Risk Factor For Severe Preeclampsia Research Articles

Relationship between parity and history of hypertension with MEOWS score in early onset severe preeclampsia patients

Introduction: Parity and a history of hypertension are some of the highest risk factors for severe preeclampsia, especially early onset. The severity of recurrent preeclampsia will increase compared to preeclampsia in the first pregnancy. Although there is a correlation between chronic hypertension and unfavorable pregnancy outcomes, several case-control studies have consistently shown that chronic hypertension is the most often acknowledged risk factor for adverse events affecting both the mother and the fetus. Women with the risk factors above can potentially fall into bad conditions, so close monitoring must be carried out. Modified Early Obstetric Warning System (MEOWS) is used for early detection, care, treatment, and referral of changes in obstetric patient parameters that are leading to worsening. Objective: Analyze the relationship between parity and history of hypertension with MEOWS scores in early-onset severe preeclampsia patients. Methods: A cross-sectional approach was used in this study by involving 63 patients. The population was early-onset severe preeclampsia patients treated at Dr. Soetomo Regional Public Hospital Surabaya Indonesia 2022; the sampling technique used was total sampling. This data was collected using secondary data from medical records and analyzed statistically using bivariate test, specifically the chi-square test using SPSS software. Results: The majority of patients were of reproductive age (73%), the gestational age was predominantly in the very preterm (28-<32 weeks) category (49.2%), the most obstetric status was multigravida (77.8 ), and most patients had no history of hypertension (66.7%). The average MEOWS score in early-onset PEB patients was 8.11. Parity vs MEOWS score (p>0.05), while the history of hypertension vs MEOWS score (p<0.05). Conclusion: Parity and MEOWS score did not have a significant relationship, while the history of hypertension had a significant relationship with MEOWS score.

RISK FACTORS FOR SEVERE PREECLAMPSIA AT DR. WAHIDIN SUDIRO HUSODO HOSPITAL MOJOKERTO CITY IN 2021-2022

Background: Preeclampsia and eclampsia are major causes of morbidity and mortality during the perinatal period. The change from preeclampsia to severe preeclampsia can progress rapidly. The case of severe preeclampsia in Dr. Wahidin Sudiro Husodo Hospital, is very high. Purpose: To analyze the risk factors for severe preeclampsia at Dr. Wahidin Sudiro Husodo Hospital, Mojokerto City. Subjects and Methods: This study was conducted using an observational analytic quantitative method with an case control design. The sampling method used consecutive sampling. This study involved a total of 150 samples from two groups, consisting of pregnant women and laboring women. Results: The variables that had a significant relationship with the incidence of severe preeclampsia were age variables (p-value: 0.000; OR: 4.330; CI: 1.972-9.507), history of obesity (p-value: 0.000; OR: 15.460; CI: 5.255-45.483), history of preeclampsia (p-value: 0.001; OR: 7.579; CI: 2.127-27.006), history of diabetes mellitus (p-value: 0.012; OR: 11.385; CI: 1.419-91.352), and history of chronic hypertension (p-value: 0.000; OR: 6.945; CI: 2.931-16.456) were all significantly associated with the incidence of severe preeclamsia . the variables of age, history of obesity, and history of chronic hypertension met the final modeling in multivariate analysis. Conclusion: The history of obesity being the most dominant variable.

ANALISIS FAKTOR RESIKO PRE EKLAMPSIA BERAT PADA IBU HAMIL DI BLUD RSU KOTA BANJAR

Maternal and child health services are a major priority in Indonesia's health development because there is still a significant problem with maternal mortality and morbidity. A measure of health is the Maternal Mortality Rate (MMR). 2015 saw an MMR of 305 per 100,000 live births in Indonesia. MMR reduction to 183 per 100,000 live births by 2024 and to less than 70 fatalities per 100,000 live births by 2030 is a global SDG target. Pregnancy-related hypertension is currently the leading cause of death in Indonesia. When proteinuria is absent and other organs are also affected by severe preeclampsia, blood pressure is >160/110 mmHg at >20 weeks of gestation. Preeclampsia's specific etiology is unknown as of right now. Preeclampsia in pregnant women can be caused by a number of variables, including low education levels, overworked mothers, primiparity or grande multiparity, and birth spacing that is either too near or too far apart. This study was conducted at BLUD RSU Banjar City with the aim of identifying the risk factors for severe pre-eclampsia in pregnant women. Correlational or association research, a retrospective study with a cross sectional design, is this kind of investigation. 614 pregnant women make up the study's population, which was chosen at random to create a sample size of 61. The findings revealed no relationship between educational factors (p-value: 0.394), employment (p-value: 0.664), parity (p-value: 1.000), and the time between pregnancies (p-value: 0.835; greater than 0.05) and the incidence of severe pre-eclampsia in pregnant women at BLUD RSU Banjar City. The frequency of severe pre-eclampsia in pregnant women at BLUD RSU Banjar City is not significantly correlated with education, occupation, parity, or pregnancy spacing.

Pregnancy outcomes and disease phenotype of hypertensive disorders of pregnancy in singleton pregnancies after in vitro fertilization: a retrospective analysis of 1130 cases

BackgroundAlthough in vitro fertilization (IVF) can increase the incidence of hypertensive disorders of pregnancy (HDP), the pregnancy outcomes and disease phenotype of HDP in singleton pregnancies conceived via IVF remain unclear.MethodsThis retrospective cohort study enrolled 1130 singleton pregnancies with HDP from 2016 to 2020. According to the mode of conception, they were allocated into IVF (n = 102) and natural conception (NC) groups (n = 1028). All IVF pregnancies were subdivided into frozen embryo transfer (FET) group (n = 42) and fresh embryo transfer (ET) group (n = 60). Demographic data, pregnancy outcomes and disease phenotypes of HDP among the groups were compared. The risk factors for severe preeclampsia (PE) and early-onset PE were analyzed.ResultsThe incidences of early-onset PE (P<0.001), severe PE (P = 0.016), cesarean section (P<0.001) and preterm births (P = 0.003) in the IVF-HDP group were significantly higher than those in the NC-HDP group, and gestational age at diagnosis of HDP (P = 0.027) and gestational age at delivery (P = 0.004) were earlier and birthweight of the neonates (P = 0.033) were lower in the IVF group. In singleton pregnancies with HDP, IVF was associated with increased risks for both severe PE and early-onset PE (aOR 1.945, 95% CI 1.256, 3.014; and aOR 2.373, 95% CI 1.537, 3.663, respectively), as well as FET, family history of preeclampsia, intrahepatic cholestasis of pregnancy, gestational hypothyroidism and multiparity were associated with increased risks of severe PE and early-onset PE.ConclusionsIn singleton pregnancies with HDP, IVF was associated with an increased incidence of the disease phenotype (severe or early-onset PE), as well as an increased incidence of pregnancy outcomes related to severe PE and early-onset PE.

Risk factors for severe pre-eclampsia in pregnant women with type 2 diabetes mellitus

Risk factors for severe pre-eclampsia in pregnant women with type 2 diabetes mellitus

Incidence and Risk Factors for Severe Preeclampsia, Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome, and Eclampsia at Preterm and Term Gestation: A Population-based Study

(Am J Obstet Gynecol. 2021;225:538.e1–538.e19) Preeclampsia is a complication of pregnancy that is among the most common in high-income countries and portents other sequelae including severe preeclampsia, eclampsia, and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count syndrome). Prevalence of these serious diagnoses range from 0.2 to 7.6 per 1000 deliveries in high-income countries. The risk factors and gestational age-specific incidence of preeclampsia with severe features, eclampsia and HELLP syndrome is not well characterized, and previous investigations of these outcomes have been hospital-based with small numbers of patients. This study provides a large population-based inquiry into the development of these further related conditions following preeclampsia at term and preterm gestation, along with associations of maternal and clinical factors.

The Value of Prenatal First Systolic Blood Pressure Can Predict Severe Preeclampsia and Birth Weight in Patients With Preeclampsia.

BackgroundPreeclampsia is a serious complication of pregnancy that threatens the safety of the fetus and mother. We assessed the relationship between systolic blood pressure (SBP) in the early pregnancy stage (12 weeks) in patients with preeclampsia and the development of severe eclampsia and birth weight.MethodsPatients were categorized based on the quartiles of the prenatal first SBP level. Logistic regression analysis was performed to assess whether prenatal first SBP was a risk factor for low birth weight and severe preeclampsia. The area under the receiver-operating characteristic curve (AUC) of sensitivity and specificity were used to predict the risk of low birth weight and severe preeclampsia.ResultsA total of 333 patients with preeclampsia were enrolled. There were 162 (48.6%) patients with severe preeclampsia and 270 (81.08%) cesareans. Group I patients with a prenatal first SBP ≤ 119 mmHg prenatal had a higher birth weight. Multiple logistic regression analysis showed that serum creatinine (p = 0.025), prenatal first SBP (p = 0.029), S-preeclampsia (p = 0.003), gestational age (p < 0.001), total cholesterol (TC) (p < 0.001), and low-density lipoprotein (LDL) (p < 0.001) were independent risk factors for low birth weight. Multiple logistic regression analysis showed that prenatal first SBP (p = 0.003), TC (p = 0.002), and B-type natriuretic peptide (BNP) (p < 0.001) were independent risk factors for severe preeclampsia. Compared with Group I (SBP ≤ 119 mmHg), the incidence of low birth weight for patients in groups III (131 ≤ SBP ≤ 138 mmHg) and IV (SBP ≥ 139 mmHg) was significantly higher. Even after correcting for age, gestational age, and biochemical indices, the difference remained statistically significant. The risk of diagnosed severe preeclampsia for patients in Groups IV (SBP ≥ 139 mmHg), III (131 ≤ SBP ≤ 138 mmHg), and II (120 ≤ SBP ≤ 130 mmHg) was significantly higher than that in Group I (SBP ≤ 119 mmHg). The AUC of the prenatal first SBP for predicting low birth weight and severe preeclampsia was 0.676 (95% CI 0.618–0.733, p < 0.001) and 0.727 (95% CI 0.673–0.781, p < 0.001), respectively, in patients with preeclampsia.ConclusionsPrenatal first SBP was associated with birth weight and severe preeclampsia. Higher prenatal first SBP in patients with preeclampsia can predict low birth weight and severe preeclampsia.

Incidence and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm and term gestation: a population-based study

The majority of previous studies on severe preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome were hospital-based or included a relatively small number of women. Large, population-based studies examining gestational age-specific incidence patterns and risk factors for these severe pregnancy complications are lacking. This study aimed to assess the gestational age-specific incidence rates and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia. We carried out a retrospective, population-based cohort study that included all women with a singleton hospital birth in Canada (excluding Quebec) from 2012 to 2016 (N=1,078,323). Data on the primary outcomes (ie, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia) were obtained from delivery hospitalization records abstracted by the Canadian Institute for Health Information. A Cox regression was used to assess independent risk factors (eg, maternal age and chronic comorbidity) for each primary outcome and to assess differences in the effects at preterm vs term gestation (<37 vs ≥37 weeks). The rates of severe preeclampsia (n=2533), hemolysis, elevated liver enzymes, and low platelet count syndrome (n=2663), and eclampsia (n=465) were 2.35, 2.47, and 0.43 per 1000 singleton pregnancies, respectively. The cumulative incidence of term-onset severe preeclampsia was lower than that of preterm-onset severe preeclampsia (0.87 vs 1.54 per 1000; rate ratio, 0.57; 95% confidence intervals, 0.53-0.62), the rates of hemolysis, elevated liver enzymes, and low platelet count syndrome were similar (1.32 vs 1.23 per 1000; rate ratio, 0.93; 95% confidence interval, 0.86-1.00), and the preterm-onset eclampsia rate was lower than the term-onset rate (0.12 vs 0.33 per 1000; rate ratio, 2.64; 95% confidence interval, 2.16-3.23). For each primary outcome, chronic comorbidity and congenital anomalies were stronger risk factors for preterm- vs term-onset disease. Younger mothers (aged <25 years) were at higher risk for severe preeclampsia at term and for eclampsia at all gestational ages, whereas older mothers (aged ≥35 years) had elevated risks for severe preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Regardless of gestational age, nulliparity was a risk factor for all outcomes, whereas socioeconomic status was inversely associated with severe preeclampsia. The risk for severe preeclampsia declined at term, eclampsia risk increased at term, and hemolysis, elevated liver enzymes, and low platelet count syndrome risk was similar for preterm and term gestation. Young maternal age was associated with an increased risk for eclampsia and term-onset severe preeclampsia. Prepregnancy comorbidity and fetal congenital anomalies were more strongly associated with severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm gestation.

RISK FACTORS OF PREECLAMPSIA WITH SEVERE FEATURES AND ITS COMPLICATIONS

Abstract.Background : The maternal mortality rate in Indonesia is dominated by preeclampsia as the second highest cause after bleeding. Several predictors can be categorized as risk factors that can be used to increase alertness in the care of pregnant women with severe preeclampsia to avoid complications. The purpose of this study was to study the relationship between risk factors for severe preeclampsia and its complications. Methods: This study used an observational analytic method with a case control design. The sampling technique is simple random sampling. The number of samples in this study were 80 samples, with 40 samples in each group. The case group was severe preeclampsia with one complication and the control group was severe preeclampsia without complications. Statistical analysis used was chi square and multiple logistic regression analysis. Results: The results showed that there was a significant relationship between age variables (p value = 0.001 &lt; 0.05; OR = 5.318; CI = 2.118 – 13,356), BMI (p value = 0.002 &lt; 0.05; OR = 6.000; CI = 1.958 – 18.384 ) and gestational age (p value = 0.039 &lt; 0.05; OR = 2.636; CI = 1.040 – 6.685). Multiple logistic regression analysis showed that BMI (p = 0.003), age (p = 0.001) and gestational age (p = 0.048) were variables included in the final modeling of the regression analysis with the incidence of severe preeclampsia complications. Conclusion: BMI is the variable that has the strongest relationship with the incidence of severe preeclampsia complications.

Inherited thrombophilia is significantly associated with severe preeclampsia

Methods to prevent the development of pathologies due to placental dysfunctions, such as gestational hypertension and preeclampsia, are the main approaches for obtaining the best maternal and fetal antepartum and postpartum prognosis. During 5 years of study (January, 2015 to December, 2019), the cases of pregnancy and puerperium complicated with pathology due to placental dysfunction were analyzed. The main objective was to determine the magnitude of the impact of thrombophilia on the development of an entity of gestational hypertension disorder. We compared the impact of thrombophilia and its associated complications in patients with gestational hypertension with moderate and severe preeclampsia. Thus, we found obesity, thrombophilia, and underlying cardiac pathology to be significant risk factors for severe preeclampsia. Regarding the comparative analysis of the risk factors and complications associated with patients with mild preeclampsia compared with those with severe preeclampsia, the presence in severe preeclampsia of thrombophilia, endocrine, liver, and cardiac pathology was higher and, a higher rate of complications was observed; complications included fetal death, intrauterine growth restriction (IUGR), prematurity, fetal arrhythmia with acute fetal distress, HELLP syndrome, and placental abruption. Thrombophilia has a significant effect on the development of severe preeclampsia, and oligohydramnios as specific complication of mild preeclampsia. Factors indicating an increased risk of progression from mild preeclampsia to severe preeclampsia are in addition to inherited thrombophilia the underlying pathologies, namely cardiac, hepatic, and endocrine factors.

Expression and clinical diagnostic value of miR-383 in patients with severe preeclampsia

This study aimed to investigate the expression and clinical diagnostic value of miR-383 in patients with severe preeclampsia. Thirty patients with severe preeclampsia from July 2017 to December 2018 were selected as a research group, twenty healthy pregnant women undergoing physical examination at the same period were selected as a control group, and miR-383 and miR-16 in placenta tissue of the two groups were detected by qRT-PCR. ROC curve was drawn to evaluate the predictive value of diagnostic efficiency, Spearman test was used for correlation analysis, and Logistic univariate and multivariate analysis was performed on the risk factors related to the metastasis of severe preeclampsia. The miR-383 expression in the research group was significantly lower than that in the control group (P&lt; 0.001), while the miR-16 expression in the research group was significantly higher than that in the control group (P&lt; 0.001). The miR-383 and miR-16 expression levels were tied to TNM staging and metastasis (P&lt; 0.001). The sensitivity, specificity and AUC of miR-383 single diagnosis were 75.00%, 83.33% and 0.847 respectively, and those of miR-16 single diagnosis were 65.00%, 63.33% and 0.728 respectively. The relative expression of miR-383 in placenta tissue was negatively correlated with APACHE II score of severe preeclampsia (r = -0.4129, P= 0.0233), but the relative expression of miR-16 in placenta tissue was positively correlated with APACHE II score of severe preeclampsia (r = 0.9833, P&lt; 0.001). Blood pressure, miR-383, miR-16 at the admission of pregnant women were independent risk factors for severe preeclampsia. miR-383 and miR-16 might participate in the process of occurrence, development and metastasis of severe preeclampsia, and could be used as potential biomarkers of placental tissue for its diagnosis and disease assessment of metastasis.

The ability of thromboelastography parameters to predict severe pre-eclampsia when measured during early pregnancy.

To examine the predictive value of thromboelastography parameters during early pregnancy as potential markers of severe pre-eclampsia during late pregnancy. An observational retrospective case-control study was conducted among pregnant women who attended a single hospital in Shanghai, China, between July 1, 2016, and February 31, 2018. Data were obtained from medical records and a structured questionnaire completed by the participants. Thromboelastography parameters included time r; time k; α angle; maximum amplitude; clot lysis at 60minutes; and coagulation index. Other risk factors for severe pre-eclampsia were also assessed. The pre-eclampsia and control groups comprised 46 and 138 women, respectively. Women with a coagulation index below zero at 13-20weeks experienced an increased risk of severe pre-eclampsia (odds ratio [OR] 31.72, 95% confidence interval [CI] 11.28-89.24; P<0.001). Other risk factors for severe pre-eclampsia were family history of hypertension (OR 3.79, 95% CI 1.21-11.48; P=0.017) and pre-pregnancy body mass index (OR 2.83, 95% CI 1.14-7.36; P=0.023). Coagulation index determined by thromboelastography was an early marker for severe pre-eclampsia.

162. Progression from isolated proteinuria to severe preeclampsia – Does severity of proteinuria matter?

Introduction The majority of women with preeclampsia have increased proteinuria. However, the 2013 Task Force on Hypertension in Pregnancy suggested that the degree of proteinuria is no longer a severe feature of preeclampsia due to a minimal correlation between proteinuria levels and pregnancy outcome. This change has brought about even more uncertainty regarding the clinical significance of isolated proteinuria in the development of pre-eclampsia. Objective To investigate the association between the severity of isolated proteinuria and later development of severe preeclampsia and other placental mediated complications. Methods Pregnant women with new onset proteinuria levels exceeding 300 mg in 24-h urine collection, who were referred to our institution between 2014 and 2017 were approached. Exclusion criteria included immediate diagnosis of preeclampsia, chronic renal disease or chronic hypertension. 104 women met inclusion criteria and were followed throughout pregnancy and until after delivery. Results Overall, 29 of 104 (28%) women developed severe preeclampsia. The rate of severe preeclampsia was significantly higher in women with proteinuria ⩾3 g⧹24 h (57.1%) compared to women with proteinuria ± 2 for women with ⩾3 g ⧹ 24 h, versus 36.4 ± 1 for women with 3 g ⧹ 24 h, (p 0.01). The median time interval (days) between the diagnosis of proteinuria and presentation of severe preeclampsia was not significantly different between women with ⩾ 3 g ⧹ 24 h (15) and 3 g ⧹ 24 h (17). Discussion Isolated proteinuria > 3 g ⧹ 24h is a significant risk factor for severe preeclampsia and HELLP syndrome with a rapid and earlier progression to clinical disease.

119. The management of pregnant women with chronic kidney disease: An 8-year review in a tertiary care center

Objective The management and treatment of kidney disease has advanced, and women who are pregnant and give birth have also increased recently. On the other hand, pregnancy with kidney disease causes preeclampsia (19–30%), intrauterine fetal death (16–20%), postpartum renal failure (3–5%). The purpose of this study was to review the maternal and neonatal outcomes in pregnant women with chronic kidney disease (CKD), and to evaluate the appropriate management that may contribute to obstetric outcomes. Methods We conducted a retrospective review of 126 births and 129 neonates in 110 CKD patients who were seen at Osaka University Hospital between January, 2010, and December, 2017. Results The mean patient age was 33.5 (18–49) years, and the nulliparity rate was 61%. The most frequent disease was IgA nephropathy (43/126; 34%) and the second was lupus nephritis and renal transplantation (both were 15/126; 12%). Second trimester abortion and preterm delivery occurred in 5% and 20% of the patients, respectively. There was no maternal and neonatal death. Fetal growth restriction and preeclampsia occurred in 10% and 25% of the patients, respectively. Two patients with lupus nephritis and one with Henoch-Schonlein purpura nephritis had severe preeclampsia occurred before 20 weeks gestation. sFlt1/PlGF ratio were 427, 865 and 1183, respectively. Conclusions To predict and prevent the adverse events in the care of pregnant women with CKD is important for good maternal and neonatal outcomes. Furthermore, Henoch-Schonlein purpura nephritis that had been already ameliorated may be also a risk factor for severe preeclampsia.

Correlation of Maternal Serum Homocysteine in the First Trimester with the Development of Gestational Hypertension and Preeclampsia.

BackgroundThis study investigated the relationship of serum homocysteine in early pregnancy with the risk of gestational hypertension (GH) and preeclampsia (PE) and with the severity of preeclampsia.Material/MethodsIn a retrospective cohort study, we identified 147 confirmed cases of preeclampsia (103 with mild PE and 44 with severe PE) and 147 confirmed cases of GH; 4418 women who remained normotensive and nonproteinuric throughout pregnancy served as controls. Maternal blood samples were collected at between 11 and 13 weeks of gestation to test serum concentrations of homocysteine (Hcy), folic acid, and VitB12. A logistic regression model was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsWomen who subsequently developed GH and PE were older and had higher body mass indexes (BMIs) than those in the control group. Compared with the control group, women who developed PE were less educated (P=0.031), and more of those who developed GH were primiparas (P=0.012). The serum levels of Hcy in severe PE were significantly higher than those in the control group (median: 8.50 μmol/L vs. 7.33 μmol/L, P<0.001). After logistic regression analyses for potential confounding factors, the adjusted odds ratios (aORs) of Hcy was 1.12 for severe PE (95% CI 1.06–1.20). The serum concentrations of folic acid and VitB12 in those with GH and PE were not significantly different from controls.ConclusionsA high level of Hcy in the first trimester is an independent risk factor for severe PE, although it is not a useful marker for the subsequent development of GH and mild PE.

Fetal hydrops and the risk of severe preeclampsia

Objective: To assess the incidence and severity of preeclampsia in pregnancies complicated by fetal hydrops.Methods: We performed a retrospective cohort study of singleton gestations from 2005 to 2008 in California. The primary predictor was fetal hydrops and the primary outcome was preeclampsia. Selected adverse maternal and neonatal events were assessed as secondary outcomes. Potential confounders examined included fetal anomalies, polyhydramnios, race/ethnicity, nulliparity, chronic hypertension, and gestational or pregestational diabetes mellitus.Results: We identified 337 pregnancies complicated by fetal hydrops, 70.0% had a concomitant fetal anomaly and 39.8% had polyhydramnios. Compared to the general population, hydrops was associated with an increased risk for severe preeclampsia (5.26 versus 0.91%, p < .001) but not mild preeclampsia (2.86 versus 2.02%, p = .29). In multivariable analysis, fetal hydrops remained an independent risk factor for severe preeclampsia (as adjusted odds ratios (aOR) 3.13, 1.91–5.14). Hydrops was also associated with increased rates of eclampsia, acute renal failure, pulmonary edema, postpartum hemorrhage, blood transfusion, preterm birth, and neonatal death.Conclusions: We find that fetal hydrops is an independent risk factor for severe preeclampsia. In light of serious concerns for maternal and neonatal health, heightened surveillance for signs and symptoms of severe preeclampsia is warranted in all pregnancies complicated by fetal hydrops.

Human chorionic gonadotropin, fetal sex and risk of hypertensive disorders of pregnancy: A nested case-control study.

To assess whether human chorionic gonadotropin (HCG) and fetal sex are two independent risk factors for hypertensive pregnancy in the early second-trimester of pregnancy. This was a retrospective nested case-control study based on a cohort of 2521 singleton pregnancies, among whom we recruited 98 hypertensive pregnancies (subdivided into severe preeclampsia, n=34; mild preeclampsia, n=29 and gestational hypertension, n=35) and 196 normotensive pregnancies. Maternal serum HCG levels were measured at 15-20 weeks of gestation and fetal sex was determined from the neonatal record. Mann-Whitney U and chi-square tests were performed to assess differences of HCG levels and fetal sex between groups. Logistic regressions were performed to evaluate the effect of HCG and fetal sex on hypertensive pregnancy. There were 35 male and 63 female fetuses in the hypertensive group, and 102 male and 94 female fetuses in the normotensive group (p=0.008). HCG (MoM) levels were significantly higher in only severe preeclamptic pregnancies (n=34) (p=0.013). There were no significant differences of the HCG (MoM) levels between male and female fetuses in each sub-group. aOR for increased maternal HCG levels and female fetus were 2.4 (95% CI: 1.434-3.954) and 2.9 (95% CI: 1.227-6.661) respectively in severe preeclamptic pregnancies compared with normotensive pregnancies. There is a female preponderance in hypertensive pregnancies. Increased HCG levels and female fetus are two independent risk factors for severe preeclampsia in the early second-trimester of pregnancy.

Association between decreased plasma levels of soluble human leukocyte antigen-G and severe pre-eclampsia.

The aim of this study was to investigate the levels of different isoforms of soluble human leukocyte antigen-G (sHLA-G) in maternal plasma during early and late pregnancy, and to investigate the expression of sHLA-G isoforms in women with early or late-onset severe preeclampsia. This prospective, nested, case-control study was performed in 24 early-onset severe preeclamptic, 34 late-onset severe preeclamptic, and 74 uncomplicated pregnant women. Plasma levels of sHLA-G1/5 were measured using ELISA. Plasma sHLA-G1 levels in women with late-onset severe preeclampsia were markedly lower compared with normal controls (median: 0 vs. 1.22 ng/mL) at the first trimester, and plasma sHLA-G1 levels in women with early-onset severe preeclampsia were markedly lower compared with normal controls at the second (median: 0 vs. 1.24 ng/mL) and third (median: 0 vs. 1.34 ng/mL) trimesters. There was no difference between the late-onset and early-onset groups at three trimesters. As for sHLA-G5, there was no difference in concentrations among the three groups at any time point. However, compared with controls, more women with early- or late-onset severe preeclampsia had undetectable sHLA-G5 levels in the first (71.4% and 76.2% vs. 14.1%), second (75.0% and 73.3% vs. 19.0%), and third (100.0% and 70.4% vs. 14.8%, respectively) trimester (all P<0.05). sHLA-G1 levels in the first (odds ratio [OR]=0.254, 95% confidence interval [CI]=0.109-0.591, P=0.010), second (OR=0.315, 95% CI=0.158-0.627, P=0.001), and third (OR=0.170, 95% CI=0.054-0.533, P=0.002) trimester was a risk factor for severe preeclampsia. Severe preeclampsia was associated with low/undetectable maternal plasma levels of sHLA-G. Low sHLA-G1 levels might be a risk marker for severe preeclampsia.

Maternal Vitamin D Status and the Risk of Mild and Severe Preeclampsia

We sought to determine the association between maternal vitamin D status at ≤26 weeks' gestation and the risk of preeclampsia by clinical subtype. We conducted a case-cohort study among women enrolled at 12 US sites from 1959 to 1966 in the Collaborative Perinatal Project. In serum collected at ≤26 weeks' gestation (median 20.9 weeks) from 717 women who later developed preeclampsia (560 mild and 157 severe cases) and from 2986 mothers without preeclampsia, we measured serum 25-hydroxyvitamin D, over 40 years later, using liquid chromatography-tandem mass spectrometry. Half of women in the subcohort had 25-hydroxyvitamin D (25(OH)D) >50 nmol/L. Maternal 25(OH)D 50 to 74.9 nmol/L was associated with a reduction in the absolute and relative risk of preeclampsia and mild preeclampsia compared with 25(OH)D <30 nmol/L in the crude analysis but not after adjustment for confounders, including race, prepregnancy body mass index, and parity. For severe preeclampsia, 25(OH)D ≥50 nmol/L was associated with a reduction in three cases per 1000 pregnancies (adjusted risk difference = -0.003 [95% confidence interval = -0.005 to 0.0002]) and a 40% reduction in risk (0.65 [0.43 to 0.98]) compared with 25(OH)D <50 nmol/L. Conclusions were unchanged (1) after restricting to women with 25(OH)D measured before 22 weeks' gestation or (2) with formal sensitivity analyses for unmeasured confounding. Maternal vitamin D deficiency may be a risk factor for severe preeclampsia but not for its mild subtypes. Contemporary cohorts with large numbers of severe preeclampsia cases would be needed to confirm or refute these findings.

A Nested Case-Control Study of Midgestation Vitamin D Deficiency and Risk of Severe Preeclampsia

Vitamin D may be important in the pathogenesis of severe preeclampsia. Given the few effective preventive strategies for severe preeclampsia, studies establishing this link are needed so that effective interventions can be developed. Our objective was to assess whether midgestation vitamin D deficiency is associated with development of severe preeclampsia. We conducted a nested case-control study of pregnant women who had previously given blood for routine genetic multiple marker screening and subsequently delivered at a tertiary hospital between January 2004 and November 2008. Participants included women with singleton pregnancies in the absence of any chronic medical illnesses. From an overall cohort of 3992 women, 51 cases of severe preeclampsia were matched by race/ethnicity with 204 women delivering at term with uncomplicated pregnancies. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D]. The main outcome was severe preeclampsia. Midgestation maternal 25(OH)D concentration was lower in women who subsequently developed severe preeclampsia compared with controls [median (interquartile range), 75 (47-107) nmol/liter vs. 98 (68-113) nmol/liter; P = 0.01]. Midgestation maternal 25(OH)D of less than 50 nmol/liter was associated with an almost 4-fold odds of severe preeclampsia (unadjusted odds ratio, 3.63; 95% confidence interval, 1.52-8.65) compared with midgestation levels of at least 75 nmol/liter. Adjustment for known confounders strengthened the observed association (adjusted odds ratio, 5.41; 95% confidence interval, 2.02-14.52). Maternal midgestation vitamin D deficiency was associated with increased risk of severe preeclampsia. Vitamin D deficiency may be a modifiable risk factor for severe preeclampsia.