Definition Of Preeclampsia Research Articles

103 The prevalence of hypertensive disorders according to the old and new criteria of ISSHP and ACOG

Introduction Affecting 2–8% of pregnancies, preeclampsia (PE), along with other hypertensive disorders of pregnancy, is a major contributor to maternal-fetal morbidity and mortality worldwide. This syndrome is characterized by the new onset of hypertension and proteinuria after 20 weeks of gestation. Based on scientific evidence, the inaccuracies in the measurement of proteinuria, the occurrence of severe maternal complications in women with de novo hypertension without proteinuria, and a number of scholarly guidelines both the ACOG and ISSHP revised their definition of preeclampsia. Objective To compare the frequency of different hypertensive disorders of pregnancy as defined by the ISSHP 2001 and 2014 and ACOG 2013 criteria. Methods In a cohort of 352 women with hypertensive pregnancy disorders admitted between 2014 and 2016, we determined the prevalence of chronic hypertension, gestational hypertension (GH), (superimposed) PE and HELLP syndrome during pregnancy according to the ISSHP 2001 and 2014 and the ACOG 2013 criteria. Results Confirming to the old criteria, 157 (45%) of the 352 patients were diagnosed with (superimposed) PE, and according to the new ISSHP and ACOG criteria 202 ((57%), p Conclusion In our cohort the number of PE increased according to the ISSHP2014 criteria, but not according to the ACOG as compared with the ISSHP 2001.

Prevention of pre-eclampsia by low-molecular-weight heparin in addition to aspirin: a meta-analysis

To estimate the impact of adding low-molecular-weight heparin (LMWH) or unfractionated heparin to low-dose aspirin started ≤ 16 weeks' gestation on the prevalence of pre-eclampsia (PE) and the delivery of a small-for-gestational-age (SGA) neonate. A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed by searching the medical databases PubMed, EMBASE, Web of Science and Cochrane Central. Pregnant women randomized to receive LMWH or unfractionated heparin in addition to low-dose aspirin were compared with those who received low-dose aspirin alone. Outcome measures were PE, severe PE, early-onset PE and SGA. Pooled relative risks (RRs) with 95% CI were calculated using a random-effects model. Eight RCTs met the inclusion criteria; the indication for recruitment was previous recurrent miscarriage in five studies (three included women with thrombophilia) and a history of severe or early-onset PE in three studies (including women with thrombophilia in one). LMWH was administered in seven studies and unfractionated heparin in one. In women with a history of PE, treatment with LMWH and aspirin, compared with aspirin alone, was associated with a significant reduction in development of PE (three trials (n = 379); RR, 0.54 (95% CI, 0.31-0.92); P = 0.03) and in delivery of SGA neonates (two trials (n = 363); RR, 0.54 (95% CI, 0.32-0.91); P = 0.02). These outcomes were not significantly reduced in women with recurrent miscarriage who received LMWH and aspirin, compared with aspirin alone. The small number of studies precluded sensitivity analyses and the evaluation of publication biases. Blinding to the allocation treatment was absent in all RCTs. Based on limited evidence, the addition of LMWH to low-dose aspirin could reduce the prevalence of PE and SGA in women with a history of PE. This observation should be the basis of a well-conducted future trial rather than a recommendation for immediate clinical application. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

The Pvu II and Xba I polymorphisms in the estrogen receptor alpha gene in Chinese patients with severe preeclampsia

To assess the allele and genotype frequencies of the estrogen receptor alpha ( ESR alpha) Pvu II and Xba I polymorphisms in patients with severe preeclampsia and compare them with those of normal pregnant women. Blood samples from 131 patients with severe preeclampsia and 223 normal pregnant women from Chinese Han in Chengdu area were analyzed, using PCR-RFLP method. Pregnant patients with blood pressure exceeding 140/90 mmHg (or 18.7/12 kPa) were recruited with a strict definition of preeclampsia. Genotyping was performed using PCR-RFLP for Pvu II and Xba I polymorphisms in the ESR alpha gene. The T and C allele frequencies for Pvu II site were 0.580 and 0.420 in the patient group, and 0.576 and 0.424 in the controls, respectively. The A and G allele frequencies for Xba I site were 0.763 and 0.237 in the patient group, and 0.807 and 0.193 in control group, respectively. No significant difference in the allele frequencies of either site was observed between the two groups. However, the CC homozygotes or CT heterozygotes in the control pregnant women had higher systolic blood pressure levels than TT homozygotes for Pvu II site after the data was adjusted for age and BMI (114.00+/-21.44 mmHg or 114.33+/-1.21 mmHg vs. 108.62+/-1.91 mmHg, P<0.05). No genotype effect on the blood pressures was found for Pvu II site in the case group, nor for Xba I site in either group. Our work has excluded the association of the ESRalpha Pvu II and Xb I polymorphism with severe preeclampsia in a Southwest Chinese population, although this polymorphism may be associated with the systolic blood pressure level in the normal pregnant women.

PL59. The impact of classification of hypertensive disorders of pregnancy based on the ACOG 2013 and ISSHP 2014 criteria

Introduction A standardized classification of hypertensive disorders of pregnancy would be highly needed to achieve the comparability of the studies and the adequate management of the patients. In the last two years, the American College of Obstetricians and Gynecologists (ACOG), as well as the International Society for the Study of Hypertension in Pregnancy (ISSHP) revised the classification of hypertensive disorders in pregnancy. Objectives In Hungary, the ACOG 2002 criteria were used in the last decade to classify hypertensive disorders during pregnancy. This study aimed to determine the impact of the ACOG 2013 and ISSHP 2014 criteria on the occurrence of different forms of hypertensive disorders, as well as on perinatal outcome compared to the ACOG 2002 criteria. Methods All pregnant women with hypertensive disorders and singleton pregnancies who delivered in the 1st Dept. of Ob-Gyn. at the Semmelweis University between 1 Jan 2012 and 31 Dec 2014 ( n =755) were enrolled in this study. We determined the prevalence of different forms of hypertensive disorders according to the ACOG 2002, ACOG 2013 and ISSHP 2014 criteria. We also examined the reasons for re-classification of chronic hypertensive (CHT) and gestational hypertensive (GHT) patients to the preeclampsia (PE) group, as well as its impact on the perinatal outcome. Results The extended definition of PE according to ACOG 2013 and ISSHP 2014 classifications raised the incidence of PE by 8,2% and 17,2% compared to the ACOG 2002 classification. The most frequent cause of re-classification of GHT and CHT patients to the PE group were abnormal laboratory findings in 35% of cases according to ISSHP 2014 classification and subjective symptoms in 36% of cases according to ACOG 2013 classification. The median values of fetal birth weight were significantly lower in women with GHT (3330g (IQR: 2985–3750g) vs. 2735g (IQR: 2125–3375g), p 0,001) and CHT (3330g (IQR: 2980–3650g) vs. 2605g (IQR: 1720–3350g), p 0,001) who were re-classified to the PE group compared to those who remained in the original group. There was no statistically significant difference between the median values of gestational age at delivery and birth weight in PE patients based on ACOG 2002 and ISSHP 2014 classifications: 36 weeks (IQR: 32–38 weeks) vs. 36 weeks (IQR: 33–38 weeks), 2450g (IQR: 1540–3180g) vs. 2530g (IQR: 1650–3260g). Conclusions The extended definition of PE in both ACOG 2013 and ISSHP 2014 classifications raised the incidence of PE but did not influence perinatal outcomes significantly.

Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice.

Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice.

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Objectives To study adverse outcomes associated with definitions of preeclampsia and compare them to patients not meeting diagnostic criteria for preeclampsia. Methods A multicenter, prospective, observational study was conducted on women with suspected preeclampsia (PE). Patients were managed by local protocol, and final diagnoses were adjudicated by independent panel. Subjects were classified as Traditional PE (TrPE) with both hypertension and proteinuria, or eclampsia or HELLP syndrome (ACOG 2012); Nonproteinuric PE (NpPE) with severe gestational hypertension (BP >160/110) or mild hypertension plus ⩾1 severe feature (ACOG, 2013); or No diagnosis (NoD). Adverse outcomes included preterm birth (PTB), SGA, IUFD, neonatal demise (NND), and severe maternal adverse outcomes (MAO - abruption, renal failure, pulmonary edema, fatty liver, TTP, DIC, stroke, and retinal detachment). Comparisons tested with Chi square, α = 0.05. Results A total of 757 subjects with signs or symptoms of PE were enrolled Table 1 ). 96 had chronic hypertension or mild gestational hypertension. As compared to TrPE, women with NpPE experienced similar rates of all adverse outcomes. Subjects with NoD also had similar rates of IUFD, NND, and MAO. However, women with NoD experienced lower rates of PTB p Conclusions Among patients with suspected preeclampsia before 35 weeks, the risks of severe adverse outcomes are elevated, even for those who fall outside current clinical diagnostic categories. Patients without a diagnosis, however have fewer preterm deliveries and SGA babies. Diagnostic criteria for preeclampsia poorly predict severe adverse outcomes, and may contribute to preterm delivery. Disclosures D. Woelkers: None. J. Barton: None. P. von Dadelszen: None. B. Sibai: None.

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Objectives Medical school in Brazil lasts six years to permit the M.D. degree; the first four years are theoretical and the last two are internship. This study assessed the knowledge of students of medicine about preeclampsia. Methods Questionnaire applied to 362 undergraduate students from a private school medicine in the state of Sao Paulo/Brazil with fifteen multiple choice questions about preeclampsia and its renal involvement. Results Total of 362 students, with 315 from theoretical years [first year 17.1% (54/315), second 31.7% (100/315), third 23.8% (75/315) and fourth 27.3% (86/315)] and 147 from internship [fifth year 44.2% (65/147) and sixth 55.8% (82/147)]. In relation to correct answers, first year reached 20.2% (164/810), second 20.1% (302/1500), third 23.1% (260/1125), fourth 27.3% (352/1290), fifth year 25.7% (251/975) and sixth 34.5% (425/1230), the theoretical years totaled 22.8% (1078/4725) and the internship 30.6% (676/2205), all 362 students totaled 35.6% (1754/4930). The theoretical years had over 90% of error about reference value of proteinuria in preeclampsia and its definition, the fifth year, 90.8% (59/65) about diagnostic tests for HELLP syndrome and the sixth, 79.3% (65/82) about tests to assess renal function in prenatal. The next most frequent error in internship was the definition of preeclampsia and evaluation of renal failure, fifth year had 78.1% (203/260) of error and sixth, 74.4% (244/328). There was an increase of right answers of 7.1% from first to fourth year and 8.8% from fifth to the sixth. Conclusions The knowledge of undergraduate medical students about preeclampsia and its renal involvement is apparently scarce. The emphasis on teaching preeclampsia and its evolution is important to reduce its complications. Fapesp n°2014/00213-7. Table 1. Percentage of correct answers from undergraduate medical students about preeclampsia. First year Second year Third year Fourth year Fifth year Sixth year Proportion of correct answers 20.2% 20.1% 23.1% 27.3% 25.7% 34.5% Disclosures T.A. Facca: None. E.A. Fama: None. G. Annicchino: None. J. Vieira: None. J. Vasconcelos: None. R. Campos: None. M.G. Ierardi: None. M.S. Geraldo: None. M.B. Silva: None. B.R. Ortega: None. A.R. Sabino: None. G. Mastroianni-Kirsztajn: None. N. Sass: None.

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Objectives Obesity is associated with a 3-fold increase in the frequency of preeclampsia. However, a 3% prevalence in the general population indicates that 90% of obese women do not develop preeclampsia. We proposed that higher early-pregnancy body fat percentage might identify obese women at higher risk for preeclampsia. Methods We performed an analysis of the Prenatal Exposures and Preeclampsia Prevention 3 (PEPP3) longitudinal cohort study of preeclampsia mechanisms in obese and overweight women. Subjects completed questionnaires regarding their health behaviors, had hematocrit, weight, height, and waist and hip circumferences measured, and had resistance and reactance measured by bioelectric impedance analysis (BIA) machine during the first, second, and third trimesters. Total body water, fat mass, and percent body fat were calculated using pregnancy-specific formulas. Preeclampsia was assessed using the clinical (ACOG) definition at the time the study was performed and a research definition (clinical preeclampsia plus hyperuricemia). Logistic regression models were constructed to analyze BMI and body fat percentage as predictors of the two preeclampsia outcomes. Results 373 women were included in the analysis; 30 (8.7%) had clinical preeclampsia and 14 (3.8%) had research preeclampsia. There was no relationship between BMI and preeclampsia risk in obese subjects, but body fat percentage was significantly associated with both the clinical definition of preeclampsia and the research definition. In obese women, a one-percentage-point increase in body fat was associated with approximately 12% increased odds of clinical preeclampsia (OR and 95% CI, 1.127, 1.009–1.257) and 24% increased risk of preeclampsia by the research definition (OR and 95% CI 1.294, 1.060–1.581). Conclusions Early-pregnancy body fat appears to be important in the pathophysiology of preeclampsia in obese women and may help to predict which obese women have the greatest risk of developing preeclampsia. Disclosures L.K. Sween: None. A.D. Althouse: None. J.M. Roberts: None.

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Objectives The Preeclampsia Registry (TPR) is a “living database” of patient reported clinical data launched by the Preeclampsia Foundation in September 2013. TPR consists largely of structured data fields designed to capture detailed pregnancy outcomes and medical history. Additionally, two open-ended queries were included to more fully capture the patient perspective through narrative. We sought to evaluate the extent to which TPR participants responded to narrative inquiries and to ascertain the depth of information provided in free-text format to a particular question related to patient education. Methods We evaluated participants’ narrative responses in TPR as of 6/27/14, focusing on the open-ended question: “Is there any other information about this pregnancy that would have been helpful to you?” Response rates were calculated; detailed review of responses enabled categorization into several consistent themes. Chi square analysis was performed to assess potential predictors for response. Results Of 807 participants enrolled as of 6/27/14, 301 (37.3%) provided a response for a total of 355 pregnancies. Of these, 34/355 (11.3%) had completed question 2 prior to completing the remainder of their questionnaire. 93/355 (26.2%) expressed no need for additional information. Of responses affirming a desire for additional information, 241/262 (92.0%) described desired information within one of the themes outlined below, with some responses touching on more than one theme. Conclusions Our results demonstrate TPR participants’ responsiveness to an open-ended, free text query regarding patient need for additional information in pregnancy. Detailed responses were analyzable as themes through which novel approaches to patient education may be identified. General area of desired additional information N (%) Symptoms 89 (34) Definition of preeclampsia 75 (29) Improved provider communication 60 (23) Risk factors for preeclampsia 28 (11) Postpartum preeclampsia 4 (2) Closer monitoring 15 (6) Psychological support 7 (3) Complications 17 (7) Dietary concerns 9 (3) Disclosures A.N. Brewer: None. E.Z. Tsigas: None. L. Poye: None. H.S. Gammill: None.

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Objectives To estimate the change in the diagnostic prevalence of preeclampsia after introduction of revised definitions of preeclampsia in the 2013 ACOG Report of the Task Force on Hypertension in Pregnancy. Methods A multicenter, prospective, observational study was conducted in 24 maternity units in North America of women with suspected preeclampsia. Subjects were enrolled in gestational age blocks between 20 and 41 weeks, and were managed according to local protocols. Final diagnoses were adjudicated by an independent expert panel. Preeclampsia (PE) was defined as Traditional (TrPE, both hypertension and proteinuria, ACOG, 2002), or Revised (RePE, hypertension with either proteinuria or ⩾1 severe feature, ACOG, 2013). Standard definitions of Chronic (CH) and Gestational (GH) hypertension were unchanged. Subjects who did not meet any definition were classified as No Disease (NoD). Results 1223 subjects with signs or symptoms of preeclampsia were followed through delivery. At, enrollment, 980 subjects (80.1%) had hypertension (67% new onset; 33% worsening hypertension) and 602 (49.2%) had new onset proteinuria. 395 (32.3%) reported headaches or visual changes and 80 (6.5%) had RUQ pain. After adjudication of final diagnosis, 120 subjects (9.8%) had GH, 74 (6.1%) had CH, and 199 (16.3%) had NoD. 661 (54.0%) pregnancies met criteria for TrPE, while 794 (64.9%) met criteria for RePE, an increase of 20.1% (p 37 weeks), the number of subjects meeting criteria for preeclampsia increased from 81 (33.5%) with TrPE to 119 (49.2%) with RePE, a 46.9% increase, due primarily to an increase in the prevalence of preeclampsia without proteinuria. Conclusions Redefining preeclampsia by the revised 2013 ACOG criteria will increase the diagnostic prevalence of preeclampsia by 20%. The effect of this diagnostic change on rates of intervention (hospital admission, laboratory testing, and iatrogenic delivery) and prevention of adverse outcome, remains to be determined. Disclosures D. Woelkers: None. J. Barton: None. P. von Dadelszen: None. B. Sibai: None.

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Objectives InterPregGen is investigating the genetic basis of pre-eclampsia in women from Europe, Central Asia and South America. Recruitment of 4000 women affected by pre-eclampsia, their partners and babies, and 4000 pregnant control women is on-going in Kazakhstan and Uzbekistan. The objective is Assessment of clinical features of pre-eclampsia in Central Asia. Methods The ISSHP definition of pre-eclampsia was used to identify women with new onset hypertension and proteinuria at 7 maternity units in Kazakhstan and 9 units in Uzbekistan. Pregnant controls had no history of hypertension in pregnancy. 1021 white European women recruited to the UK GOPEC genetic study of pre-eclampsia were used for comparison. Results Data were available from 1716 Kazakh and 897 Uzbek cases. 54% of Kazakh women with pre-eclampsia were primiparous, compared with over 70% of Uzbek and UK recruits. Factors predisposing to pre-eclampsia included high BMI ( P P 20% had a past history of hypertensive pregnancy. SBP and DBP at first antenatal visit were higher in cases than controls in Kazakh ( P Conclusions Interim analysis confirms common risk factors for pre-eclampsia in Central Asian women, and highlights areas of concern regarding outcomes for babies and mothers which merit further enquiry. Disclosure N. Zakhidova: None.

Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines.

BackgroundClinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice.Methodology & Principal FindingsMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of s of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3–1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi) delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii) active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i) definitions of pre-eclampsia and severe pre-eclampsia; (ii) target BP for non-severe hypertension; (iii) timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv) MgSO4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring.ConclusionsExisting international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research.

Early-pregnancy percent body fat in relation to preeclampsia risk in obese women

The purpose of this study was to identify differences of early-pregnancy body fat percentage and body mass index (BMI) between obese women that experienced preeclampsia and those who did not. We performed an analysis of the Prenatal Exposures and Preeclampsia Prevention 3 longitudinal cohort study of preeclampsia mechanisms in obese and overweight women. Women completed questionnaires regarding their health behaviors; had hematocrit level, weight and height, and waist and hip circumferences measured, and had resistance and reactance measured by bioelectric impedance analysis machine during the first, second, and third trimesters. Total body water, fat mass, and percent body fat were calculated with the use of pregnancy-specific formulas. Preeclampsia was assessed with the clinical definition and a research definition (clinical preeclampsia plus hyperuricemia). Logistic regression models were constructed to analyze early-pregnancy BMI and body fat percentage (measured at 10.2 ± 3.0 weeks of gestation) as predictors of preeclampsia outcomes. Three hundred seventy-three women were included in the analysis: 30 women had preeclampsia by clinical definition (8.0%), and 14 women had preeclampsia by the research definition (3.8%). There was no relationship between BMI and preeclampsia risk in obese women; however, body fat percentage was associated significantly with increased risk of both the clinical definition of preeclampsia and the research definition. In 239 obese women, a 1% increase in body fat was associated with approximately 12% increased odds of clinical preeclampsia and 24% increased risk of preeclampsia by the research definition. Early-pregnancy body fat appears to be important in the pathophysiologic condition of preeclampsia in obese women.

Early and late-onset pre-eclampsia.

There is discrepancy in the literature on the definitions of severe and early-onset pre-eclampsia. We aimed to determine those definitions for clinical purposes and to introduce them in the classification of the hypertensive disorders of pregnancy forpublication purposes. We circulated a questionnaire to the International Committee of the International Society for the Study of Hypertension in Pregnancy focusing on the thresholds for defining severe preeclampsia and the gestation at which to define early-onset preeclampsia, and on the definition and inclusion of the HELLPsyndrome or other clinical features in severe preeclampsia. The questions were closed, but all answers had space for more open detailed comments.There was a general agreement to define preeclampsia as severe if blood pressure was ⩾160mmHg systolic or 110mmHg diastolic. There was scarce agreement on the amount of proteinuria to define severity. The HELLP syndrome was considered a feature to include in the severe classification. Most investigators considered early-onset preeclampsia as that occurring before 34 weeks. A definition of pre-eclampsia is paramount for driving good clinical practice. Classifications on the other hand are useful to enable international comparisons of clinical data and outcomes. We used the results of this survey to update our previous classification for the purposes of providing clinical research definitions of severe and early onset pre- eclampsia that will hopefully be accepted in the international literature.

Does proteinura in preeclampsia have enough value to predict pregnancy outcome?

Objective: Preeclampsia is defined by the new onset of elevated blood pressure and protienuria after 20 weeks of gestation. Protienuria is one of the essential criteria for the clinical definition of preeclampsia. The authors investigated the predictive value of proteinuria in the outcome of pregnancies with preeclampsia. Materials and Methods: In this retrospective cohort study, they entered all pregnant women who were admitted with diagnosis of preeclampsia in Yahyanejad Hospital from 1998 to 2008. Patients’ data such as age, gestational age, level of 24-hour urine protein, liver enzyme, blood urea nitrogen (BUN), creatinine, and other laboratory test. Also, prenatal and maternal outcome were studied. The data analyzed and compare with each other. Results: Out of 289 patients, 5.9% (17) women had placental abruption, 13.1 % (28) patients had intrauterine growth retardation (IUGR), 32.2% (96) had respiratory distress, and 26.6% (77) of the patients’ infants were transferred to neonatal intensive care unit (NICU). Although the present study showed proteinurea cannot be a sufficient predictor for adverse consequences of preeclampsia, however, the incidence of pregnancy adverse effects increased in the patients with elevated 24-hour proteinuria. Conclusion: The authors concluded that proteinuria in patients with preeclampsia is associated with adverse outcome in pregnancy, although it is not an adequate predictor.

Strategy for Standardization of Preeclampsia Research Study Design

Preeclampsia remains a major problem worldwide for mothers and babies. Despite intensive study, we have not been able to improve the management or early recognition of preeclampsia. At least part of this is because of failure to standardize the approach to studying this complex syndrome. It is possible that within the syndrome there may be different phenotypes with pathogenic pathways that differ between the subtypes. The capacity to recognize and to exploit different subtypes is of obvious importance for prediction, prevention, and treatment. We present a strategy for research to study preeclampsia, which will allow discrimination of such possible subtypes and also allow comparison and perhaps combinations of findings in different studies by standardized data and biosample collection. To make studies relevant to current clinical practice, the definition of preeclampsia can be that currently used and accepted. However, more importantly, sufficient data should be collected to allow other diagnostic criteria to be used and applied retrospectively. To that end, we present what we consider to be the minimum requirements for a data set in a study of preeclampsia that will facilitate comparisons. We also present a comprehensive or optimal data set for in-depth investigation of pathophysiology. As we approach the definition of phenotypes of preeclampsia by clinical and biochemical criteria, adherence to standardized protocols will hasten our understanding of the causes of preeclampsia and development of targeted treatment strategies.

75: Adverse outcomes are similar in preeclampsia with or without proteinuria: validation of a newly proposed definition of preeclampsia

75: Adverse outcomes are similar in preeclampsia with or without proteinuria: validation of a newly proposed definition of preeclampsia

Increased cardiovascular risk after pre‐eclampsia in women with dysglycaemia

Compared with women with uncomplicated pregnancies, women with a history of pre-eclampsia have two to five times the risk of cardiovascular disease. It is not known whether this risk is related to albuminuria, a known cardiovascular risk factor that is part of the definition of pre-eclampsia and that often persists after delivery. Our objective was to determine if the high risk of cardiovascular disease in women with pre-eclampsia is accounted for by known cardiovascular risk factors including albuminuria. We performed a cross-sectional analysis of 4080 dysglycaemic women enrolled in a large randomized controlled trial who provided an obstetric history and had at least one delivery. Blood pressure, height, weight, waist circumference and hip circumference were measured. An oral glucose tolerance test, lipids, an electrocardiogram and an albumin/creatinine ratio from a first morning urine sample were obtained. There were 3613 women with no history of pre-eclampsia during their pregnancies, 108 with severe pre-eclampsia and 359 with non-severe pre-eclampsia. Women with a history of severe pre-eclampsia had higher rates of previous cardiovascular disease than women with non-severe pre-eclampsia or women without pre-eclampsia (87, 72 and 72%, P = 0.0019). The high risk of previous cardiovascular disease in women with a history of severe pre-eclampsia (odds ratio 2.67, 95% CI 1.52-4.70) persisted after adjustment for albuminuria (odds ratio 2.74, 95% CI 1.55-4.83) and also after adjusting for other covariates including albuminuria (odds ratio 3.03, 95% CI 1.69-5.44). Even after accounting for cardiovascular risk factors including albuminuria, a history of severe pre-eclampsia is independently associated with a threefold higher risk of cardiovascular disease.

The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP)

ObjectiveThere is discrepancy in the literature on the definitions of severe and early-onset pre-eclampsia. We aimed to determine those definitions for clinical purposes and to introduce them in the classification of the hypertensive disorders of pregnancy for publication purposes. MethodsWe circulated a questionnaire to the International Committee of the International Society for the Study of Hypertension in Pregnancy focusing on the thresholds for defining severe preeclampsia and the gestation at which to define early-onset preeclampsia, and on the definition and inclusion of the HELLP syndrome or other clinical features in severe preeclampsia. The questions were closed, but all answers had space for more open detailed comments. ResultsThere was a general agreement to define preeclampsia as severe if blood pressure was >160mmHg systolic or 110mmHg diastolic. There was scarce agreement on the amount of proteinuria to define severity. The HELLP syndrome was considered a feature to include in the severe classification. Most investigators considered early-onset preeclampsia as that occurring before 34weeks. ConclusionsA definition of pre-eclampsia is paramount for driving good clinical practice. Classifications on the other hand are useful to enable international comparisons of clinical data and outcomes. We used the results of this survey to update our previous classification for the purposes of providing clinical research definitions of severe and early onset pre-eclampsia that will hopefully be accepted in the international literature.

Obstetric Nephrology

Preeclampsia, a common and potentially devastating multisystem disorder unique to human pregnancy, represents a novel form of secondary hypertension with complex renal and systemic effects. Recent translational and clinical research reveals key pathophysiologic contributions due to dysregulation of angiogenic factors and of angiotensin signaling. Despite these insights, there are still difficulties in the clinical definition of preeclampsia and in the diagnosis of women with this disorder. Although recent research suggests the potential for new preventive and treatment strategies, most have not yet been shown ready for clinical use.