oxide (NO) production in normal pregnancy, pre-eclampsia and eclampsia. Int. J. Gynaecol. Obstet. 72, 127-133.

Sibai, B., Dekker, G., Kupferminc, M., 2005. Pre-eclampsia. Lancet. 365, 785-799.

Sladek, S.M., Magness, R.R., Conrad, K.P., 1997. Nitric oxide and pregnancy. Am. J. Physiol. 272, 441-463.

Slaghekke, F., Dekker, G., Jeffries, B., 2006. Endogenous inhibitors of nitric oxide and preeclampsia: A review. J. Matern. Fetal. Neonatal Med. 19, 447-452.