Assessment of serum leptin and insulin levels in recurrent pregnancy loss

Abstract

Two or more failed clinical pregnancies before 20 weeks according to the American Society for Reproductive Medicine (ASRM) are defined as recurrent pregnancy loss (RPL). Before considering abortion, the biochemically diagnosed pregnancy must be documented by ultrasound and histological examination (The Practice Committee of the American Society for Reproductive Medicine. 2013). Although there are different multiple etiologic factors for RPL, no apparent cause could be found in 50–75% of the cases (unexplained RPL) (Lund et al ., 2012). There are only few evidence based strategies for diagnosis and treatment of RPL. Intensive research for the cause behind RPL is pursued within immunological and genetic studies (Saravelos et al ., 2012). Most of the published studies emphasized on the causes and treatment of unexplained RPL with little effort done for founding a predictor of pregnancy continuation in these cases (Saravelos et al ., 2014). Leptin hormone was originally thought to be produced only by adipocytes to modulate satiety and energy (Kershaw et al ., 2004). However, now it is known to be produced in many other tissues and is responsible for specific events in the reproductive maturity and fertility e.g. implantation, maternal physiological changes, regulation of conceptus development and fetal growth (Moschos et al ., 2002). Leptin hormone is involved in supporting normal pregnancy and its disturbance is recently implicated in the pathogenesis of various disorders during pregnancy that might lead to recurrent pregnancy loss (RPL). Insulin resistance (IR) and hyperinsulinemia are incriminated as potential causes of the high rate of pregnancy loss and have been linked to the metabolic and endocrine abnormalities associated with the pathophisiologyology of RPL (Li ZL et al .,2012). Some studies suggested the use of leptin and insulin as predictors for pregnancy continuation beyond 20 weeks in cases of RPL ( Toth et al ., 2009). This cross sectional , comparative clinical study comprised 55 women with history of RPL and 55 control women with no history of RPL. The study was conducted at Ain Shams maternity Hospital . History taking was done . Serum leptin, insulin level , eight hours fasting blood glucose , two hours post prandial blood sugar and lipid profile ( cholesterol , triglycerides , LDL and HdL ) were determined.