Previous Preeclampsia Research Articles

Investigating antioxidant effect of vitamins e, c on the incidence rate of preeclampsia and maternal and fetal prognosis in patients with increased risk of preeclampsia

Disorders of hypertension in pregnancy are a component of the triple causes related to the morbidity and mortality of mother and baby. In the investigations, the role of oxidative stress has been proven in the pathophysiology of preeclampsia and the effect of free radicals in endothelial dysfunction. Essential nutrients such as vitamins C and E are able to eliminate free radicals that lead to cellular damage. Due to the cases above, this study was conducted to investigate the antioxidant effect of vitamins E&C on the incidence of Preeclampsia in pregnant women with high risk in terms of the incidence of this disease. The present study is a clinical trial. The statistical population includes 700 at risk women in terms of preeclampsia (nuliparas women). Subjects were in the age range of 20 to more than 35 years, with insulin-dependent diabetes, multiple pregnancies, overweight, previous preeclampsia history, chronic hypertension, vascular disease, collagen disease and renal disease. Patients were divided into two groups of 350 persons including the control group that just received Iron and folic acid and treatment group that received the antioxidant (E & C) in addition to iron and folic acid, afterwards the incidence rate of preeclampsia and its intensity was investigated in the two groups. Analysis was conducted by the chi-square method. The incidence rate of preeclampsia had no significant difference in the two groups of control and treatment but the incidence severity was less in the treatment than control group (P< 0.001) and also weight less than 2500 grams and gestational age less than 37 weeks was more in the control than treatment group. This difference was statistically significant (P< 0.001). According to the above-mentioned cases, consumption of antioxidants in patients with high risk in terms of preeclampsia can decrease severity of illness, reduce and improve neonatal and maternal outcome. Therefore, the use of these antioxidants is recommended during pregnancy in patients with preeclampsia.

Reference Ranges of Coagulation Parameters in Pregnancies of Healthy Women and Women with Mild Bleeding Disorders

Introduction:It is well know that most of the coagulation factor increase during pregnancy in healthy women. Nevertheless the uninterrupted course of coagulation parameters from the beginning until the end of a pregnancy in healthy women has not been described yet. Only reference ranges for the third month and the sixth month of pregnancy are evaluated. There aren’t any data available for the course of coagulation parameters during pregnancy in women with known coagulation disorders.In 2012 we started a study to investigate reference ranges during pregnancy for all coagulation factors, anticoagulants and activation markers of coagulation in 100 healthy pregnant women and 100 pregnant women with a previously known mild bleeding disorders.The study has been approved by the Ethics Committee Nordrhein.Samples and Methods:We analysed samples of pregnant women by conducting the following tests: Blood count, VWF:RCo, VWF:Ag, VWF:CB, Fibrinogen (Clauss), activities of FII, FV, FVII, FVIII (clotting and chromogenic), FIX, FX, FXI, FXII, FXIII. d-dimer, prothrombin fragment 1.2, Quick, partial thromboplastin time, plasma thrombin time , CRP, proteine S, proteine C, antithrombin, Lupus antigoaculant, ACA, ß2-GP in week 10, 16, 22, 28, 34, 40 and 6 weeks post partum (max. +/- 1)Interim Results:Currently 21 pregnant women were included in our study. 16 obviously healthy women were used to calculate the reference ranges for pregnancy. Because of strict inclusion and exclusion criteria (no previous spontaneous abortion, no previous placenta haematoma, no previous pre-eclampsia and only natural pregnancies) most of the women are in the group of the no known coagulation disorder so far.Discussion/Conclusion:There are signs that defects in the coagulation system can be associated to complications during pregnancy like child loss, intrauterine haematoma and genital bleeding. The evaluation of reference ranges helps to detect and to value coagulation disorders during pregnancy.It might be possible to explain the higher abortion rate in women with mild bleeding disordersby determination of reference values of all pro- and anticoagulants during pregnancy. If a treatment with coagulation factor concentrates can help to prevent miscarriage is still subject of ongoing studies.Determination of reference ranges for coagulation factors in the third trimenon might help to determine the peripartum bleeding risk of women with mild coagulation disorders and to help to decide whether a women needs coagulation factor concentrate during labour.Limitation:Based on the strict inclusion and exclusion criteria the number of patients is small. DisclosuresHalimeh:Biotest: The authors declare that they receive research grant from Biotest AG Other. Rott:Biotest: The authors declare that they receive research grant from Biotest AG Other. Osseiran:Biotest: The authors declare that they receive research grant from Biotest AG Other. Kappert:Biotest: The authors declare that they receive research grant from Biotest AG Other. Siebert:Biotest: The authors declare that they receive research grant from Biotest AG Other.

Preeclampsia: what could happen in a subsequent pregnancy?

Preeclampsia is the most common type of the hypertensive disorders of pregnancy, affecting nearly 5% of pregnant women. The risk of recurrence influences the choices of parents regarding subsequent pregnancies and necessitates the counseling of obstetricians. To review the risk of recurrence of hypertensive disorders in a subsequent pregnancy. Women with a history of preeclampsia are at an increased risk of preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies. The magnitude of this risk is dependent on gestational age at the time of disease onset, severity of disease, and presence or absence of preexisting medical disorders. For preeclamptic women with severe features in an initial pregnancy, recurrence rates for any type of preeclampsia are very high, approaching 50% in some studies. Significant maternal and fetal complications are more common in recurrent preeclampsia compared with an initial episode. Because women with previous preeclampsia are at an increased risk for adverse pregnancy outcomes (preterm delivery, fetal growth restriction, abruptio placentae, and fetal death) in subsequent pregnancies, we recommend more frequent monitoring for signs and symptoms of severe hypertension or preeclampsia than that recommended for normal pregnancy. The best option is to review the existing literature with patients, allow them to make informed decisions, and provide them the best available prenatal care.

In vivo experiments reveal the good, the bad and the ugly faces of sFlt-1 in pregnancy.

ObjectiveSoluble fms-like tyrosine kinase (sFlt)-1-e15a, a primate-specific sFlt-1-isoform most abundant in the human placenta in preeclampsia, can induce preeclampsia in mice. This study compared the effects of full-length human (h)sFlt-1-e15a with those of truncated mouse (m)sFlt-1(1-3) used in previous preeclampsia studies on pregnancy outcome and clinical symptoms in preeclampsia.MethodsMice were injected with adenoviruses or fiber-mutant adenoviruses overexpressing hsFlt-1-e15a, msFlt-1(1-3) or control GFP under the CMV or CYP19A1 promoters on gestational day 8 (GD8) and GD11. Placentas and pups were delivered by cesarean section, and dams were monitored postpartum. Blood pressure was telemetrically recorded. Urine samples were collected with cystocentesis and examined for albumin/creatinine ratios. Tissue specimens were evaluated for transgene as well as endogenous mFlt-1 and msFlt-1-i13 expression. H&E-, Jones- and PAS-stained kidney sections were histopathologically examined. Placental GFP expression and aortic ring assays were investigated with confocal microscopy.ResultsMean arterial blood pressure (MAP) was elevated before delivery in hsFlt-1-e15a-treated mice compared to controls (GD18: ΔMAP = 7.8 mmHg, p = 0.009), while ΔMAP was 12.8 mmHg (GD18, p = 0.005) in msFlt-1(1-3)-treated mice. Urine albumin/creatinine ratio was higher in hsFlt-1-e15a-treated mice than in controls (GD18, p = 0.04; PPD8, p = 0.03), and msFlt-1(1-3)-treated mice had marked proteinuria postpartum (PPD8, p = 4×10−5). Focal glomerular changes were detected in hsFlt-1-e15a and msFlt-1(1-3)-treated mice. Aortic ring microvessel outgrowth was decreased in hsFlt-1-e15a (p = 0.007) and msFlt-1(1-3)-treated (p = 0.02) mice. Full-length msFlt-1-i13 expression was unique for the placenta. In hsFlt-1-e15a-treated mice, the number of pups (p = 0.046), total weight of living pups (p = 0.04) and maternal weights (p = 0.04) were higher than in controls. These differences were not observed in truncated msFlt-1(1-3)-treated mice.ConclusionsTruncated msFlt-1(1-3) simulated the preeclampsia-promoting effects of full-length hsFlt-1. MsFlt-1(1-3) had strong effect on maternal endothelium but not on placentas and embryos. In contrast, hsFlt-1-e15a induced preeclampsia-like symptoms; however, it also increased litter size. In accord with the predominant placental expression of hsFlt-1-e15a and msFlt-1-i13, full-length sFlt-1 may have a role in the regulation of embryonic development. These observations point to the difference in the biological effects of full-length and truncated sFlt-1 and the changes in the effect of full-length sFlt-1 during pregnancy, and may have important implications in the management of preeclampsia.

Prediction of preeclampsia-bench to bedside.

Hypertensive disorders of pregnancy (HDP) constitute the most common medical condition seen during gestation, effecting 1 in 10 pregnancies in the USA. Traditionally, preeclampsia (PE) is defined as a new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman. Preeclampsia is a potentially life-threatening condition with widespread underlying endothelial dysfunction, and accompanying inflammation, vasoconstriction, and platelet activation. Women with preeclampsia are at an increased risk for life-threatening complications and progression to eclampsia. Worldwide, 10 to 15 % of maternal deaths are from preeclampsia and related complications. Traditionally, diagnosis of preeclampsia is made based upon presence of risk factors and clinical criteria. Diagnosis is challenging in asymptomatic women early in pregnancy as well as in nulliparous women as they lack obstetric history; however, it is well known that women with previous preeclampsia have a 14.7 % risk of the condition in the second pregnancy. Prediction of those at risk and early diagnosis is crucial to enable close surveillance of high-risk women in order to improve maternal and fetal outcomes. There has been much advance in our understanding of the pathogenesis of PE and in the field of angiogenic markers. However, no one test meets the criteria for a good biomarker. A multiparametric approach appears to be optimal as we await newer systems biology approaches to give us better insight into the pathogenesis of the disease.

OP03.01: A potential role of circulating LHCGR forms for the prediction of pre‐eclampsia in the first trimester of pregnancy

To explore the predictive role of circulating human chorionic gonadotrophin receptor (LHCGR) forms for the prediction of early and late pre-eclampsia (PE) in the first trimester of pregnancy, combined with maternal baseline risk, biophysical parameters and angiogenic factors. A case-control study, within a cohort of 5,759 pregnancies including 20 cases of early PE, 20 of late PE (cut-off: 34 weeks at delivery), 300 controls. Maternal characteristics, mean arterial pressure (MAP), uterine artery (UtA) Doppler (11-13 weeks), placental growth factor (PlGF), soluble Fms-like tyrosine kinase-1 (sFtl-1), circulating sLHCGR, and hCG-LHCGR complexes (8-11 weeks) were measured/recorded. LHCGR difference (LHCGR-D) was calculated by subtracting hCG-LHCGR value from the corresponding sLHCGR. All parameters were normalized by logarithmic transformation, converted in MoM, and logistic regression analysis was used to predict PE. For the prediction of early PE, significant contributions were provided by black ethnicity, chronic hypertension, previous PE, MAP, UtA Doppler, PlGF, sFlt-1, and LHCGR forms. A model including these predictors together with LHCGR-D, achieved detection rates (DR) of 100% for 5% false positive rates (FPR) (AUC: 0.995 [95%CI: 0.988-0.999]). For late PE, significant contributions were provided by body mass index, previous PE, UtA Doppler, PlGF, sFlt-1, and LHCGR forms. The model including these factors together with LHCGR-D achieved DR of 85% at 5% of FPR (AUC: 0.961 [95%CI: 0.928-0.995]). Among LHCGR forms, the LHCGR-D improves substantially the prediction for early and late PE in first trimester, if used in algorithms. These new biomarkers seemed useful if used in combination (LHCGR-D) in the context of prediction of PE.

Lead and Cadmium Levels In Blood of Pregnant Women in Assiut Governorate; Do They Have A Role in Preeclampsia?

Preeclampsia (PE) represents a major cause of morbidity and mortality in mother, fetus and infant in many parts of the world. In Egypt, the prevalence of PE is 10.7% in a community based study while, in hospital based studies it ranged from 9.1% to 12.5% of all deliveries. High blood lead and cadmium levels were associated with adverse pregnancy outcomes including preeclampsia. So, the aim of this study was to evaluate the relationship between lead and cadmium blood levels in pregnant females and preeclampsia in Assiut Governorate. This cross sectional study was done in Maternal Health Hospital, Assiut University in a period of sixth months from August 2013 to January 2014. The study included 80 pregnant women were suffering from preeclampsia (preeclampsia group) and another 50 healthy pregnant women as (control group). Blood and cadmium levels were detected in the venous blood of the cases. There were variations in blood lead and cadmium levels among different age groups with increase in level as age increase. Urban residence was significant risk factor for preeclampsia and also associated with high lead and cadmium levels in blood; Significant correlation was found between preeclampsia and low educational level and this was associated with high blood lead and cadmium levels .Smoking of the husband was associated with low blood lead of their wife's in comparison to non-smokers. Preeclampsia occurred in both primiparous and multiparous women and this was associated with relatively high blood lead and cadmium level, also the risk of preeclampsia significantly increases in women with previous preeclampsia. History of previous preeclampsia was associated with relatively high level of blood lead and cadmium. 25% of cases had family history of preeclampsia in comparison with 4% among control. This finding was associated with increase in blood lead and cadmium level. Contamination of water supply, paint use at houses, living near busy street and exposure to motor car exhaust and grinding wheat had been found to be one of the important sources of exposure to lead and cadmium. In conclusion: high blood lead and cadmium levels are significant risk factors for preeclampsia due to exposure to different sources lead and cadmium.

Avaliação das propriedades dinâmicas da pressão arterial em mulheres com antecedentes de pré‐eclâmpsia

BackgroundWe investigated viscoelastic properties of the arterial wall in women with previous preeclampsia (PE) compared to those with normal pregnancy (NP). MethodsIn a cross‐sectional study 45 women with previous PE and 55 with NP were included, matched for age (PE 38±6 vs. NP 38±5 years, NS) and body mass index: (PE 25±4 vs. NP 26±4 kg/m2, NS) studied, respectively, 76±34 and 86±48 months after delivery. We assessed arterial distensibility – pulse wave velocity (PWV, Complior) and reflected waves (augmentation pressure [AP], mmHg) and augmentation index (AIx) – in the central pressure wave and blood pressure (BP) on 24‐h ambulatory BP monitoring (ABPM). ResultsPE showed higher (p<0.01) peripheral systolic blood pressure (SBP): PE 131±18 vs. NP 121±19, and central SBP: PE 122±18 vs. NP 110±19 mmHg, with less amplification of central‐peripheral pressure: PE 10±4 vs. NP 12±5, p=0.041, and higher (p<0.05) AP: PE 10±3 vs. NP 8±2, and AIx: PE 26±5 vs. NP 20±5 mmHg, but PE and NP did not differ in pulse wave velocity. On ABPM, PE (n=39) vs. NP (n=33) had higher nighttime SBP: PE 121±10 vs. NP 108±10 mmHg and lower percentage nocturnal SBP fall: PE 11±6 vs. NP 18±11%, both p<0.02. During follow‐up, the need for antihypertensive medication was seven times higher in PE than in NP. ConclusionWomen with previous PE have a greater risk of hypertension, higher nighttime BP values, blunted nocturnal BP fall and changes in central pressure suggestive of increased reflected waves and peripheral vascular resistance. These factors may contribute to their higher cardiovascular risk after pregnancy.

Assessment of central hemodynamic properties of the arterial wall in women with previous preeclampsia

BackgroundWe investigated viscoelastic properties of the arterial wall in women with previous preeclampsia (PE) compared to those with normal pregnancy (NP). MethodsIn a cross-sectional study 45 women with previous PE and 55 with NP were included, matched for age (PE: 38±6 vs. NP: 38±5 years, NS) and body mass index: PE: 25±4 vs. NP: 26±4 g/m2, NS) studied respectively, 76±34 and 86±48 months after delivery. We assessed arterial distensibility – pulse wave velocity (PWV, Complior) and reflected waves (augmentation pressure [AP], mmHg) and augmentation index (AIx) – in the central pressure wave and blood pressure (BP) on 24-h ambulatory BP monitoring (ABPM). ResultsPE showed higher (p<0.01) peripheral systolic blood pressure (SBP): PE 131±18 vs. NP 121±19, and central SBP: PE 122±18 vs. NP 110±19 mmHg, with less amplification of central-peripheral pressure: PE 10±4 vs. NP 12±5, p=0.041, and higher (p<0.05) AP: PE 10±3 vs. NP 8±2, and AIx: PE 26±5 vs. NP 20±5 mmHg, but PE and NP did not differ in pulse wave velocity. On ABPM, PE (n=39) vs. NP (n=33) had higher nighttime SBP: PE 121±10 vs. NP 108±10 mmHg and lower percentage nocturnal SBP fall: PE 11±6 vs. NP 18±11%, both p<0.02. During follow-up, the need for antihypertensive medication was seven times higher in PE than in NP. ConclusionWomen with previous PE have a greater risk of hypertension, higher nighttime BP values, blunted nocturnal BP fall and changes in central pressure suggestive of increased reflected waves and peripheral vascular resistance. These factors may contribute to their higher cardiovascular risk after pregnancy.

Thicknesses of individual layers of artery wall indicate increased cardiovascular risk in severe pre‐eclampsia

To assess whether thicknesses of the intima and media in the common carotid artery (CCA) and the intima/media ratio (I/M) indicate an increased cardiovascular risk in non-pregnant women with a history of previous severe pre-eclampsia. Thicknesses of the CCA intima and media layers were measured using non-invasive high-frequency (22 MHz) ultrasound in 42 women with a history of severe pre-eclampsia and 44 women with previous normal pregnancy. Women with a history of severe pre-eclampsia had a thicker CCA intima and a higher I/M than had women with previous normal pregnancy, also after adjustment for mean arterial pressure, body mass index and CCA intima-media thickness (IMT) (all P < 0.0001). CCA-IMT did not differ significantly between groups. In receiver-operating characteristics curve analysis, intima thickness and I/M clearly discriminated between women with and those without previous pre-eclampsia (area under the receiver-operating characteristics curve (AUC), 0.98 and 0.93), whereas CCA-IMT did not (AUC, 0.52). CCA individual intima and media thicknesses as well as I/M, but not CCA-IMT, reflect the known increased long-term cardiovascular risk of pre-eclampsia. Estimation of individual CCA layers using high-frequency ultrasound appears preferable to measuring CCA-IMT for investigating arterial effects and the increased cardiovascular risk in women with a history of severe pre-eclampsia.

AB0526 Pregnancy Outcomes in Women with Systemic Lupus Erythematosus from A Mexican Cohort

BackgroundSystemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder that disproportionally affects women, especially in their reproductive years. SLE is associated with considerable pregnancy-related morbidity, including fetal loss, preterm birth...

Prognosis and outcome of pregnancy following renal transplantation

Objective The aim of this study was to determine the impact of renal transplantation and immunosuppressive medications both on the mother and on the foetus in pregnancy. Study design This was a controlled study. Patients and methods The study compared two groups of patients; each group included 20 patients. The patients in the study group became pregnant following renal transplantation and the control group included 20 normal healthy women; the outcome of pregnancy, including maternal and foetal complications, was assessed. Results The mean maternal age was 29.68±4.74 years in our study group and 26.9±3.57 years in the control group. Gestational age at birth showed a mean of 35.89±2.45 weeks, birth weight 2647±417 g, in the study group versus 38.21±1.72 weeks, birth weight 3394±327 g, in the control group. The most common cause of renal failure was previous preeclampsia, followed by hypertension and glomerulonephritis. Almost 95% of the study cases (19 patients) used a combination of three medications, namely, cyclosporine+steroids+azathioprine, and 5% used a combination of only two medications. The incidences of pregnancy complications, namely, maternal anaemia, pregnancy-induced hypertension, preeclampsia, premature rupture of membranes and preterm labour were all higher in the study group compared with the control group. Conclusion Renal transplantation has provided women of childbearing age with return of fertility and the possibility of a successful pregnancy outcome. Several prognostic factors should be considered to help counsel the patients carefully on the impact of pregnancy and the use of medications on the mother and foetus.

Risk Factors for Pre-eclampsia in Multiparous Women in Lagos, Nigeria

Objectives: The study was aimed at examining the risk factors for pre-eclampsia in the multiparous women in Lagos, Nigeria.Methods: This is a cross-sectional case-control study designed to examine the risk factors for pre-eclampsia in the multiparous women in Lagos, Nigeria. Structured questionnaires were administered to eligible participants (pre-eclamptic and normotensive) who delivered at the two teaching hospitals in Lagos during the study period. Information obtained were entered into computer and analysis was done using Epi-Info 2008 version 3.5.1 statistical software package.Results: A total of 350 multiparous women participated in the study. 150 of them were preeclamptic while the remaining 200 who were normotensive were used as control. Monogamous relationship, change of spouse, age of 40 years and above, previous pre-eclampsia, chronic hypertension, diabetes, family history of hypertension and unbooked status were the risk factors found to be associated with pre-eclampsia in multiparous women in the study (P?0.05).Conclusion: Identified risk factors were not different from previously identified factors in other studies. A call for early antenatal booking, good control of hypertension and diabetes cannot be overemphasized in the prevention of preeclampsia/eclampsia.

Preeclampsia in high risk women is characterized by risk group-specific abnormalities in serum biomarkers

To determine if early pregnancy serum biomarkers in high-risk women who develop preeclampsia vary according to risk factor. We performed a secondary analysis of the Maternal-Fetal Medicine Units Network randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in high-risk women. Serum biomarker levels at enrollment (before initiation of aspirin or placebo) were compared between women who did and did not develop preeclampsia, both for the group as a whole and within each of 4 high-risk groups (insulin-dependent diabetes, hypertension, multiple gestation, and previous preeclampsia) using a regression model adjusting for gestational age at collection and prepregnancy body mass index. 1258 women were included (233 with insulin-dependent diabetes, 387 with chronic hypertension, 315 with a multiple gestation, 323 with previous preeclampsia). Multiple early pregnancy serum biomarkers differed between women who did and did not develop preeclampsia. Each high-risk group had a unique and largely nonoverlapping pattern of biomarker abnormality. Differences between those who did and did not develop preeclampsia were noted in vascular cell adhesion molecule in the diabetes group; human chorionic gonadotropin, soluble tumor necrosis factor receptor-2, tumor necrosis factor-alpha, selectin and angiogenin in the chronic hypertension group; interleukin-6, placental growth factor, soluble fms-like tyrosine kinase plus endoglin to placental growth factor ratio in the multiple gestation group; and angiogenin in the previous preeclampsia group. Patterns of serum biomarkers vary by high-risk group. These data support the hypothesis that multiple pathogenic pathways lead to the disease recognized clinically as preeclampsia.

Early onset preeclampsia in subsequent pregnancies correlates with early onset preeclampsia in first pregnancy

ObjectivePreeclampsia is a major complication of pregnancy and its occurrence in a first pregnancy is a major risk factor for recurrence in subsequent pregnancies. Whether the time of onset or the severity of preeclampsia in a first pregnancy is associated with the incidence of recurrent preeclampsia is not clear. We performed a retrospective study to analyse the incidence of recurrent preeclampsia and associations of the time of onset and the severity of preeclampsia between first preeclampsia and recurrent preeclampsia. Study designNinety-two women with previous preeclampsia who had a second pregnancy in a 4 year period were included. Data on the first and second pregnancies were obtained and included maternal age, maternal height and weight, gestation week at onset of preeclampsia and at delivery, blood pressure, proteinuria, interval between pregnancies and birth weights. ResultsFifty-five women with previous preeclampsia developed recurrent preeclampsia (59.8%). The difference in the incidence of recurrent early and late onset preeclampsia was not significant different (65.3% versus 53.4%, p>0.05). The difference in the incidence of mild or severe disease in those who experienced recurrent preeclampsia was also not significant (59.6% versus 60%, p>0.05). The severity of preeclampsia in second pregnancy was not associated with the severity of preeclampsia in first pregnancy. However 93.7% women with previous early onset preeclampsia developed early onset preeclampsia in second pregnancy and 56.5% women with previous late onset preeclampsia developed early onset preeclampsia in second pregnancy. In addition, 76.2% women with previous mild preeclampsia developed severe preeclampsia in second pregnancy. The baby weight in recurrent preeclampsia was significantly decreased compared to that in first pregnancy with preeclampsia. ConclusionOur data demonstrate that there was no association between the incidence of recurrent preeclampsia and the time of onset or severity of preeclampsia in first pregnancy. But our data here may suggest that women with early onset preeclampsia in first pregnancy are more likely to experience early onset preeclampsia in second pregnancy. The severity of recurrent preeclampsia is increased regardless the severity in first pregnancy.

Added Value of Angiogenic Factors for the Prediction of Early and Late Preeclampsia in the First Trimester of Pregnancy

Objective: To explore the predictive role of angiogenic factors for the prediction of early and late preeclampsia (PE) in the first trimester. Methods: A nested case-control study, within a cohort of 5,759 pregnancies, including 28 cases of early, 84 of late PE (cut-off 34 weeks) and 84 controls. Maternal characteristics, mean blood pressure (MAP), uterine artery (UtA) Doppler (11-13 weeks), vascular endothelial growth factor, placental growth factor (PlGF), soluble Fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (8-11 weeks) were measured/recorded. All parameters were normalized by logarithmic transformation; logistic regression analysis was used to predict PE. Results: For early PE, significant contributions were chronic hypertension, previous PE, MAP, UtA Doppler, PlGF and sFlt-1. A model including these predictors achieved detection rates (DR) of 77.8 and 88.9% for 5 and 10% false-positive rates (FPR), respectively (AUC 0.958; 95% CI 0.920-0.996). For late PE, significant contributions were provided by body mass index, previous PE, UtA Doppler, PlGF and sFlt-1. The model including these factors achieved DR of 51.2 and 69% at 5 and 10% FPR, respectively (AUC 0.888; 95% CI 0.840-0.936). Conclusions: Among angiogenic factors, not only PlGF but also sFlt-1 substantially improve the prediction for early and late PE. The data need confirmation in larger studies.

Effect of an Educational Intervention on Cardiovascular Disease Risk Perception among Women with Preeclampsia

To promote knowledge and awareness about cardiovascular disease (CVD) among women with recent preeclampsia so that this population may develop more accurate perceptions of their personal CVD risk. An exploratory single group, pretest/posttest educational intervention study. Telephone-based interviews. Sixty-four women with preeclampsia in the most recent pregnancy completed the study. The sample was predominately African American. Knowledge about CVD and the study covariates (age, race, parity, income, marital status, education, and history of previous preeclampsia) were measured prior to CVD education. Levels of CVD risk perception were measured both before and after the CVD educational intervention. Structured CVD education by telephone. After CVD education, levels of CVD risk perception were significantly higher than at baseline. As an intervention, CVD education provided by telephone served as a practical and effective approach to contact postpartum women with recent preeclampsia and demonstrated effectiveness in increasing perception of CVD risk.

In women with previous pregnancy hypertension, levels of cardiovascular risk biomarkers may be modulated by haptoglobin polymorphism.

Preeclampsia (PE) may affect the risk for future cardiovascular disease. Haptoglobin (Hp), an acute phase protein with functional genetic polymorphism, synthesized in the hepatocyte and in many peripheral tissues secondary of oxidative stress of PE, may modulate that risk through the antioxidant, angiogenic, and anti-inflammatory differential effects of their genotypes. We performed a prospective study in 352 women aged 35 ± 5.48 years, which 165 had previous PE, 2 to 16 years ago. We studied demographic, anthropometric, and haemodynamic biomarkers such as C-reactive protein (CRP), myeloperoxidase (MPO), and nitric oxide metabolites (total and nitrites), and others associated with liver function (AST and ALT) and lipid profile (total LDL and cholesterol HDL, non-HDL, and apolipoproteins A and B). Finally, we study the influence of Hp genetic polymorphism on all these biomarkers and as a predisposing factor for PE and its remote cardiovascular disease prognosis. Previously preeclamptic women either hypertensive or normotensive presented significant differences in those risk biomarkers (MPO, nitrites, and ALT), whose variation may be modulated by Hp 1/2 functional genetic polymorphism. The history of PE may be relevant, in association with these biomarkers to the cardiovascular risk in premenopausal women.

Significance, aetiology and prevention of venous thromboembolism in pregnancy and puerperium

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Uterine Artery Doppler in Women with History of Previous Pre Eclampsia and Women with Chronic Hypertension: Re-evaluation of a Prognostic Value in a High-Risk Population

Objective: To evaluate the prognostic role of uterine artery Doppler for pre-eclampsia in high-risk patients. Because of the higher prevalence of new onset of disease in a high-risk population, a better performance could be expected in this special group. Methods: This retrospective study compares uterine artery Doppler to predict pre-eclampsia in patients with a history of pre-eclampsia and also in patients with chronic hypertension, both with high-risk to develop recurrent, superimposed or new onset pre eclampsia. Doppler measurements of uterine arteries were performed every 4 weeks in the 1st and 2nd trimester. Results: Pre-eclampsia occured in 33% of current high-risk pregnancies. The best performance of pre eclampsia was provided by bilateral notching plus increased PI ≥ 2.5, both in the 1st and 2nd trimester. In the 1st trimester the specifity was 81% (95% CI: 58-95) in the Prior PE group and 95% (95% CI: 74-100) in the C. H. group. In the 2nd trimester the sensitivity was 97% (95% CI: 86-100) in the Prior PE group and 100% (95% CI: 93 100) in the C. H. group. Sensitivity was very low in the 1st and 2nd trimester. Conclusion: Our results show, that the negative predictive value of uterine artery Doppler works well even in a high risk group. Data however suggest relative poor positive predictive value of uterine artery Doppler even in a high-risk population using a cut-off of 2.5 PI. A value of the uterine artery Doppler using a high cut-off might be in the increased specifity. Nevertheless, a combination of the uterine artery Doppler with biochemical markers and maternal parameters seems to be essential.