Thrombophilic patients demonstrate progressive increases in vascoactivity compared to normal pregnancy

Abstract

ObjectivePregnancy is characterized by progressive coagulation activation. Adrenomedullin (AM) is a specific G-protein signaling peptide vasodilator whose maternal plasma levels increase in pregnancy. While pregnant patients with thrombophilic conditions have elevated coagulation activation, AM levels has never been measured in this group. We speculate thrombophilia is associated with exaggerated vasoactivity and coagulation activation compared to normal pregnancy.Study designIn this nested case control study, we compared matermal plasma levels of SFP and AM from 42 singleton uncomplicated and 23 thrombophilic singleton gestations, matched from gravidity, parity, gestational age (GA) at draw. Patients were sampled in three trimesters prospectively in pregnancy and plasma was stored at −80°C until assay. AM and SFP levels were measured by radioimmunoassay and immunoassay, resp. Data were analyzed by Spearman correlaton and Fisher Exact test.ResultsThrombophilic patients demonstrate progressive increases in BOTH AM and SFP levels in pregnancy, while patients with normal pregnancy display only significantly elevated AM levels in the third trimester. There is a significant correlation (rs=0.738; p<.05) between the AM concentration in the third trimester and SFP in normal pregnancy. There were no differences in GA at draw, GA at del, gravidity or parity.ConclusionTabled 1Maternal SFP and AM throuthout pregnancyIst trimester2nd trimester3rd trimesterThrombophilic SFP μg/ml11.0 ± 3.516.4 ± 3.624.8 ± 2.9Normal SFP μg/ml9.2 ± 3.19.7 ± 2.58.8 ± 2.0Thrombophilic AM νg/ml31.2 ± 3.942.5 ± 2.352.9 ± 41Normal AM νg/ml34.1 ± 4.633.4 ± 2.257.1 ± 5.0 Open table in a new tab ObjectivePregnancy is characterized by progressive coagulation activation. Adrenomedullin (AM) is a specific G-protein signaling peptide vasodilator whose maternal plasma levels increase in pregnancy. While pregnant patients with thrombophilic conditions have elevated coagulation activation, AM levels has never been measured in this group. We speculate thrombophilia is associated with exaggerated vasoactivity and coagulation activation compared to normal pregnancy. Pregnancy is characterized by progressive coagulation activation. Adrenomedullin (AM) is a specific G-protein signaling peptide vasodilator whose maternal plasma levels increase in pregnancy. While pregnant patients with thrombophilic conditions have elevated coagulation activation, AM levels has never been measured in this group. We speculate thrombophilia is associated with exaggerated vasoactivity and coagulation activation compared to normal pregnancy. Study designIn this nested case control study, we compared matermal plasma levels of SFP and AM from 42 singleton uncomplicated and 23 thrombophilic singleton gestations, matched from gravidity, parity, gestational age (GA) at draw. Patients were sampled in three trimesters prospectively in pregnancy and plasma was stored at −80°C until assay. AM and SFP levels were measured by radioimmunoassay and immunoassay, resp. Data were analyzed by Spearman correlaton and Fisher Exact test. In this nested case control study, we compared matermal plasma levels of SFP and AM from 42 singleton uncomplicated and 23 thrombophilic singleton gestations, matched from gravidity, parity, gestational age (GA) at draw. Patients were sampled in three trimesters prospectively in pregnancy and plasma was stored at −80°C until assay. AM and SFP levels were measured by radioimmunoassay and immunoassay, resp. Data were analyzed by Spearman correlaton and Fisher Exact test. ResultsThrombophilic patients demonstrate progressive increases in BOTH AM and SFP levels in pregnancy, while patients with normal pregnancy display only significantly elevated AM levels in the third trimester. There is a significant correlation (rs=0.738; p<.05) between the AM concentration in the third trimester and SFP in normal pregnancy. There were no differences in GA at draw, GA at del, gravidity or parity. Thrombophilic patients demonstrate progressive increases in BOTH AM and SFP levels in pregnancy, while patients with normal pregnancy display only significantly elevated AM levels in the third trimester. There is a significant correlation (rs=0.738; p<.05) between the AM concentration in the third trimester and SFP in normal pregnancy. There were no differences in GA at draw, GA at del, gravidity or parity. ConclusionTabled 1Maternal SFP and AM throuthout pregnancyIst trimester2nd trimester3rd trimesterThrombophilic SFP μg/ml11.0 ± 3.516.4 ± 3.624.8 ± 2.9Normal SFP μg/ml9.2 ± 3.19.7 ± 2.58.8 ± 2.0Thrombophilic AM νg/ml31.2 ± 3.942.5 ± 2.352.9 ± 41Normal AM νg/ml34.1 ± 4.633.4 ± 2.257.1 ± 5.0 Open table in a new tab