Pregnancy Induced Hypertension Cases Research Articles

Study of structural changes in placenta in pregnancy-induced hypertension.

Background:Hypertension is one of the most common complication during pregnancy. It contributes significantly to maternal and perinatal morbidity and mortality. This study was designed to investigate the morphological and histopathological changes in placenta from pregnancies complicated with hypertension.Objectives:To study the morbid changes in placenta in cases of pregnancy-induced hypertension (PIH) and to correlate the findings with birth weight of new born babies in comparison with normotensive mothers.Materials and Methods:The study was done on 100 placentas, out of which 50 were collected from normotensive mothers and the remaining 50 from PIH cases. All the placentas were studied morphologically and histologically. The birth weight of neonates was recorded.Results:In the present study it was observed that weight and dimensions of placenta was less in study group when compared with control group. The mean neonatal birth weight was more in normal pregnancy and feto-placental weight ratio was significantly high in hypertensive group. Histopathological study showed significant number of syncitial knots, areas of fibrinoid necrosis, hyalinization, calcification, and medial coat proliferation of medium sized blood vessels in hypertensive group.Conclusion:PIH significantly affects the placenta by reducing its weight and dimensions. These changes may cause placental insufficiency as a result of compromised utero-placental blood flow. Therefore has an adverse affect on the neonatal birth weight. PIH has definite influence on morphology, histology of placenta, and thus affects the growth of the fetus.

Study of Methyl Dopa Versus Labetalol in Management of Preeclampsia and Gestational Hypertension

Objective: To assess the efficacy and safety of labetalol compared with methyldopa in the management of mild and moderate cases of pregnancy-induced hypertension (PIH). Methods: Eighty patients with PIH were randomly allocated to receive either labetalol (group A) or methyldopa (group B). Administration of drugs with respect to Age, Gravid Status, Blood Pressure, Urine albumin Levels, Side Effects, Drug dosage, Additional Treatment, Prolongation of Pregnancy, New born Screening Test (NST), mode of termination, Indication of caesarean section, Perinatal safety and APGAR scores were studied. The statistical level of significance was taken at P<0.05. Results: A labetalol has been very effective in control as well as earlier onset of action in patients with methyl dopa. With effective control of blood pressure, prevention of eclampsia and the pregnancy can be prolonged to achieve fetal maturity. Labetalol has lesser side effects when compared to methyldopa. Labetalol is not associated with adverse fetal effects in the immediate and late neonatal period. The chances of spontaneous onset of labor were greater in the labetalol group when compared to methyldopa group. Though there was no difference in the groups with regard to obstetric intervention. At clinically effective doses, both the drugs were found to be safe for the neonate. Conclusions: Labetalol is safer, quicker in achieving adequate control of blood pressure with considerable prolongation of the duration of pregnancy with fewer side effects on the mother as well as the neonate when used in the management hypertensive disorders of pregnancy.

Prenatal Clinical Assessment of sFlt-1 (Soluble fms-like Tyrosine Kinase-1)/PlGF (Placental Growth Factor) Ratio as a Diagnostic Tool for Preeclampsia, Pregnancy-induced Hypertension, and Proteinuria.

Background: Aim of the study was a critical assessment of the clinical validity of the prenatal determination of sFlt-1/PlGF for preeclampsia (PE), pregnancy-induced hypertension (PIH), and proteinuria. Our analysis was based on a specificity of 95 % and a sensitivity of 82 % for the prediction of preeclampsia, as described by Elecsys (Roche). Methods: In this retrospective study the ratio of the prenatal antiangiogenic factor sFlt-1 (soluble fms-like tyrosine kinase-1) to the proangiogenic factor PIGF (placental growth factor) was analyzed using the electrochemiluminescence immunoassay of Elecsys (Roche Diagnostics, Mannheim, Germany) in 173 pregnant women. Sixty-three women with PE, 34 women with PIH and 6women with proteinuria were compared to 72controls. On average, the sFlt-1/PlGF ratio was determined 8 (controls), 2.4 (PE), 3.2 (PIH) and 4.1 (proteinuria) weeks before delivery. The PE and PIH cases were further subdivided into early (< 34 weeks of gestation) and late (≥ 34 weeks of gestation) onset groups. Statistical data analysis was done using the usual descriptive statistics and logistic regression analysis. ROC curves were calculated, and the sensitivity, specificity, and negative and positive predictive value (NPV, PPV) were estimated for a threshold of 85. Results: Although the specificity of the sFlt-1/PlGF ratio was high for PE, the sensitivity was low (only 59.4 %), thus giving unsatisfying results for PE. The sensitivity only increased to 62.5 % for the early-onset PE group. Intriguingly, a high ratio was detected for the combination of IUGR (intrauterine growth restriction) and PE in the early-onset PE group (8 cases). In the control group, 4cases exceeded the cut-off value of 85 but showed no clinical signs of PE and the birth was unremarkable. In summary, we found that the sFlt-1/PIGF ratio could not be used as a predictive test for preeclampsia but rather as an indicator for the development and estimation of the severity of PE. Thus, the test is less suitable for the reliable exclusion of PE in routine clinical practice. Recommendation: The determination of the sFlT-1/PlGF ratio is only one element for PE diagnosis in addition to the measurement of blood pressure, proteinuria, ultrasound and Doppler.

Morphological study in Hyrtl's anastomosis of umbilical arteries in pregnancy-induced hypertension

Introduction: The anatomic structure of Hyrtl's anastomosis is of a large variability. The aim of this study is to investigate the occurrence and types of the anastomoses in the umbilical arteries of pregnancy-induced hypertension. Anastomosis between the two umbilical arteries has been described earlier but no comparative morphology between the normotensive and pregnancy-induced hypertension has been carried out. Method: A routine dissection method has been performed to demonstrate the occurrence of the anastomosis. Result: In an attempt to verify the presence and type of Hyrtl anastomosis, 34 transverse type and 22 oblique were more common. A significant difference was observed between the normotensive and pregnancy-induced hypertension cases, whereas the transverse type of anastomosis was mostly observed in pregnancy-induced hypertension.

Complement split product C4d deposition in placenta in systemic lupus erythematosus and pregnancy‐induced hypertension

Systemic lupus erythematosus (SLE) and pregnancy-induced hypertension (PIH) are related to premature delivery and intrauterine growth restriction (IUGR), and share histological findings of the placenta. Association with complement dysregulation has been reported in pregnancy for both disorders. The purpose of this study was to investigate the utility of C4d immunohistochemistry for placentas with SLE- and PIH-associated pregnancy. C4d staining was performed on paraffin-embedded tissue of placentas from 26 patients with SLE, 26 with PIH, and 25 control cases. We used the H-score with a range of 0-300 for the evaluation of C4d immunoreactivity. Placentas of SLE and PIH cases showed a higher H-score than control cases (average, SLE, 38.3 (P < 0.05); PIH, 17.8; control, 1.68), with linear staining on the membrane of syncytiotrophoblast. C4d-high groups comprised 50% (12/26) of SLE and 35% (9/26) of PIH cases, with H-scores ranging 14-270 and 15-170. C4d-high groups were significantly associated with low-placental weights and low birth weight in both SLE and PIH (P < 0.05), and lower gestational age (P < 0.05) in PIH cases. These results suggest that C4d might be utilized as a biomarker evaluating the subsequent risk for IUGR and disease control during the gestation period in these patients.

English

CONTEXT: Pregnancy induced hypertension (PIH) accounts for almost 10 to 15% of antenatal cases. As per WHO “In developing countries like India there is 40% increase in the incidence of PIH in recent years.” AIMS: To evaluate the effect of good antenatal care on incidence & outcome of pregnancy induced hypertension in booked versus unbooked cases. Settings and Design: This was an open labeled and comparative study. METHODS AND MATERIAL: This study was conducted on 340 patients admitted in the Department of Obstetrics and Gynaecology at Sri Aurobindo Medical College, Indore over a period of 6 months. Results: Out of 340 antenatal cases studied, 44 cases were found to be suffering from pregnancy induced hypertension. Incidence came out to be 13%. Out of 13%, 8.53% were primigravida and 4.4% were multigravida. Out of total PIH cases, 36.15% cases were booked cases whereas 63.30% cases were unbooked. CONCLUSIONS: Pregnancy induced hypertension is not a totally preventable disease but maternal and foetal Complication due to PIH can be halted at mild stage by quality antenatal care with good outcome. KEY-WORDS: Antenatal care, Pregnancy induced hypertension, Incidence, Outcome INTRODUCTION: Pregnancy induced hypertension (PIH) accounts for almost 10 to 15% of antenatal cases.(1) As per WHO, in developing countries like India there is 40% increase in the incidence of PIH(2). Incidence of PIH in hospital practice varies widely. Imperfect documentation and lack of uniformity in the diagnostic criteria are responsible factors in variation of statistics. In developing Countries incidence is expected to be higher. Comparative low figures in hospital statistic are due to inclusion of only severe degree of the Syndrome, the minor ones being ignored. MATERIALS AND METHODS: The patients attending antenatal clinics and those admitted in labour room were selected as cases irrespective of age and parity. On a specially designed proforma for this study, the patient’s particulars including detailed obstetric examinations and lab findings were recorded. ESSENTIAL CRITERIA: PIH of early onset (B.P >140/90 mm Hg after 20 weeks of gestation but before 32 weeks) associated with proteinuria and edema.

Pregnancy Outcomes after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Korean Patients

Laparoscopic sleeve gastrectomy (LSG) is an effective procedure for treating morbid obesity, and the majority of female patients who received LSG were at childbearing age. Female patients, who successfully lost weight following LSG and became pregnant, need to be evaluated carefully. Information was gathered, through prospectively maintained database and phone interview, on women who underwent LSG from May 2003 to July 2011. A total of 136 women underwent LSG in this period. There were 13 (9.6%) pregnancies in 12 patients after LSG. The age before surgery was 28.3 ± 4.0. The mean weight and body mass index (BMI) before LSG were 95.3 ± 9.4kg and 35.1 ± 3.5kg/m(2), respectively. The average time from LSG to the first live birth was 32.0 ± 19.1months. Mean BMI decreased significantly after LSG, from 35.1 ± 3.5 to 24.9 ± 2.3kg/m(2) at conception. The mean percentage of excess body mass index loss was 85.8 ± 16.7% at conception and 42.7 ± 25.1% at delivery. Gained weight during pregnancy was 15.1 ± 5.2kg. The mean gestational age and birth weight were 39.0 ± 1.6weeks and 3,229.0 ± 505.9g. In two cases (15.4%), cesarean section was performed. No cases of pregnancy-induced hypertension and diabetes developed. Major congenital anomalies and neonatal deaths were not recorded. Larger study with longer follow-up is needed to evaluate the effect of LSG in pregnancies. However, these findings show that LSG seems to be a safe option for morbidly obese women in their reproductive period.

Clinical Study of Maternal and Perinatal Outcome in Pregnancies Complicated By Hellp Syndrome

Background & Objectives: HELLP syndrome is considered a placenta-instigated, liver-targeted acute inflammatory condition, with elements of disordered immunological processes. HELLP syndrome can be a great masquerader with vague and varied nature of presenting complaints making its diagnosis difficult. Delay in diagnosis may be life threatening with poor maternal and perinatal outcome. METHODS: 81 cases diagnosed of pregnancy induced hypertension(PIH) between May 2011 and April 2012 in department of obstetrics and gynaecology, Mamatha Medical College was included in the study. Of these 81, 18 cases fulfilled the criteria of HELLP. Maternal and perinatal outcome and also clinical and therapeutic factors affecting outcome were studied. Results: The incidence of pregnancy induced hypertension(PIH) during this period is 14.3%, of these 22.2% fulfilled the criteria of HELLP. Maximum incidence is among age group 20 – 30 years (88%). The incidence of maternal complications in our study was higher compared to Hemanth et al 3 , with incidence of pleural effusion/ ascites being highest (44.4%). The incidence of intra uterine deaths was 33.3% and the incidence of neonatal deaths was 16.6%. Interpretation & Conclusion: The reason for higher morbidity in our study is delay in identifying the problem by referring doctors. This study uncovers only the tip of the iceberg and HELLP syndrome in non PIH cases were not evaluated. Earlier diagnosis and intervention improves maternal and perinatal outcome

Microanatomical analysis of hypertensive placentae - a retrospective case control study

Abstract Background : Placenta is regarded as the byproduct of the birth process, but actually it is the mirror of maternal and foetal status. It often reflects the progress of many maternal conditions during pregnancy and is known to undergo changes both structurally and functionally in hypertensive pregnancy due to hypoxia. Aim: To compare the histopatological changes in hypertensive placentae with that of normal placentae. Materials and methods: A retrospective case control study was carried out on human placentae with 50 as study and 50 as control group . Placentae of study group were divided into three categories depending upon severity of hypertension. Tissues were microscopically studied for various histopathological changes. Results: Among severe pregnancy induced hypertension cases (PIH), 77.77% showed red infarction while 70.6% of eclampsia showed white infarction. 76.47%, 64.7% and 58.82% of eclampsia cases showed syncytial knots, fibrinoid necrosis and stromal fibrosis repectively. 70.6% of eclampsia cases showed cytotrophoblastic proliferation and calcification separately. Hyperplasia of tunica media was found in 20%, 50% and 58.82% of mild PIH, severe PIH and eclampsia respectively. Conclusion: Infarction, cyotrophoblastic cellular proliferation, syncytial knots, fibrinoid necrosis, stromal fibrosis, calcification and tunica media hyperplasia were seen with increased frequency in the study group as compared to control group. In study group, eclamptic placentae showed all the microscopic changes in significant number.This study of microscopic changes occurring in hypertensive placentae can be used to enhance our knowledge about the severity and progress of the disease. This can equip us to effectively manage the hypertensive pregnancies.

PP104. Pregnancy-induced hypertension is a strong risk factor for hypertension just 5 years after delivery: A double cohort study at the National Center for Child Health and Development and Showa University Hospital, Tokyo

Pregnancy-induced hypertension (PIH) is associated with increased risk for cardiovascular diseases later in life. To assess the prevalence of subsequent hypertension and other life-style diseases five years after delivery in women who experienced pregnancy- induced hypertension. A total of 1527 women who delivered singletons were registered at the National Center for Child Health and Development and Showa University Hospital Mother and child health center of integrated perinatal period between 2003 and 2005. After five years, these women were invited to participate in this study by mail, and 816 women completed the analysis. The women visited our hospital and underwent a medical examination. Women who were pregnant and nursing at the time when the physical examination was conducted were excluded from this survey. The outcomes assessed included the prevalences of hypertension, diabetes, and dyslipidemia. The number of PIH cases was 27 (3.3%: PIH group), whereas 787 women were used as controls subjects. The mean blood pressure five years after delivery was higher in the PIH group than in the control group (91.6±15.5mmHg vs 82.4±8.8mmHg, respectively; p<0.001), and the prevalence of hypertension five years after labor was 18.5% in the PIH group and 2.9% in the controls (odds ratio UOR Y=6.2; 95% confidence interval (CI)=2.2-17.5; p=0.003). Moreover, regarding high-normal blood pressure (>130/85mmHg), the prevalence was 33.4% in the PIH group and 6.1% in the control subjects (OR=7.2; 95% CI=3.1-16.3; p=0.003). No differences in the prevalences of subsequent diabetes or dyslipidemia were observed. Five years after the index pregnancy, women who experienced PIH exhibit an increased risk for subsequent hypertension. Therefore, the blood pressure of women with history of PIH should be regularly monitored after delivery.

MATERNAL AND FOETAL OUTCOME IN PREGNANCY INDUCED HYPERTENSION: A STUDY FROM RURAL TERTIARY CARE TEACHING HOSPITAL IN INDIA

Background: Preeclampsia and eclampsia have been recognized as clinical entities since the times of Hippocrates. Pregnancy induced hypertension (PIH) is one of the commonest disorders associated with the increased risk of maternal and fetal complications. It is reported in the world literature that the incidence of eclampsia is on the decline, but still a menace in developing countries. Objectives: To study the maternal and foetal outcome in pregnancy induced hypertension. Material and Methods: A prospective randomized study was carried out from February 2009 to January 2010 in the Department of Obstetrics and Gynecology of Pravara Rural Hospital, Loni, India. A total of 100 pregnant women with PIH were enrolled in the study. A pre-tested interview tool was used to collect necessary information such as detailed history, clinical examination findings and investigations performed. Results were analysed using SPSS 13.0 Results: In the present study, the overall incidence of PIH was 8.96%, which includes preeclampsia in 7.26% and eclampsia in 1.70%. Preterm labour was the commonest maternal obstetrical complication observed in 18% of mild PIH and 48% of severe PIH cases. Prematurity was the commonest foetal complication seen in 17.99%, 47.62% and 52.63% of mild PIH, severe PIH and Eclampsia cases respectively. Conclusion: Pregnancy induced hypertension is a common medical disorder seen associated with pregnancy in the rural population, especially among young primigravidas, who remain unregistered during pregnancy. Maternal and fetal morbidity and mortality can be reduced by early recognition and institutional management.

Impacts of Exogenously Derived Nitrogen Oxide and Sulfur Compounds on the Structure and Function of the Vascular Endothelium Link Pregnancy Hypertension with Later Life Hypertension

The relationship between pregnancy hypertension and later life hypertension is explained by long-term impacts of environmental oxidants on the vascular endothelium. These impacts may precede the onset of the disease as a primary defect and may participate in the pathogenesis of hypertension itself. Continuous exposure to strong exogenous oxidants such as NOx (NO and NO 2 ) reversibly oxidizes oxyhemoglobin (Fe 2+ ) to methemoglobin (Fe 3+ ), and irreversible methemoglobinemia can arise because of disruption of the oxidant/antioxidant balance supported by SO 2 metabolites, as inhibitors of antioxidants, and by synergistic degradation of antioxidant thiols . Methemoglobin by itself and from heme, redox-active ferric iron as product of methemoglobin catabolism, have prooxidant properties and cause important structural and functional changes in the vascular endothelium such as growth arrest, senescence, morphological alterations and cell apoptosis. In 1975, an epidemiological study among 204 pregnant women in Labin (Croatia) identified 30 (14.7%) cases of preeclampsia and 25 (12.3%) cases of hypertension in pregnancy. Ten years later, we found a significant number of hypertension cases (N=5; P=0.0027), and among them, we found a significant number of pregnancy-induced hypertension cases (N=3; P=0.0003) and a significant number of psychoneurotic disturbances (P=0.0190), but these conditions were not found in the normotensive women ten years after giving birth (P = 0.1161). Our original findings confirm that hypertension in pregnancy is not a transient impairment but instead is an extension of the effects of exogenously induced oxidative stress on the structure and function of the vascular endothelial, and indicate delayed effects plausibly manifesting as hypertension in later life.

Expression of antiangiogenic prolactin fragments in the placentas of women with pregnancy induced hypertension.

It has been reported that prolactin (PRL) is cleaved to 14 or 16 kDa fragments by cathepsin D in vitro and in vivo, and that such fragments exhibit antiangiogenic and proapoptotic properties. The aim of this study was to investigate the relationship between pregnancy induced hypertension (PIH) and the placental expression of antiangiogenic PRL fragments and cathepsin D. Placental expression of PRL fragments and cathepsin D was evaluated by Western blot analysis in a group of 9 pregnant women consisting of 5 normal pregnancies and 4 severe PIH cases. Antiangiogenic PRL fragments were detected in 4 placental samples from all PIH cases but not detected in those from normal pregnancies (p<0.05). The expression of cathepsin D in PIH placentas was significantly lower than that in those without PIH (p<0.05), while the placental expression of procathepsin D was significantly greater in PIH cases than in the normal pregnancies (p<0.05). These data suggest that antiangiogenic PRL fragments in the placenta may be present only in PIH cases, and that PRL fragments in the placenta might be implicated in the pathophysiology of PIH.

1365: Clinical Evaluation of Pulsatile Blood Flow Detection to Visualize the Placental Vasculature and Predict Pregnancy Induced Hypertension

PurposeTo assess utero-placental blood flow using the sonographic Pulsatile blood Flow Detection (PFD) method, to determine differences in the relationships in normal pregnancy and Pregnancy-Induced Hypertension(PIH) , and finally, to predict the time to onset of PIH.Methods170 cases of normal singleton pregnant women who were divided into 6 groups. 30 cases of PIH that were diagnosed after their first PFD method. The ROI of the placenta including the basal plate was determined using image analysis software, and the percentage of PFD in ROI (PFD/ placental ROI) was measured. These parameters were analyzed using Fisher's PLSD.Results1. The PFD/placental ROI was significantly higher (23.08±4.00%) at 11 week's gestation.2. PFD/placental ROI of the PIH group (1.50±0.30%) were significantly lower compared with normal pregnancy (14.14±1.40%) at 13week's gestation.ConclusionsEarly knowledge of PIH is beneficial especially for the pregnant women who were scanned using the PFD method. PurposeTo assess utero-placental blood flow using the sonographic Pulsatile blood Flow Detection (PFD) method, to determine differences in the relationships in normal pregnancy and Pregnancy-Induced Hypertension(PIH) , and finally, to predict the time to onset of PIH. To assess utero-placental blood flow using the sonographic Pulsatile blood Flow Detection (PFD) method, to determine differences in the relationships in normal pregnancy and Pregnancy-Induced Hypertension(PIH) , and finally, to predict the time to onset of PIH. Methods170 cases of normal singleton pregnant women who were divided into 6 groups. 30 cases of PIH that were diagnosed after their first PFD method. The ROI of the placenta including the basal plate was determined using image analysis software, and the percentage of PFD in ROI (PFD/ placental ROI) was measured. These parameters were analyzed using Fisher's PLSD. 170 cases of normal singleton pregnant women who were divided into 6 groups. 30 cases of PIH that were diagnosed after their first PFD method. The ROI of the placenta including the basal plate was determined using image analysis software, and the percentage of PFD in ROI (PFD/ placental ROI) was measured. These parameters were analyzed using Fisher's PLSD. Results1. The PFD/placental ROI was significantly higher (23.08±4.00%) at 11 week's gestation.2. PFD/placental ROI of the PIH group (1.50±0.30%) were significantly lower compared with normal pregnancy (14.14±1.40%) at 13week's gestation. 1. The PFD/placental ROI was significantly higher (23.08±4.00%) at 11 week's gestation. 2. PFD/placental ROI of the PIH group (1.50±0.30%) were significantly lower compared with normal pregnancy (14.14±1.40%) at 13week's gestation. ConclusionsEarly knowledge of PIH is beneficial especially for the pregnant women who were scanned using the PFD method. Early knowledge of PIH is beneficial especially for the pregnant women who were scanned using the PFD method.

Maternal Blood Lead Levels and the Risk of Pregnancy-Induced Hypertension: The EDEN Cohort Study

BackgroundPrior studies revealed associations of environmental lead exposure with risks of hypertension and elevated blood pressure.ObjectiveWe examined the effect of blood lead levels on blood pressure and the incidence of pregnancy-induced hypertension (PIH) in the second and third trimesters of pregnancy.MethodsOne thousand seventeen pregnant women were enrolled in two French municipalities between 2003 and 2005 for the EDEN (Etude des Déterminants pré et post natals du développement et de la santé de l′ Enfant) cohort study. Blood lead concentrations were measured by atomic absorption spectrometry in mothers between 24 and 28 weeks of gestation.ResultsPIH was diagnosed in 106 subjects (10.9%). Age, parity, weight gain, alcohol, smoking habits, and calcium supplementation were comparable between hypertensive and nonhypertensive women. Lead levels were significantly higher in PIH cases (mean ± SD, 2.2 ± 1.4 μg/dL) than in normotensive patients (1.9 ± 1.2 μg/dL; p = 0.02). Adjustment for potential confounder effects slightly attenuated but did not eliminate the significant association between blood lead levels and the risk of PIH (adjusted odds ratio of PIH = 3.3; 95% confidence interval, 1.1–9.7). We also observed geographic differences in lead exposure and in the incidence of PIH and found significant correlations between blood lead levels and unadjusted as well as adjusted systolic and diastolic blood pressures after 24 weeks of gestation.ConclusionsThese findings confirm the relationship between blood lead levels at mid-pregnancy and blood pressure and suggest that environmental lead exposure may play an etiologic role in PIH.

Determination of Insulin Resistance Using the Homeostatic Model Assessment (HOMA) and its Relation With the Risk of Developing Pregnancy-Induced Hypertension

To assess whether increased insulin resistance determined by homeostatic model assessment (HOMA) early in pregnancy is associated with the subsequent development of pregnancy-induced hypertension (PIH) in Colombian women with known risk factors. We conducted a nested case control study in a prospective cohort of 572 normotensive pregnant women, with gestational age < or = 30 weeks, recruited in Bucaramanga and Floridablanca, Colombia. Fasting plasma glucose and insulin concentrations were determined at enrollment, and HOMA index was calculated. Log-transformed HOMA (log-HOMA) was used in the statistical analysis. Thirty nine PIH cases (18 preeclampsia [PE], 21 gestational hypertension [GH]) were compared to 78 controls, matched by body mass index, gestational and maternal age at enrollment. Women who subsequently developed PIH had higher levels of log-HOMA at enrollment (-0.13 +/- 0.54 v 0.21 +/- 0.60; P = .002), which was significantly associated with the development of PIH (odds ratio 3.13, 95% confidence interval 1.41-6.94; P = .005). Higher log-HOMA was found in women who subsequently developed PE (0.28 +/- 0.58; P = .003), and in those who presented with GH (0.15 +/- 0.62; P = .026). Women who subsequently develop PIH have a higher degree of insulin resistance determined by log-HOMA early in pregnancy, before the onset of clinical manifestations of the disease. The HOMA seems to be a useful method to evaluate women at risk of developing PIH. More studies are required to confirm its usefulness as a screening tool to identify pregnant women at risk of developing PIH.

Relationship between imbalanced synthesis of human chorionic gonadotropin alpha and beta subunits and pregnancy-induced hypertension

To study the relationship between imbalanced synthesis of human chorionic gonadotropin (hCG) alpha and beta subunits and the pathology of pregnancy-induced hypertension (PIH). Total hCG, free alphahCG and betahCG were measured in serum samples collected from 60 cases of PIH and 30 normal gravid women by radioimmunoassay. The ratio of total hCG/betahCG, betahCG/FalphahCG, (FalphahCG+betahCG)/betahCG were calculated. Immunohistochemical staining was performed in 13 placenta from each group. In PIH group the levels of FalphahCG, total hCG and betahCG were significantly higher than those of normal group (FalphahCG: 528 +/-421 IU/L compared with 222 +/-129 IU/L; betahCG: 39396 +/-6412 IU/L compared with 24265 +/-5575 IU/L; total hCG: 66597 +/-9294 IU/L compared with 36078 +/-4767 IU/L, all P<0.001). The betahCG/FalphahCG ratio in PIH was lower than that of normal group (91.23 +/-53.38 Compared with 119.4 +/-80.1, P<0.05); (FalphahCG+betahCG)/betahCG ratio and total hCG/betahCG ratio in two groups were (1.022 +/-0.026 compared with 1.015 +/-0.011; 1.802 +/-0.339 compared with 1.807 +/-0.258, respectively P>0.05). The immunohistochemical intensity of betahCG and FalphahCG in syncytiotrophoblast was significantly increased in 13 PIH compared with the control. These data suggested that the imbalanced synthesis of hCG alpha and beta subunits may cause hypertension.

Reduction of preeclampsia in multiple pregnancies by a dedicated monitoring protocol.

To evaluate the effect of a dedicated monitoring protocol on the incidence of pregnancy-induced hypertension disorders (preeclampsia, HELLP [hemolysis, elevated liver enzymes, low platelets] syndrome, gestational hypertension) during a 5-year period in 417 women with multiple gestations. At the Department of Obstetrics and Fetomaternal Medicine, Vienna University, an outpatient care protocol for women with multiple pregnancies was established. Between March 1997 and February 2002, 379 twins and 38 triplets were followed up. Mean visits of dichorial and monochorial twins were nine and 11, respectively. Triplets were asked to at least 12 follow-up visits. Any kind of pregnancy-associated hypertensive disorders necessitating cesarean delivery developed in eight women (seven with twins, one with triplets; 1.76%). Three cases of preeclampsia, three cases of HELLP syndrome, and two cases of pregnancy-induced hypertension were diagnosed. Perinatal outcome of all 17 newborns was excellent without any mortality and only minor morbidity. All mothers left the hospital in a fully recovered condition. Because of our results we hypothesize that our monitoring protocol with frequent visits, continuous personal obstetric care, and timed delivery is effective in reduction of pregnancy-induced hypertension in multiple pregnancies.

Abundant expression of platelet-derived growth factor in spiral arteries in decidua associated with pregnancy-induced hypertension and its relevance to atherosis.

To elucidate the role of platelet-derived growth factor (PDGF) in the pathophysiology of pregnancy-induced hypertension (PIH) in which the spiral arteries of the decidua demonstrate the atherosclerotic change. We determined serum levels of PDGF and PDGF expression in the decidua as well as serum levels of 17 beta-estradiol (E2) and progesterone (P4) both in normotensive cases and in PIH cases. Furthermore, we investigated whether sex steroid hormones could interact with PDGF in cultured vascular smooth muscle cells (SMC) by immunohistochemical staining for proliferating cell nuclear antigen. Serum PDGF levels were higher (P<0.01) but serum E2 levels were lower (P<0.01) in PIH cases compared with normotensive cases. There was no statistically significant difference between serum P4 levels in PIH cases and those in normotensive cases. Immunohistochemical staining for PDGF in SMC of spiral arteries was more prominent in PIH cases than in normotensive cases. The proliferative potential of cultured SMC was stimulated by PDGF, but inhibited by concomitant treatment with PDGF and E2. PDGF is suggested to play an important role in the pathophysiology of PIH through its stimulatory effect on vascular SMC proliferation which may elicit the atherosclerotic change in the spiral arteries of the placenta.

Combination antiretroviral therapy in human immunodeficiency virus–infected pregnant women

Objective: To describe the safety, efficacy, and perinatal transmission rates of human immunodeficiency virus (HIV) with combination antiretroviral therapy in pregnancy. Methods: Retrospective study of all HIV-infected pregnant women treated with combination antiretroviral therapy after September 1, 1996, and who delivered by September 1, 1998, at Bronx-Lebanon Hospital Center. Results: Thirty women received combination therapy, 13 with protease inhibitor. Median baseline CD4 was 285 cells/mm 3; 16 (53%) had AIDS, 20 (67%) were antiretroviral-experienced, and 11 (37%) were illicit substance users. Fourteen were receiving antiretroviral therapy (eight with protease inhibitor) during the first trimester. Combination therapy was prescribed for a median of 26 weeks during pregnancy. One third changed antiretroviral therapy, and nearly half (47%) were nonadherent. Twenty-four women had a successful viral load and/or CD4 response. The median (range) delivery gestation was 39 (32–42) weeks, and the median (range) birth weight was 2892 (1430–3863) g. Adverse outcomes included one stillbirth; one case of microcephaly; and five infants less than 2500 g, two of which were under 36 weeks’ gestation. Median birth weight did not differ with maternal protease exposure. None of the 26 infants studied for at least 4 months had HIV infection. Associated maternal complications were four cases of pregnancy-induced hypertension, one of gestational diabetes, and one exacerbation of hepatitis C virus. Conclusion: Combination antiretroviral therapy in pregnancy was efficacious in reducing viral load, increasing CD4, and preventing vertical HIV transmission in women with advanced HIV disease, extensive antiretroviral experience, prior history of vertical transmission, and/or substance abuse. The findings are promising in this preliminary report that combination antiretroviral therapy may not be related to major infant toxicity, but further study is warranted.