History Of Early Preeclampsia Research Articles

Regulatory antibodies against GPCR in women ten years after early-onset preeclampsia.

Preeclampsia is associated with an increased cardiovascular risk later in life. Anti-GPCR autoantibodies have been shown to contribute to the development of cardiovascular disease. We investigated whether anti-GPCR autoantibodies are elevated in women with a history of early-onset preeclampsia 8-11 years postpartum, and whether they correlate with clinical outcomes. We investigated data from the Preeclampsia Risk EValuation in FEMales cohort, a retrospective matched case-control study. Anti AT1R-, beta1AR-, ETAR-, PAR1- and CXCR3- autoantibodies were determined in 485 samples by using commercially available ELISA. Women with the lowest combined levels of autoantibodies and a history of early preeclampsia had significantly higher SBP, DBP and MAP (all p<0.001) compared to the controls. The individual titer levels of autoantibodies were not different between controls and former early PE groups 8-11 years postpartum. In conclusion, regulatory autoantibodies alone are not sufficient to explain hypertension or other cardiovascular pathologic conditions, but together with other risk factors such as a previous hypertensive pregnancy, lower levels of autoantibodies are associated with increased blood pressure.

Long-term follow-up of psychosocial distress after early onset preeclampsia: the Preeclampsia Risk EValuation in FEMales cohort study

Objective: To examine long-term psychosocial distress in women with a history of early onset preeclampsia (PE) compared to a comparison group. Methods: Women with and without a history of early onset PE participating in the ‘Preeclampsia Risk EValuation in FEMales’ (PREVFEM) study were sent questionnaires, on average 14.1 years (SD = 3.2, range 5–23 years) after the index pregnancy. In total 265 (77%) women with PE and 268 (78%) age-matched women without PE returned questionnaires (mean age 43.5, SD =4.6 years). Group differences were examined on indicators of psychosocial distress, depressive symptoms, anxiety, fatigue, loneliness, marital quality, trait optimism and Type D personality, and unadjusted and adjusted for a priori chosen and study-specific covariates. In secondary analyses, the effect of previously detected hypertension was examined, as well as pregnancy-related events within the PE group. Results: Women with a history of PE reported more subsequent depressive symptoms (B = 0.70, 95% CI 0.09–1.32, p = 0.026) and more fatigue (B = 1.12, 95% CI 0.07–2.18, p = 0.037) compared to the non-PE group, but the differences explained less than 1% of the variance. The differences remained after adjustment for age, BMI and education level, and additional adjustment for partner, being unemployed and physical activity. No significant differences were observed for anxiety, loneliness, marital quality, optimism, or Type D personality. These differences were not explained by four-year previously measured elevated blood pressure in the PE group. Having had a stillborn child or early neonatal death during the index pregnancy was associated with higher depressive symptoms, anxiety, fatigue, and loneliness in the PE group, but these factors explained only a small proportion of the variance in these psychosocial distress factors. Conclusion: A history of early PE is associated with slightly higher levels of depressive symptoms and fatigue on average 14 years later, but this is unlikely to be of clinical relevance.

Novel cardiovascular biomarkers in women with a history of early preeclampsia

ObjectiveWomen with a history of preeclampsia are at increased risk for future cardiovascular disease. Determination of cardiovascular biomarkers may be useful to understand the pathophysiological mechanism of cardiovascular disease development in these women. MethodsWe performed an analysis in the Preeclampsia Risk EValuation in FEMales study, a retrospective cohort consisting of 339 women with a history of early preeclampsia and 332 women after normotensive pregnancy. Women attended a follow-up visit ten years after the index pregnancy.A subset of 8 different cardiovascular biomarkers was investigated, reflecting inflammatory, metabolic, thrombotic and endothelial function markers. Associations between PE and these novel biomarkers were analyzed by linear regression analysis and adjusted for traditional cardiovascular risk factors. ResultsMean age of 671 women of the PREVFEM cohort was 39 years and women were on average 10 years post index pregnancy. Women post preeclampsia had significantly higher levels of SE-selectin (adjusted difference 4.55, 99%CI 0.37; 8.74) and PAPPA (adjusted difference 19.08; 99%CI 13.18; 24.99), whereas ApoB (adjusted difference −0.23 99%CI −0.32; −0.14) was inversely associated with preeclampsia, compared to women with a previous normotensive pregnancy. Adiponectin, leptin, sICAM-1, sVCAM-1 and PAI-1 were not different between both groups. ConclusionWe demonstrated an independent association of preeclampsia with SE-selectin and PAPPA (markers of vascular dysfunction), which may contribute to future cardiovascular events in women post preeclampsia. However, ApoB (an apolipoprotein) was significantly lower and could point at a protective mechanism in our PE study women.

PP056. Cardiac adaptation in the preclinical phase of recurrent preeclampsia in women with a history of early preeclampsia

Preeclampsia is thought to be preceded by first trimester circulatory maladaptation. Early and late onset PE may exhibit two different cardiac and hemodynamic states. Moreover, early PE relates to postpartum impaired cardiac function. Incomplete resolved or impaired cardiac function may influence the pattern of cardiac adaptation in the next pregnancy and may relate to recurrent disease. We postulate that in women with a history of early PE, the pattern of early cardiac adaptation differs between those that do and those that do not develop recurrent disease. We hypothesize that after early onset PE, in the subsequent gestation, the pattern of cardiac adaptation differs between those that do and those that do not develop recurrent disease. In this cohort study, we included 84 women with a history of early-onset PE. Former PE patients who concomitantly experienced HELLP-syndrome, fetal growth restriction and/or fetal demise, were excluded. The remaining 51 women underwent serial cardiac ultrasound and automated blood pressure and heart rate recordings, once before, and again at gestational age 12, 16 and 20 weeks. Post hoc, women were subdivided into those who did (RECUR) or did not develop recurrent PE (CONTR). We analyzed data using repeated measures analysis of variance. 14/51 (27%) women developed recurrent PE. Pre-pregnant heart rate was higher (71 vs 64 bpm, p<0.05) and stroke volume lower (68 vs 77mL, p<0.05) in RECUR as compared to CONTR. Even though LVM index was consistently lower in the RECUR group, the two subgroups responded to the next pregnancy with a comparable pattern of cardiac adaptation. Despite consistently lower LVM and SV and higher HR, after early onset PE, the pattern of subsequent early pregnancy cardiac adaptation is comparable in those that do and do not develop recurrent disease.

Cardiovascular risk factors in women 10 years post early preeclampsia: the Preeclampsia Risk EValuation in FEMales study (PREVFEM)

Preeclampsia is a complication of pregnancy and a known risk factor for cardiovascular disease (CVD) later in a women's life. The best approach for prevention of CVD in affected young women is yet unclear. We sought to investigate the prevalence of cardiovascular risk factors in women at 10 years post preeclampsia in comparison with a reference group. Women with a history of early preeclampsia (exposed), DBP ≥ 90 mmHg with proteinuria ≥ 0.3 gram/24 h before 32 weeks of gestation, and an equal number of women after uncomplicated pregnancy (non-exposed) from the obstetric database of 1991-2007, were sent a questionnaire and invited for a cardiovascular screening programme. The current study included 339 exposed women and 332 non-exposed women, 10 years post index-pregnancy. Systolic and diastolic blood pressures (SBP/DBP) were 127/86 mmHg versus 119/79 mmHg in the exposed and reference group respectively (p < 0.001). Exposure to early preeclampsia was associated with a threefold increased prevalence of hypertension (adjusted odds ratio (OR) 3.59, 95%CI 2.48-5.20). BMI and waist circumference were 26.9 kg/m(2) and 86.5 cm in the exposed group and 26.2 kg/m(2) (p = 0.07) and 83 cm (p = 0.001) in the non-exposed group. We found no differences in levels of glucose, lipids and CRP. Adjusted OR for the metabolic syndrome in women post preeclampsia was 2.18 (95% CI 1.34-3.52) compared with women in the reference group. We found a high prevalence of hypertension in young women at 10 years post early preeclampsia. More research on the timing of cardiovascular screening in these high-risk women is needed.