CLINICAL SIGNIFICANCE AND UTILITY OF THE HOMA-IR AS PREDICTIVE MARKER FOR PREECLAMPSIA IN THE FIRST TRIMESTER SCREENING

January 27, 2016

CLINICAL SIGNIFICANCE AND UTILITY OF THE HOMA-IR AS PREDICTIVE MARKER FOR PREECLAMPSIA IN THE FIRST TRIMESTER SCREENING

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Title:	CLINICAL SIGNIFICANCE AND UTILITY OF THE HOMA-IR AS PREDICTIVE MARKER FOR PREECLAMPSIA IN THE FIRST TRIMESTER SCREENING
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Article_Title:	CLINICAL SIGNIFICANCE AND UTILITY OF THE HOMA-IR AS PREDICTIVE MARKER FOR PREECLAMPSIA IN THE FIRST TRIMESTER SCREENING
Authors:	Cristina Onel1, Mircea Onel⁴, Gheorghe Furău1, Amorin Popa⁶, Cristian Furău3, Voicu Daşcău1, Liana Tătaru3 , Pilat Luminita⁵, Carmen Neamțu7, and Casiana Stănescu2
Affiliation:	1”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Ob-Gyn Department, Liviu Rebreanu 86, Arad, Romania 2”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Anatomy Department, Liviu Rebreanu 86 , Arad, Romania 3”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Pathophysiology Department, Liviu Rebreanu 86, Romania 4”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Hematology Department, Liviu Rebreanu 86, Romania 5”Vasile Goldiş” Western University of Arad, Faculty of Medicine Biochemistry Department, Liviu Rebreanu 86, Romania 6″University of Oradea, Faculty of Medicine” Piata 1 Decembrie, Nr.10, Romania 7” Vasile Goldiş” Western University of Arad, Faculty of Medicine, Surgery Department, LiviuRebreanu 86 , Arad, Romania
Abstract:	The preeclampsia (PE) is defined as a complication of the hypertension during the pregnancy, having multifactorial characteristics. The PE has a much higher prevalence among the women with diabetes mellitus. Both diabetes and preeclampsia are regarded as major pregnancy both for the mother and the foetus. The pathologic mechanism involving the PE at the women with diabetes mellitus is not fully comprehended. The evaluation of insulin-resistance by the homeostatic model (HOMA-IR) is used to define the insulin-resistance as a predictor for the cardiovascular diseases. The study was performed on pregnant women hospitalised at the Department of Obstetrics-Gynaecology of the Arad County University Clinical Emergency Hospital during 2014-2015. We included in the study pregnant women with pregnancy of 11 to 14 weeks, with or without risk factors for the PE, for whom PAPP-A and insulinemia (for calculating the HOMA-IR) have been dosed, in order to correlate the results with the further development of the PE during the pregnancy.
Keywords:	Preeclampsia, Diabetes, PAPP-A, HOMA-IR, Pregnancy 11-14 weeks
References:	Akshay S. Desai, MD, MPH, Robert Toto, MD, Petr Jarolim, MD, PhD, Hajime Uno, PhD, Kai-Uwe Eckardt, MD, Reshma Kewalramani, MD, Andrew S. Levey, MD, Eldrin F. Lewis, MD, MPH,1 John J.V. McMurray, MD, Hans-Henrik Parving, MD, Scott D. Solomon, MD, and Marc A. Pfeffer, MD, PhD; Association Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anaemia, and CKD 1; Original Investigation Am J Kidney Dis.;58(5):717-728; (2011) Elnaz Mosaferi, Jafar Majidi, Mozhdeh Mohammadian, Zohreh Babaloo, Amir Monfaredan, Behzad Baradaran HLA-G Expression Pattern: Reliable Assessment for Pregnancy Outcome Prediction Advanced; Pharmaceutical Bulletin, 3(2), 443-446 ; (2013) Emmanuel Villar a, Michel Lièvre, Michèle Kessler, Vincent Lemaître, Eric Alamartine, Michel Rodier, Maud François, Philippe Zaoui, Olivier Moranne, Gabriel Choukroun, Abdallah Guerraoui, Anne Jolivot, Gérard Janin, Bernard Branger, Anne-Elisabeth Heng, Catherine Boudray, Alvine Bissery, Muriel Rabilloud, Claire Pouteil-Noble; Anemia normalization in patients with type 2 diabetes and chronic kidney disease: results of the NEPHRODIAB2 randomized trial; Journal of Diabetes and Its Complications 25; 237–243; Type 1 diabetes mellitus in a patient with homozygous sickle cell anaemia ; J Pediatr Endocr Met; 26(11-12): 1205–1207; (2013) Farideh Rezaei Abhari,1 Maryam Ghanbari Andarieh,2 Asadollah Farokhfar,3 and Soleiman Ahmady, Estimating Rate of Insulin Resistance in Patients with Preeclampsia Using HOMA-IR Index and Comparison with Nonpreeclampsia Pregnant Women BioMed Research InternationalVolume 2014 (2014), Article ID 140851, 6 pageshttp://dx.doi.org/10.1155/2014/140851 (2014) Gabriel Choukroun , Marianne Renou, Caroline Lecaque, Maïté Jauréguy ; TREAT or not to treat : anémie du patient diabétique de type 2 aux stades 3 et 4 de la maladie rénale chronique TREAT or not to treat: Anemia in type 2 diabetes and chronic kidney disease at stages 3 and 4; Néphrologie & Thérapeutique 7 ;2–9; (2011) GuoyingWang, MD, PhD; Sara Divall, MD; Sally Radovick, MD; David Paige, MD; Yi Ning, MD, ScD; Zhu Chen, PhD; Yuelong Ji, MS; Xiumei Hong, PhD; Sheila O.Walker, PhD; Deanna Caruso, MS; Colleen Pearson, BA; Mei-ChengWang, PhD; Barry Zuckerman, MD; Tina L. Cheng, MD; XiaobinWang,MD, MPH, ScD Preterm Birth and Random Plasma Insulin Levels at Birth and in Early Childhood; JAMA. 2014;311(6):587-596; (2014) Hicham Skali, MD, MSc, Julie Lin, MD, MPH, Marc A. Pfeffer, MD, PhD, Chao-Yin Chen, PhD, Mark E. Cooper, MD, John J.V. McMurray, MD, Allen R. Nissenson, MD, Giuseppe Remuzzi, MD, Jerome Rossert, MD, PhD, Patrick S. Parfrey, MD, Nairne W. Scott-Douglas, MD, PhD, Ajay K. Singh, MD, Robert Toto, MD, Hajime Uno, PhD, and Peter Ivanovich, MD; Haemoglobin Stability in Patients With Anemia, CKD, and Type 2 Diabetes: An Analysis of the TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy) Placebo Arm ;Am J Kidney Dis. 61(2):238-246. (2013) John J. V. McMurray, MD, Hajime Uno, PhD, Petr Jarolim, MD, PhD, Akshay S. Desai, MD, Dick de Zeeuw, MD, PhD, Kai-Uwe Eckardt, MD, Peter Ivanovich, MD, Andrew S. Levey, MD, Eldrin F. Lewis, MD, MPH, Janet B. McGill, MD, Patrick Parfrey, MD, Hans-Henrik Parving, MD, DMSc, Robert M. Toto, MD, Scott D. Solomon, MD, and Marc A. Pfeffer, MD, PhDb Glasgow, United Kingdom; Boston, MA; Groningen, The Netherlands; Erlangen, Germany; Chicago, IL; St Louis, MO; Newfoundland, Canada; Copenhagen, Denmark; and Dallas, TX; Predictors of fatal and nonfatal cardiovascular events in patients with type 2 diabetes mellitus, chronic kidney disease, and anaemia: An analysis of the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin-alfa) Therapy (TREAT) ;American Heart Journal Volume 162, Number 4/(2011) Magnus Domello¨ f, Inga Thorsdottir and Ketil Thorstensen Health effects of different dietary iron intakes: a systematic literature review for the 5th Nordic Nutrition Recommendations ;Food & Nutrition Research, 57: 21667 (2013) Nalinee Poolsup, Naeti Suksomboon, Muhammad Amin ; Effect of Treatment of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis ; PLoS ONE 9(3): e92485(2014) Pallavi S. Hardikar, SuyogM. Joshi, Dattatray S. Bhat, Deepa A. Raut, Prachi A. Katre, HIimangi G. Lubree, Abhay Jere, Anand N. Ppandit, Caroline H.D. Fall, Chittaranjan S. YAJNIK, Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia; Diabetes Care 35:797–802, (2012) Reena Negi, Deepti Pande, Kanchan Karki, Ashok Kumar, Ranjana S. Khanna, Hari D. Khanna; Association of oxidative DNA damage, protein oxidation and antioxidant function with oxidative stress induced cellular injury in pre-eclamptic/ eclamptic mothers during fetal circulation; Chemico-Biological Interactions 208 ; 77–83; (2014) Roger K. Schindhelm, MD, PHD , Margreet Schoorl, BSC, Johannes Van Pelt, PHD; Comment on: Hardikar et al. Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia. Diabetes Care ; Diabetes Care;35:797–802; (2012) Ver Luanni Bilano, Erika Ota, Togoobaatar Ganchimeg, Rintaro Mori, Joa˜o Paulo Souza; Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis ; PLoS ONE 9(3): e91198; (2014) W.E. Ackerman IV, L. Adamson , A.M. Carter, S. Collins, B. Coxf, M.G. Elliot, L. Ermini, A. Gruslin, P.A. Hoodless, J. Huang a, D.A. Kniss, M.R. McGowenm, M. Post, G. Rice, W. Robinson, Y. Sadovsky , C. Salafia, C. Salomon, J.G. Sled, T. Todros, D.E. Wildman, S. Zamudio, G.E. Lash; IFPA Meeting 2013 Workshop Report II: Use of ‘omics’ in understanding placental development, bioinformatics tools for gene expression analysis, planning and coordination of a placenta research network, placental imaging, evolutionary approaches to understanding pre-eclampsia; Placenta 35, Supplement A, Trophoblast Research, Vol. 28; S10eS14; (2014) Yiping Dang, Yin Xia, Yiqing Li, Danny C.W. Yu; Anemia and type 2 diabetes mellitus associated with peripheral arterial disease progression in Chinese male patients ; Clinical Biochemistry 46 ;1673–1677; (2013) Zohreh Shoar, Geoffrey Rezvani and Francesco De Luca; Type 1 diabetes mellitus in a patient with homozygous sickle cell anaemia ; Pediatr Endocr Met; 26(11-12): 1205–1207; (2013) Kenny LC1, Broadhurst DI, Dunn W, Brown M, North RA, McCowan L, Roberts C, Cooper GJ, Kell DB, Baker PN; Screening for Pregnancy Endpoints Consortium. Robust early pregnancy prediction of later preeclampsia using metabolomic biomarkers. Hypertension. Oct;56(4):741-9;(2010) Katherine R. GOETZINGER, M.D., M.S.C.I., Yan ZHONG, M.D., Alison G. CAHILL, M.D., M.S.C.I., Linda ODIBO, R.N., M.N., George A. MACONES, M.D., M.S.C.E., and Anthony O. ODIBO, M.D., M.S.C.E. The Efficiency of First-Trimester Uterine Artery Doppler, ADAM12, PAPP-A and Maternal Characteristics in the Prediction of Pre-Eclampsia J Ultrasound Med. Author manuscript; available in PMC Sep., 2014 Kalousová M, Muravská A, Zima T , Pregnancy-associated plasma protein A (PAPP-A) and preeclampsia.. Adv Clin Chem. 2014;63:169-209. (2014) U.D. Anderson, M.G. Olsson, K.H. Kristensen, B. Akerstrom, S.R. Hansson; Biochemical markers to predict preeclampsia; Placenta 33, Supplement a thropoblast research Vol 26, S42/47;(2012) Acknowledgments: The paper has been supported by the grant no PI / 3 / 21.07.2014. “The Clinical Impact of the HOMA Index in Early Detection
Read_full_article:	pdf/vol18/iss2/6 JMA 2015 – Onel Cristina – bdi prospectiv de trimisz.pdf
Correspondence:	mirceaonel@yahoo.com

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Article Title:	CLINICAL SIGNIFICANCE AND UTILITY OF THE HOMA-IR AS PREDICTIVE MARKER FOR PREECLAMPSIA IN THE FIRST TRIMESTER SCREENING
Authors:	Cristina Onel1, Mircea Onel⁴, Gheorghe Furău1, Amorin Popa⁶, Cristian Furău3, Voicu Daşcău1, Liana Tătaru3 , Pilat Luminita⁵, Carmen Neamțu7, and Casiana Stănescu2
Affiliation:	1”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Ob-Gyn Department, Liviu Rebreanu 86, Arad, Romania 2”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Anatomy Department, Liviu Rebreanu 86 , Arad, Romania 3”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Pathophysiology Department, Liviu Rebreanu 86, Romania 4”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Hematology Department, Liviu Rebreanu 86, Romania 5”Vasile Goldiş” Western University of Arad, Faculty of Medicine Biochemistry Department, Liviu Rebreanu 86, Romania 6″University of Oradea, Faculty of Medicine” Piata 1 Decembrie, Nr.10, Romania 7” Vasile Goldiş” Western University of Arad, Faculty of Medicine, Surgery Department, LiviuRebreanu 86 , Arad, Romania
Abstract:	The preeclampsia (PE) is defined as a complication of the hypertension during the pregnancy, having multifactorial characteristics. The PE has a much higher prevalence among the women with diabetes mellitus. Both diabetes and preeclampsia are regarded as major pregnancy both for the mother and the foetus. The pathologic mechanism involving the PE at the women with diabetes mellitus is not fully comprehended. The evaluation of insulin-resistance by the homeostatic model (HOMA-IR) is used to define the insulin-resistance as a predictor for the cardiovascular diseases. The study was performed on pregnant women hospitalised at the Department of Obstetrics-Gynaecology of the Arad County University Clinical Emergency Hospital during 2014-2015. We included in the study pregnant women with pregnancy of 11 to 14 weeks, with or without risk factors for the PE, for whom PAPP-A and insulinemia (for calculating the HOMA-IR) have been dosed, in order to correlate the results with the further development of the PE during the pregnancy.
Keywords:	Preeclampsia, Diabetes, PAPP-A, HOMA-IR, Pregnancy 11-14 weeks
References:	Akshay S. Desai, MD, MPH, Robert Toto, MD, Petr Jarolim, MD, PhD, Hajime Uno, PhD, Kai-Uwe Eckardt, MD, Reshma Kewalramani, MD, Andrew S. Levey, MD, Eldrin F. Lewis, MD, MPH,1 John J.V. McMurray, MD, Hans-Henrik Parving, MD, Scott D. Solomon, MD, and Marc A. Pfeffer, MD, PhD; Association Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anaemia, and CKD 1; Original Investigation Am J Kidney Dis.;58(5):717-728; (2011) Elnaz Mosaferi, Jafar Majidi, Mozhdeh Mohammadian, Zohreh Babaloo, Amir Monfaredan, Behzad Baradaran HLA-G Expression Pattern: Reliable Assessment for Pregnancy Outcome Prediction Advanced; Pharmaceutical Bulletin, 3(2), 443-446 ; (2013) Emmanuel Villar a, Michel Lièvre, Michèle Kessler, Vincent Lemaître, Eric Alamartine, Michel Rodier, Maud François, Philippe Zaoui, Olivier Moranne, Gabriel Choukroun, Abdallah Guerraoui, Anne Jolivot, Gérard Janin, Bernard Branger, Anne-Elisabeth Heng, Catherine Boudray, Alvine Bissery, Muriel Rabilloud, Claire Pouteil-Noble; Anemia normalization in patients with type 2 diabetes and chronic kidney disease: results of the NEPHRODIAB2 randomized trial; Journal of Diabetes and Its Complications 25; 237–243; Type 1 diabetes mellitus in a patient with homozygous sickle cell anaemia ; J Pediatr Endocr Met; 26(11-12): 1205–1207; (2013) Farideh Rezaei Abhari,1 Maryam Ghanbari Andarieh,2 Asadollah Farokhfar,3 and Soleiman Ahmady, Estimating Rate of Insulin Resistance in Patients with Preeclampsia Using HOMA-IR Index and Comparison with Nonpreeclampsia Pregnant Women BioMed Research InternationalVolume 2014 (2014), Article ID 140851, 6 pageshttp://dx.doi.org/10.1155/2014/140851 (2014) Gabriel Choukroun , Marianne Renou, Caroline Lecaque, Maïté Jauréguy ; TREAT or not to treat : anémie du patient diabétique de type 2 aux stades 3 et 4 de la maladie rénale chronique TREAT or not to treat: Anemia in type 2 diabetes and chronic kidney disease at stages 3 and 4; Néphrologie & Thérapeutique 7 ;2–9; (2011) GuoyingWang, MD, PhD; Sara Divall, MD; Sally Radovick, MD; David Paige, MD; Yi Ning, MD, ScD; Zhu Chen, PhD; Yuelong Ji, MS; Xiumei Hong, PhD; Sheila O.Walker, PhD; Deanna Caruso, MS; Colleen Pearson, BA; Mei-ChengWang, PhD; Barry Zuckerman, MD; Tina L. Cheng, MD; XiaobinWang,MD, MPH, ScD Preterm Birth and Random Plasma Insulin Levels at Birth and in Early Childhood; JAMA. 2014;311(6):587-596; (2014) Hicham Skali, MD, MSc, Julie Lin, MD, MPH, Marc A. Pfeffer, MD, PhD, Chao-Yin Chen, PhD, Mark E. Cooper, MD, John J.V. McMurray, MD, Allen R. Nissenson, MD, Giuseppe Remuzzi, MD, Jerome Rossert, MD, PhD, Patrick S. Parfrey, MD, Nairne W. Scott-Douglas, MD, PhD, Ajay K. Singh, MD, Robert Toto, MD, Hajime Uno, PhD, and Peter Ivanovich, MD; Haemoglobin Stability in Patients With Anemia, CKD, and Type 2 Diabetes: An Analysis of the TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy) Placebo Arm ;Am J Kidney Dis. 61(2):238-246. (2013) John J. V. McMurray, MD, Hajime Uno, PhD, Petr Jarolim, MD, PhD, Akshay S. Desai, MD, Dick de Zeeuw, MD, PhD, Kai-Uwe Eckardt, MD, Peter Ivanovich, MD, Andrew S. Levey, MD, Eldrin F. Lewis, MD, MPH, Janet B. McGill, MD, Patrick Parfrey, MD, Hans-Henrik Parving, MD, DMSc, Robert M. Toto, MD, Scott D. Solomon, MD, and Marc A. Pfeffer, MD, PhDb Glasgow, United Kingdom; Boston, MA; Groningen, The Netherlands; Erlangen, Germany; Chicago, IL; St Louis, MO; Newfoundland, Canada; Copenhagen, Denmark; and Dallas, TX; Predictors of fatal and nonfatal cardiovascular events in patients with type 2 diabetes mellitus, chronic kidney disease, and anaemia: An analysis of the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin-alfa) Therapy (TREAT) ;American Heart Journal Volume 162, Number 4/(2011) Magnus Domello¨ f, Inga Thorsdottir and Ketil Thorstensen Health effects of different dietary iron intakes: a systematic literature review for the 5th Nordic Nutrition Recommendations ;Food & Nutrition Research, 57: 21667 (2013) Nalinee Poolsup, Naeti Suksomboon, Muhammad Amin ; Effect of Treatment of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis ; PLoS ONE 9(3): e92485(2014) Pallavi S. Hardikar, SuyogM. Joshi, Dattatray S. Bhat, Deepa A. Raut, Prachi A. Katre, HIimangi G. Lubree, Abhay Jere, Anand N. Ppandit, Caroline H.D. Fall, Chittaranjan S. YAJNIK, Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia; Diabetes Care 35:797–802, (2012) Reena Negi, Deepti Pande, Kanchan Karki, Ashok Kumar, Ranjana S. Khanna, Hari D. Khanna; Association of oxidative DNA damage, protein oxidation and antioxidant function with oxidative stress induced cellular injury in pre-eclamptic/ eclamptic mothers during fetal circulation; Chemico-Biological Interactions 208 ; 77–83; (2014) Roger K. Schindhelm, MD, PHD , Margreet Schoorl, BSC, Johannes Van Pelt, PHD; Comment on: Hardikar et al. Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia. Diabetes Care ; Diabetes Care;35:797–802; (2012) Ver Luanni Bilano, Erika Ota, Togoobaatar Ganchimeg, Rintaro Mori, Joa˜o Paulo Souza; Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis ; PLoS ONE 9(3): e91198; (2014) W.E. Ackerman IV, L. Adamson , A.M. Carter, S. Collins, B. Coxf, M.G. Elliot, L. Ermini, A. Gruslin, P.A. Hoodless, J. Huang a, D.A. Kniss, M.R. McGowenm, M. Post, G. Rice, W. Robinson, Y. Sadovsky , C. Salafia, C. Salomon, J.G. Sled, T. Todros, D.E. Wildman, S. Zamudio, G.E. Lash; IFPA Meeting 2013 Workshop Report II: Use of ‘omics’ in understanding placental development, bioinformatics tools for gene expression analysis, planning and coordination of a placenta research network, placental imaging, evolutionary approaches to understanding pre-eclampsia; Placenta 35, Supplement A, Trophoblast Research, Vol. 28; S10eS14; (2014) Yiping Dang, Yin Xia, Yiqing Li, Danny C.W. Yu; Anemia and type 2 diabetes mellitus associated with peripheral arterial disease progression in Chinese male patients ; Clinical Biochemistry 46 ;1673–1677; (2013) Zohreh Shoar, Geoffrey Rezvani and Francesco De Luca; Type 1 diabetes mellitus in a patient with homozygous sickle cell anaemia ; Pediatr Endocr Met; 26(11-12): 1205–1207; (2013) Kenny LC1, Broadhurst DI, Dunn W, Brown M, North RA, McCowan L, Roberts C, Cooper GJ, Kell DB, Baker PN; Screening for Pregnancy Endpoints Consortium. Robust early pregnancy prediction of later preeclampsia using metabolomic biomarkers. Hypertension. Oct;56(4):741-9;(2010) Katherine R. GOETZINGER, M.D., M.S.C.I., Yan ZHONG, M.D., Alison G. CAHILL, M.D., M.S.C.I., Linda ODIBO, R.N., M.N., George A. MACONES, M.D., M.S.C.E., and Anthony O. ODIBO, M.D., M.S.C.E. The Efficiency of First-Trimester Uterine Artery Doppler, ADAM12, PAPP-A and Maternal Characteristics in the Prediction of Pre-Eclampsia J Ultrasound Med. Author manuscript; available in PMC Sep., 2014 Kalousová M, Muravská A, Zima T , Pregnancy-associated plasma protein A (PAPP-A) and preeclampsia.. Adv Clin Chem. 2014;63:169-209. (2014) U.D. Anderson, M.G. Olsson, K.H. Kristensen, B. Akerstrom, S.R. Hansson; Biochemical markers to predict preeclampsia; Placenta 33, Supplement a thropoblast research Vol 26, S42/47;(2012) Acknowledgments: The paper has been supported by the grant no PI / 3 / 21.07.2014. “The Clinical Impact of the HOMA Index in Early Detection
*Correspondence:	mirceaonel@yahoo.com

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