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Abstract Preeclampsia is a multisystem multifactorial disorder in the second half of pregnancy. It affects about 3% of prim gravidae and is characterized by widespread endothelial cell dysfunction.it is considered as a major cause of maternal and perinatal mortality and morbidity. Pre-eclampsia is defined as a syndrome characterized by hypertension with or without edema and proteinuria manifested after 20 weeks of pregnancy. Even-though the pathogenesis of the illness has been determined after many studies. It‘s a etiology is still unknown certain theories have been put forward in this regard :endothelial call damage, decreased placental perfusion, changed vascular activity, instability between prostacydin and threnboxane, genetic factors, increased newel system irritability, and uterine ischemia. Rennin-angiotensin-aldosterone system related vascular and hemostatic hyperactivity, thrombocytes and eicosanoids have also been blamed for this disease. Several independent investigators have demonstrated through human and animal studies the association of androgens, especially testosterone, with hypertension. Interestingly accumulating evidence indicates that androgens have important effects on vascular reactivity, the renin-angiotensin system, eicosanoids, and platelets, in ways that are strikingly similar to those reported for preeclampsia. Some studies have shown that women with polycystic ovary (PCO), a disease associated with hyperandrogenemia, are at risk for pregnancy induced hypertension independent of body mass index (BMI). Summery 67 It has been suggested that overproduction of steroid hormones, especially androgens, is the main factor for appearance of preeclampsia in PCO patients. Recently it has also been found that serum concentrations of inhibin A were higher in patients with preeclampsia than in control subjects with matched pregnancies and this finding was interpreted as further evidence for Androgen levels in Preeclampsia trophoblastic dysfunction in preeclampsia. Additionally, inhibin was recently shown to increase androgen production by ovarian theca cells, in turn increasing circulating androgen levels in women. It is thus possible that effects of increased serum inhibin in preeclampsia may be manifested through increased circulating androgen levels. We therefore hypothesized that levels of sex androgens, and more specially that of testosterone, may be increased in pregnancies complicated by preeclampsia. We suspected that such an increase might be implicated in pathogenesis of preeclampsia. Of course, there have been some studies that have not demonstrated this correlation between androgens and preeclampsia. Consequently, this study was conducted and aimed to compare between androgens level (serum total and free testosterone) in women with preeclampsia and normal ones in the third trimester of pregnancy (28-40 weeks). This prospective case control study was conducted at Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University Hospitals and Shebin Al Kom Teaching Hospital from February 2022 until February 2023. Summery 68 During this study, 80 pregnant women were enrolled, after consenting each of them and divided into two groups; group A consisted of 40 women in the third trimester of pregnancy with preeclampsia at time of admission and group B consisted of 40 healthy normotensive women in the third trimester and they are control for group A with respect to maternal age, gestational age and BMI. Our study revealed that free and total testosterone levels were significantly higher among pre-eclamptic cases compared with healthy women with no differences between groups regarding maternal age, gestational age and fetal sex. In conclusion, serum androgen levels (free and total testosterones) during third trimester of pregnancy are higher in pre-eclamptic women and this may propose an effect of androgens in the pathogenesis of preeclampsia. While the pathogenesis of preeclampsia in women remains unknown, a role for androgens is emerging. The relationship between androgens and maternal cardiovascular and placental function deserves particular consideration because testosterone levels in the circulation of preeclamptic women are elevated approximately two- to three-fold and are positively correlated with vascular dysfunction. Preeclampsia is also associated with elevated placental androgen receptor (AR) gene expression. Studies in animal models mimicking the pattern and level of increase of adult female testosterone levels to those found in preeclamptic pregnancies, replicate key features of preeclampsia, including gestational hypertension, endothelial dysfunction, exaggerated vasoconstriction to angiotensin II, reduced spiral artery remodeling, placental hypoxia, decreased nutrient transport and fetal growth restriction. Summery 69 Taken together, these data strongly implicate AR-mediated testosterone action as an important pathway contributing to clinical manifestation of preeclampsia. |