266 Metabolomic biomarkers of chronic hypertension in pregnancy

Abstract

Chronic hypertension is associated with adverse risks for the mother and fetus in pregnancy. Metabolomic profiling can help elucidate disease pathways. Free fatty acid (FFA) levels are elevated in hypertensive non-pregnant adults, and FFAs appear to impair microvascular function and contribute to microangiopathy. The objective of this study is to compare metabolomic biomarkers of chronic hypertension in a pregnant cohort. We prospectively collected fasting serum samples from pregnant patients at 24-28 weeks gestation from 5 patients who had well-controlled chronic hypertension not on anti-hypertensive medications and 28 controls. These samples were then processed and evaluated using Q-TOF mass spectrometry and analyzed using a targeted protocol of 25 types of free fatty acids known to be present in people with hypertension. We used Student’s t-test to compare metabolites between the two study groups. Maternal age, parity, BMI, gestational age at delivery, neonatal birthweight, and APGAR scores were similar between the two groups. None of the patients developed preeclampsia or required acute treatment for hypertension. Accounting for Bonferroni correction, we found statistically significant elevations of 1.45-2.03 fold in 9 of the targeted unsaturated fatty acids in the chronic hypertension group compared to controls. Using metabolomic profiling, we found that 9 unsaturated fatty acid were elevated in the serum of fasting pregnant women with chronic hypertension. This free fatty acid profile mirrors that of people with chronic hypertension outside of pregnancy. This may represent a possible pathway explaining how pregnant women with well controlled chronic hypertension remain at high risk for complications such as preeclampsia. Larger studies are needed to compare the fatty acid profile in women with chronic hypertension who developed pre-eclampsia.