Previous Preeclampsia Research Articles

Prevalence and Risk Factors of Preterm Premature Rupture of Membranes in Pregnant Women admitted to Hospital, Pakistan

In both high- and low-income nations, preterm pre-labou membrane rupture is a significant contributor to perinatal, neonatal, and maternal illness and mortality. Premature membrane rupture puts a woman at risk for postpartum haemorrhage, intraamniotic infection, and even death. The purpose of this study was to ascertain the prevalence of preterm premature rupture of membranes and its related factors among pregnant women admitted to health institutions because little is known about the issue in the study region. A total of 300 participants participated in this research among which 100 had preterm PROM, 100 had PROM, and 100 had preterm deliveries. The ages of the participants ranged from 18-40 years with a mean age of 25.12 ± 4.43 years. Among 300 participants, 9.33, 17.33, 21, 24.33, and 28% were 18-20, 21-25, 26-30, 31-35, and 40 years of age, respectively. Among the total, 19 (6.33%), 271 (90.33%) and 10 (3.33%) were divorced, married and widowed, respectively. Among a total, 44, 40.33, and 15.66% of the participants were multigravida, primigravida, and grand-multigravida, respectively. The majority (87%) of mothers had ANC follow-up in their current pregnancy. In the large population, 255 (85%) had labor pain while 171 (578%) of mothers showed vaginal bleeding in the current pregnancy and 167 (55.67%) of mothers had cephalic presentation. 88.33% of pregnant women had no history of PROM. 97 (32.33%) of mothers had urinary tract infection in pregnancy, 32 (10.66%) had anaemia, and 41 (13.67%) had an abnormal vaginal discharge. The pregnant mothers had not used any cocaine, and cigarettes. Different risk factors associated with PPROM such as current urinary tract infection, gravidity, history of previous PPROM, preeclampsia, economic status, and anaemia were recorded. The major risk factors are use of smoking, chat, and cocaine. To lower the incidence of preterm premature rupture of membranes, early detection and treatment of urinary tract infections and atypical vaginal discharges were advised. Keywords: Preterm prelabour rupture of membranes; fetal outcome; Female urogenital disorders; maternal age; Pakistan

Association between previous spontaneous abortion and preeclampsia: a case–control study

BackgroundThe association between previous spontaneous abortion and preeclampsia is not yet fully understood. The current study was conducted to assess the association between previous spontaneous abortion and preeclampsia among pregnant women in Sudan.MethodsA case–control study (involving 180 women in each study group) was conducted at Saad Abuelela Hospital, Khartoum, Sudan. The cases were pregnant women with preeclampsia, while the control group included healthy pregnant women. The participants’ sociodemographic, obstetric, and clinical characteristics were assessed via a questionnaire.ResultsThere was no significant difference in the age, parity, education level, employment status, blood group, body mass index, and hemoglobin level between the patient and control groups. Forty (22.2%) women with preeclampsia and 68 (37.8%) women in the control group had a history of spontaneous abortion (p = 0.001).Multivariate logistic regression analysis (adjusted) revealed that women with a history of spontaneous abortion had a lower risk of preeclampsia than those without a history of spontaneous abortion [adjusted odds ratio (AOR) = 0.44, 95% confidence interval (CI) = 0.26‒0.73]. However, women with a history of preeclampsia had a higher risk of recurrence of preeclampsia (AOR = 1.92, 95% CI = 1.11‒3.32).ConclusionThe present study revealed that previous spontaneous abortion reduced the risk of preeclampsia by 59.0%.

What matters to short interpregnancy intervals between pregnancies in Western Australia?

ObjectivesStudies showed that short interpregnancy interval - time between birth of the previous (index) child to the conception of the next - is associated with adverse perinatal and maternal outcomes, impacting sibling relations, parenting, and couple relations. This study aims to investigate the demographic and obstetric determinants of short interpregnancy interval in Western Australia.
 ApproachWe used a longitudinal study using data linkage obtained from Western Australian Midwives Notification System and Hospital Morbidity Data System for 150,712 women who gave births between 2006 and 2010. We estimated unadjusted and adjusted hazard ratio (aHR) and 95% CI using Gompertz gamma shared frailty model. In the study, event was deemed when women conceived within 18 months after index (previous) births. Otherwise, we considered as censored when women conceived after 18 months of the index births or if they did not conceive until the last date of the follow up period (31st December 2015).
 ResultsWe found that 20% (n=30,916) of births in WA conceived within 18 months after the index pregnancy. We found that women aged <20 years (aHR=1.46, 95% CI: 1.37, 1.54), 20-34 years (aHR=1.75, 95% CI: 1.69, 1.81), women with stillbirths (HR=3.31, 95% CI: 3.00, 3.65) and women in the lowest socioeconomic status (HR=1.14, 95% CI: 1.10, 1.19) had a greater hazard of having short interpregnancy intervals. However, women with previous gestational diabetes mellitus (aHR=0,90, 95% CI: 0.85, 0.95), women with previous preeclampsia (aHR=0,92 95% CI: 0.87, 0.90), women with more than one previous birth ((aHR=0,41; 95% CI: 0.40, 0.42), women with multiple births (aHR=0,65, 95% CI: 0.60, 0.71) had less hazards than their counterparts to have short interpregnancy intervals.
 ConclusionOne in five Western Australian women conceived within the sub-optimal range of interpregnancy interval. Demographic and obstetric factors play a significant role in determining short interpregnancy intervals.

Association between Cardiorespiratory Fitness and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.

Hypertensive disorders of pregnancy (HDP) are associated with future cardiovascular disease (CVD), which may be mediated by diminished cardiorespiratory fitness (CRF). In this systematic review and meta-analysis, we summarize evidence linking CRF with HDP before, during, and after pregnancy. We searched relevant databases to identify observational or randomized studies that measured CRF (VO2 max or peak, VO2 at anaerobic threshold, or work rate at peak VO2) in women with and without HDP. We pooled results using random effects models. Fourteen studies (n = 2406 women) reporting on CRF before, during, and after pregnancy were included. Before pregnancy, women who developed HDP had lower CRF (e.g., VO2max < 37 vs. ≥37 mL O2/min) than those without HDP (two studies, 811 women). VO2max at 14–18 weeks of pregnancy was marginally lower among women who developed preeclampsia vs. normotensive women (three studies, 275 women; mean difference 0.43 mL/kg/min [95% CI 0.97, 0.10]). Postpartum, there was a trend towards lower VO2peak in women with previous preeclampsia (three studies, 208 women; 0.26 mL/kg/min [−0.54, 0.02]). While exploratory, our findings raise the possibility that CRF can identify women at risk for HDP, and furthermore, that HDP confers a hit to a woman’s cardiorespiratory reserve.

Factors associated with preterm births in sacred heart hospital, Lantoro, Abeokuta, Ogun state

This research was carried out to ascertain the factors associated with preterm births in Sacred Heart Hospital, Lantoro, Abeokuta, Ogun State, Nigeria. The Objectives were to assess the Knowledge of mothers on the causes of preterm labour during ANC, assess causes of preterm birth in Sacred Heart Hospital, Lantoro, Abeokuta, determine the socio-demographic factors that influence preterm delivery in mothers attending Sacred Heart Hospital, Lantoro, Abeokuta and Investigate the possible options to the management of preterm labour. The significance of this study is to empower clients and health care professionals to understand and prevent preterm births, minimize the complications of preterm births and give better care to premature babies. Nurses could educate pregnant women based on the findings of this study to avoid practices that predispose them to preterm births. Early detection and prompt treatment of disease conditions associated with premature births. It will also serve as a base-line for future studies. Research design was retrospective/cross sectional study. Data was collected from the records of women who delivered in the hospital between January 2016 and December 2018. Sample size was determined by the use of Cochran’s formula to select 162 respondents from the ANC using self–structured questionnaire. Quantitative data was collected using abstract form questionnaire with 4 sections on socio-demographic, knowledge of causes of preterm births, preterm delivery among respondents and available options for the management of preterm births. Findings from the analysis revealed that 62% of nursing mothers have heard of preterm births, 57.1% have poor knowledge of causes. Majority (89.3%) were married and from monogamous homes (89.3%). Previous preterm births (78.6%) and pre-eclampsia (82.1%), the highest risk factor. Eighty-nine percent of mothers had babies with low apgar score while 80% had slow development. Almost all mothers (100%) opted for Kangoro Mother Care. Recommendations were made based on the findings that nurses should update their knowledge and skills on the causes, prevention and special care of preterm babies so as to guide the mothers aright thereby reducing infant morbidity and mortality associated with premature births.

The association between chronic liver diseases and preeclampsia

BackgroundPreeclampsia is a multisystem disorder characterized by an abnormal vascular response to placentation associated with increased systemic vascular resistance. As liver involvement is one of the main clinical features of preeclampsia, we sought to determine if there is an association between chronic liver diseases and preeclampsia.MethodsA retrospective matched case–control analysis was conducted in a tertiary medical center. Three hundred eleven (311) pregnant women with preexisting chronic liver disease (study group), including viral and autoimmune hepatitis, non-alcoholic fatty liver, Wilson disease, and cirrhosis, were match for age, parity, and number of fetuses to 933 healthy pregnant women (control group). The primary outcome measure was the incidence of preeclampsia in each group. Secondary outcome measures were obstetrical and neonatal complications. Confounders found to be significant on univariate analysis were evaluated using logistic regression models, and odds ratios (OR) and confidence intervals (CI) were calculated.ResultsPreeclampsia was diagnosed in 28 women (9.0%) in the study group and 33 women (3.54%) in the control group (p < 0.001).On multivariate analysis adjusted for maternal age, parity, previous preeclampsia, chronic hypertension, gestational diabetes mellitus, pregestational diabetes mellitus, antiphospholipid syndrome, and mode of conception, chronic liver disease was found to be an independent risk factor for preeclampsia (aOR 2.631, 95% CI 1.518–4.561). Although there was no difference in the gestational week at delivery between the groups (38.6 ± 2.13 vs. 38.8 ± 2.17 for study and control group, respectively, p = 0.410), the study group had a lower mean neonatal birthweight (3088 ± 551 vs. 3182 ± 566 g, p = 0.011). There were no between-group differences in the other parameters evaluated.ConclusionIn our study, preexisting chronic liver disease was associated with a 2.6-fold increased risk of preeclampsia.

Early Coronary Atherosclerosis in Women With Previous Preeclampsia

BackgroundWomen with previous preeclampsia have an increased risk of coronary artery disease later in life. ObjectivesThis study aimed to determine the prevalence of coronary atherosclerosis in younger women with previous preeclampsia in comparison with women from the general population. MethodsWomen aged 40-55 years with previous preeclampsia were matched 1:1 on age and parity with women from the general population. Participants completed an extensive questionnaire, a clinical examination, and a coronary computed tomography angiography (CTA). The main study outcome was the prevalence of any coronary atherosclerosis on coronary CTA or a calcium score >0 in case of a nondiagnostic coronary CTA. ResultsA total of 1,417 women, with a mean age of 47 years, were included (708 women with previous preeclampsia and 709 control subjects from the general population). Women with previous preeclampsia were more likely to have hypertension (284 [40.1%] vs 162 [22.8%]; P < 0.001), dyslipidemia (338 [47.7%] vs 296 [41.7%]; P = 0.023), diabetes mellitus (24 [3.4%] vs 8 [1.1%]; P = 0.004), and high body mass index (27.3 ± 5.7 kg/m2 vs 25.0 ± 4.2 kg/m2; P < 0.001). Cardiac computed tomography was performed in all women. The prevalence of any coronary atherosclerosis was higher in the preeclampsia group (193 [27.4%] vs 141 [20.0%]; P = 0.001) with an OR: 1.41 (95% CI: 1.08-1.85; P = 0.012) after adjustment for age, dyslipidemia, diabetes mellitus, smoking, body mass index, menopause, and parity. ConclusionsYounger women with previous preeclampsia had a slightly higher prevalence of coronary atherosclerosis compared with age- and parity-matched women from the general population. Preeclampsia remained an independent risk factor after adjustment for traditional cardiovascular risk factors. (The CoPenHagen PREeClampsia and cardIOvascUlar diSease study [CPH-PRECIOUS]; NCT03949829)

Reference values for uterine artery mean pulsatility index throughout pregnancy customized by parity, transvaginal measurement and blood pressure.

Population-specific reference ranges for uterine artery (UtA) mean pulsatility index (PI) throughout pregnancy have been shown to be of value in antenatal care. To construct reference values for UtA mean PI throughout pregnancy, customized by maternal characteristics, transvaginal measurement and blood pressure in a Mexican population. Cross-sectional study in 2286 normal singleton pregnancies in Mexico City. Blood pressure and UtA mean PI were measured using standardized methodology. Reference ranges by gestation were constructed. The effects of independent variables were tested by multiple linear regression. UtA mean PI median value between 11 and 41 weeks decreased from 1.714 to 0.523. The 95th percentile decreased from 2.600 to 0.653. Previous parity without preeclampsia had the main effect on UtA mean PI. Mean blood pressure had an effect on UtA mean PI by interaction with parity. Previous preeclampsia had an effect on UtA mean PI by interaction with maternal characteristics. A correction factor was obtained for transvaginal measurement. UtA mean PI usually decreases according to placentation and maternal adaptation to pregnancy. The effects of parity on blood pressure and UtA mean PI might reflect cardiovascular remodeling after gestation.

Association between hypertensive disorders of pregnancy and later risk of cardiovascular outcomes

BackgroundHypertensive disorders of pregnancy are common pregnancy complications that are associated with greater cardiovascular disease risk for mothers. However, risk of cardiovascular disease subtypes associated with gestational hypertension or pre-eclampsia is unclear. The present study aims to compare the risk of cardiovascular disease outcomes for women with and without a history of gestational hypertension and pre-eclampsia using national hospital admissions data.MethodsThis was a retrospective cohort study of national medical records from all National Health Service hospitals in England. Women who had one or more singleton live births in England between 1997 and 2015 were included in the analysis. Risk of total cardiovascular disease and 19 pre-specified cardiovascular disease subtypes, including stroke, coronary heart disease, cardiomyopathy and peripheral arterial disease, was calculated separately for women with a history of gestational hypertension and pre-eclampsia compared to normotensive pregnancies.ResultsAmongst 2,359,386 first live births, there were 85,277 and 74,542 hospital admissions with a diagnosis of gestational hypertension and pre-eclampsia, respectively. During 18 years (16,309,386 person-years) of follow-up, the number and incidence of total CVD for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were n = 8668, 57.1 (95% CI: 55.9–58.3) per 100,000 person-years; n = 521, 85.8 (78.6–93.5) per 100,000 person-years; and n = 518, 99.3 (90.9–108.2) per 100,000 person-years, respectively. Adjusted HRs (aHR) for total CVD were aHR (95% CI) = 1.45 (1.33–1.59) for women with prior gestational hypertension and aHR = 1.62 (1.48–1.78) for women with prior pre-eclampsia.Gestational hypertension was strongly associated with dilated cardiomyopathy, aHR = 2.85 (1.67–4.86), and unstable angina, aHR = 1.92 (1.33–2.77). Pre-eclampsia was strongly associated with hypertrophic cardiomyopathy, aHR = 3.27 (1.49–7.19), and acute myocardial infarction, aHR = 2.46 (1.72–3.53). Associations were broadly homogenous across cardiovascular disease subtypes and increased with a greater number of affected pregnancies.ConclusionsWomen with either previous gestational hypertension or pre-eclampsia are at greater risk of a range of cardiovascular outcomes. These women may benefit from clinical risk assessment or early interventions to mitigate their greater risk of various cardiovascular outcomes.

Association between interpregnancy interval and pregnancy complications by history of complications: a population-based cohort study

ObjectiveTo examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications.Design and settingPopulation-based longitudinally linked cohort study in Western Australia...

Cardiac dysfunction and remodeling regulated by anti-angiogenic environment in patients with preeclampsia: the ANGIOCOR prospective cohort study protocol

BackgroundCardiovascular diseases (CVD) are cause of increased morbidity and mortality in spite of advances for diagnosis and treatment. Changes during pregnancy affect importantly the maternal CV system. Pregnant women that develop preeclampsia (PE) have higher risk (up to 4 times) of clinical CVD in the short- and long-term. Predominance of an anti-angiogenic environment during pregnancy is known as main cause of PE, but its relationship with CV complications is still under research. We hypothesize that angiogenic factors are associated to maternal cardiac dysfunction/remodeling and that these may be detected by new cardiac biomarkers and maternal echocardiography.MethodsProspective cohort study of pregnant women with high-risk of PE in first trimester screening, established diagnosis of PE during gestation, and healthy pregnant women (total intended sample size n = 440). Placental biochemical and biophysical cardiovascular markers will be assessed in the first and third trimesters of pregnancy, along with maternal echocardiographic parameters. Fetal cardiac function at third trimester of pregnancy will be also evaluated and correlated with maternal variables. Maternal cardiac function assessment will be determined 12 months after delivery, and correlation with CV and PE risk variables obtained during pregnancy will be evaluated.DiscussionThe study will contribute to characterize the relationship between anti-angiogenic environment and maternal CV dysfunction/remodeling, during and after pregnancy, as well as its impact on future CVD risk in patients with PE. The ultimate goal is to improve CV health of women with high-risk or previous PE, and thus, reduce the burden of the disease.Trial registrationNCT04162236

Increased prevalence of premature coronary atherosclerosis after preeclampsia

Abstract Background Women with preeclampsia have increased risk of manifest coronary artery disease later in life. However, it remains unknown if and when premature coronary atherosclerotic stages can be identified. This knowledge could enable early intervention in women considered at high risk for future manifest coronary artery disease. Purpose Using cardiac computed tomography, we aimed to investigate the prevalence of premature coronary atherosclerosis in women with previous preeclampsia in comparison with women from the general population. Methods Women, aged 40–55 years, with previous preeclampsia were recruited in the CPH-PRECIOUS study and compared 1:1 with age- and parity-matched women from the CGPS. Both groups underwent a cardiac computed tomography, including a contrast-enhanced coronary computed tomography angiography and a non-contrast coronary artery calcium scoring, as well as an overall assessment of cardiovascular risk factors imbedded in an extensive questionnaire. Cardiac computed tomography examinations were analysed blindly. The main outcome of the study was the prevalence of any coronary atherosclerosis defined as any plaque at coronary computed tomography angiography or a calcium score &amp;gt;0 in case of a non-diagnostic coronary computed tomography angiography. Results A total of 1,424 women were included (715 women with previous preeclampsia and 709 controls from the general population). Women with previous preeclampsia were more likely to have cardiovascular risk factors (hypertension, dyslipidaemia, diabetes mellitus). The prevalence of any coronary atherosclerosis was significantly higher in the preeclampsia group (27.4% vs. 20.0%) (P=0.001). A calcium score &amp;gt;0 was also more prevalent in the preeclampsia group (16.6% vs. 11.8%) (P=0.009). Preeclampsia remained an independent risk factor for the presence of any coronary atherosclerosis after adjusting for cardiovascular risk factors (age, hypertension, dyslipidaemia, diabetes, smoking, body mass index, parity) (OR=1.37, 95% CI (1.05–1.79), P=0.021). Conclusion Women with previous preeclampsia are more likely show premature signs of coronary atherosclerosis compared with an age- and parity matched control group from the general population. Preeclampsia is an independent risk factor for premature coronary atherosclerosis. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationSkibsreder Per Henriksen, R og Hustrus FondKong Christian den Tiendes FondBrødrene Hartmanns FondHans og Nora Buchards FondArvid Nilssons FondAnita og Tage Therkelsens FondLægefondenAase og Ejnar Danielsens FondHjertecentrets Forskningsudvalg (Rigshospitalet)Direktør Kurt Bønnelycke og Hustru Fru Grethe Bønnelyckes FondLægeforeningens ForskningsfondTorben &amp; Alice Frimodt FondHenry og Astrid Møllers Fond

EARLY MANAGEMENT OF SEVERE PRE-ECLAMPTIC AND ECLAMPTIC REFFERAL PATIENT AT KOTABARU REGENCY

ABSTRACTBackground: The maternal mortality rate is 305 per 100,000 live births in Indonesia. The most common cause of maternal death is preeclampsia / eclampsia. The maternal mortality rate is 247 per 100,000 live births in 2017 in Kotabaru Regency. Most preeclamptic referral patients are in critical condition when they arrive at the hospital. Method: This type of research is an observational descriptive study. The population is all patients with severe preeclampsia and eclampsia in the delivery room of RS Pangeran Jaya Sumitra Kabupaten Kotabaru from January - December 2018. The sample is total sampling.Results: PEB referral patients was 57 cases. Most of those are in the group age of 20 - 35 years which are 35 people (61.4%), not nullipara is 31 people (54,4%), 34-40 weeks of gestation is 43 people (75,4%), as many as 44 people (77,2%) with previous severe preeclampsia/ hypertension, 41 people (71,9%) brought referral letters, referred by Puskesmas are 47 people (82.5%), most of the locations of referral is from Pulau Laut as many as 35 referrals (61,4%). The initial management of PEB and eclampsia: IV Pathway in 11 patients (19.3%) of severe preeclamptic and eclamptic patients, 50 patients (87.7%) were not given MgSO4, 51 people (89.5% ) did not get anti-hypertension, 52 patients (91.2%) were not installed catheters. Conclusion: Early management of severe preeclamptic and eclamptic patients is not optimal and does not fulfil the standard yet. Proper and appropriate early management can reduce morbidity and maternal mortality from complications of severe preeclampsia and eclampsia that can be prevented by providing right initial management.

Does interpregnancy BMI change affect the risk of complications in the second pregnancy? Analysis of pooled data from Aberdeen, Finland and Malta

ObjectiveWeight management interventions during pregnancy have had limited success in reducing the risk of pregnancy complications. Focus has now shifted to pre-pregnancy counselling to optimise body weight before subsequent conception. We aimed to assess the effect of interpregnancy body mass index (BMI) change on the risk of perinatal complications in the second pregnancy.MethodsA cohort study was performed using pooled maternity data from Aberdeen, Finland and Malta. Women with a BMI change of ±2 kg/m2 between their first and second pregnancies were compared with those who were BMI stable (remained within ±2 kg/m2). Outcomes assessed included pre-eclampsia (PE), intrauterine growth restriction (IUGR), preterm birth, birth weight, and stillbirth in the second pregnancy. We also assessed the effect of unit change in BMI for PE and IUGR. Logistic regression was used to calculate odds ratios with 95% confidence intervals.ResultsAn increase of ≥2 kg/m2 between the first two pregnancies increased the risk of PE (1.66 (1.49–1.86)) and high birthweight (>4000 g) (1.06 (1.03–1.10)). A reduction of ≥2 kg/m2 increased the chance of IUGR (1.15 (1.01–1.31)) and preterm birth (1.14 (1.01–1.30)), while reducing the risk of instrumental delivery (0.75 (0.68–0.85)) and high birthweight (0.93 (0.87–0.98)). Reducing BMI did not significantly decrease PE risk in women with obesity or those with previous PE. A history of PE or IUGR in the first pregnancy was the strongest predictor of recurrence independent of interpregnancy BMI change (5.75 (5.30–6.24) and (7.44 (6.71–8.25), respectively).ConclusionChanges in interpregnancy BMI have a modest impact on the risk of high birthweight, PE and IUGR in contrasting directions. However, a prior history of PE and IUGR is the dominant predictor of recurrence at second pregnancy.

Y-016. Interaction between previous preeclampsia and inter-pregnancy chronic hypertension development on preeclampsia risk in the subsequent pregnancy

Our recent study demonstrates the beneficial effect of a combined supplementation of vitamin B12, folic acid, and docosahexaenoic acid in reducing the severity of pregnancy induced hypertension (PIH). It is also known to be associated with angiogenic imbalance and inflammation. The current study examines whether the individual/combined supplementation of folic acid, vitamin B12 and omega-3 fatty acid during pregnancy can ameliorate the inflammatory markers and restore the angiogenic balance in a rat model of PIH.There were total of six groups, control and five treatment groups: PIH Induced; PIH+vitamin B12; PIH+folic acid; PIH+Omega-3 fatty acids and PIH+combined micronutrient supplementation (vitamin B12+folic acid+omega-3 fatty acids). Hypertension during pregnancy was induced using L- Nitroarginine methylester (L-NAME; 50 mg/kg body weight/day). Dams were dissected at d20 of gestation and placental tissues were collected for further analysis.Animals from the PIH induced group demonstrated lower (p<0.01 for both) IL-10 and VEGF levels as compared to control. However, PIH induction did not alter the protein levels of eNOS, IL-6, Flt and mRNA levels of VEGF and VEGFR-1/ Flt-1. Individual micronutrient supplementation of vitamin B12 and folate did not offer benefit. In contrast individual omega-3 fatty acid as well as combined micronutrient supplementation showed IL-10 and VEGF levels comparable to that of control.Omega 3 fatty acid supplementation plays a key role in reducing inflammation in pregnancy induced hypertension.

P-099. Previous preeclampsia and its association with future cardiovascular diseases: A systematic review and meta-analysis

This paper shows how to apply frequency-domain system identification of the parameters of a linear system based on both one-bit stimulation and data acquisition. The proposed technique is based on the usage of maximum-length binary sequences as signal sources. One-bit acquisition, based on a simple comparator is assisted by a sinewave dither signal. Results are compared to those obtained by directly processing the one-bit sequence in absence of dither. Theoretical, simulation and experimental results illustrate the usage of the method and confirm the validity of the presented procedure.

Risk Factor Prevalence of Late Onset Preeclampsia in Dr. Soetomo General Hospital Surabaya

Introduction: Preeclampsia is a condition of hypertension that occurs after 20 weeks of gestation, followed by the detection of protein in the urine sample, and is one of the major causes of maternal mortality. It is categorized, based on time of gestation, into 2-stage are early and late-onset. One of the more accessible tools in diagnosing and also preventing preeclampsia is by its risk factors. The aim of this study was to observe the appearance of some of the risk factors in patients with late-onset preeclampsia and to allow a better approach in patients with said comorbidities.Methods: This was a descriptive observational study. The sample used was 35 patients diagnosed with late-onset preeclampsia in Dr. Soetomo General Hospital Surabaya from January to December 2016.Results: Among 35 patients diagnosed with late-onset preeclampsia, obesity (65.71%) appeared the most. Maternal age (37.15%) and primigravida (28.57%) appeared in second and third places. Chronic hypertension appeared only in 6 (17.14%) patients, whereas multiple pregnancies appeared in 3 (8.57%). Both patients with a history of previous preeclampsia and diabetes mellitus only appeared once (2.86%).Conclusion: Obesity has the most appearance in patients with late-onset preeclampsia, followed by maternal age and primigravida.

Novel glycoproteins identify preclinical atherosclerosis among women with previous preeclampsia regardless of type 1 diabetes status

Background and aimsInformation regarding inflammation and cardiovascular disease (CVD) risk in type 1 diabetes (T1D) or preeclampsia (PE) is scarce. We assessed differences in inflammation markers according to the presence of both conditions and their association with atherosclerosis. Methods and resultsWe recruited 112 women without CVD and last pregnancy ≥5 years previously (n = 28 per group): a)T1D and PE; b)T1D without PE; c)PE without T1D; and d)Controls (without T1D or PE). Groups were matched by several CVD risk factors, and diabetes duration and retinopathy in T1D. Carotid intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by ultrasonography. Inflammatory markers included classical variables (leucocytes and high-sensitivity C-reactive protein [hsCRP]) and glycoproteins by nuclear magnetic resonance (1H-NMR) spectroscopy (GlycA, GlycB, GlycF and the height/width [H/W] ratios of GlycA and GlycB). The age of the participants was 44.9 ± 7.8 years, and 20.5% harbored plaque. There were no differences in inflammatory markers among the four study groups. Overall, in multivariate-adjusted models, all 1H-NMR-glycoproteins (except GlycB) were positively associated with IMT measures (IMT of bulb and maximum-IMT of any carotid segment; p < 0.05). After dividing the sample according to PE status, previous findings remained largely unchanged. Furthermore, GlycF was independently associated with carotid plaque only in PE group (OR 5.08 [1.03–25.01] per 0.1 log-increments, p = 0.046). Neither leucocytes nor hsCRP were related to atherosclerosis. Regarding T1D status, non-uniform results were observed. ConclusionsHigh 1H-NMR-glycoprotein concentrations have a negative impact on carotid atherosclerosis among women with preeclampsia, regardless of T1D status.

Low physical activity levels 1 year after pregnancy complications.

Women with previous preeclampsia (PE), gestational hypertension (GH), or gestational diabetes mellitus (GDM) have increased cardiovascular disease (CVD) risk. Physical activity (PA) is an important CVD risk modifier. We aimed to assess PA levels, using a validated objective method, and other modifiable CVD risk factors in women with these previous pregnancy complications. One year postpartum we assessed PA levels for 1week in women with previous PE (n=68), GH (n=26), GDM (n=23), and normotensive pregnancies (n=65), using the ActiGraph-wGT3X-BT™ accelerometer. We assessed adherence to American PA guidelines (≥150min/week of moderate or ≥75min/week of vigorous intensity PA), and time spent in moderate and vigorous PA. We also assessed steps/day, blood pressure and anthropometric indices. Recommended PA levels were achieved in only 50%, 39%, and 35% following PE, GH, and GDM, respectively, not significantly different from controls (52%). Differences in moderate and vigorous PA levels and steps/day between the groups were non-significant, except from lower vigorous PA in women with previous GDM. Elevated blood pressure (systolic BP≥120mmHg and/or diastolic BP≥80mmHg) was more common after PE and GH. Overweight rates were significantly higher in PE, GH, and GDM groups compared to controls. Less than half of women achieved recommended PA levels 1year postpartum. This did not differ significantly between women with previous PE, GH, or GDM compared to controls. Measures to increase PA in postpartum women are warranted, especially in women with pregnancy complications associated with high risk of premature CVD.

Reduction of serum-induced endothelial STAT3(Y705) activation is associated with preeclampsia.

Preeclampsia is associated with maternal morbidity and mortality during pregnancy, and also an increased cardiovascular disease (CVD) risk later in life. During preeclampsia, alterations in secreted placental factors leading to systemic maternal endothelial dysfunction are evident. However, little is known about the associated endothelial intracellular signaling. STAT3 is a latent cytoplasmic transcription factor involved in endothelial cell differentiation, survival, and angiogenesis. We aimed to test if preeclampsia and preeclampsia-related placental factors could alter serum-induced STAT3(Y705) activation in endothelial cells. Furthermore, if altered serum-induced endothelial STAT3 (Y705) activation is related to post-preeclamptic CVD risk. HUVECs were used as a model of maternal endothelium. Experiments entailed addition of 20% human pregnancy serum as well as addition of recombinant PlGF, sFLT1 and VEGF-A165a to the cells. Levels of pSTAT3(Y705) related to STAT3 levels were evaluated by immunoblotting analysis. Our results show that preeclamptic serum induces significantly lower STAT3(Y705) phosphorylation compared with uncomplicated pregnancy serum (P=0.0089) in endothelial cells. Furthermore, STAT3(Y705) phosphorylation was not changed upon addition of PlGF, sFLT1, or VEGF-A165a together with pregnancy sera compared with sera alone. Finally, sera from women with previous preeclampsia and current hypertension and carotid atherosclerotic plaques show significantly lower STAT3(Y705) phosphorylation capabilities compared with healthy women with previous uncomplicated pregnancies 8-18years after deliveries (P=0.029). Reduction in serum-induced endothelial STAT3(Y705) activation may play an important role in the preeclampsia-associated endothelial dysfunction. Additionally, reduced endothelial STAT3(Y705) phosphorylation may contribute to increased post-preeclamptic CVD risk 8-18years after delivery.