Risk Of Developing Preeclampsia Research Articles

Inflammatory biomarkers and risk for preeclampsia development

Inflammatory biomarkers and risk for preeclampsia development

Determination of Risk Factors for Pre-eclampsia in a Tertiary Hospital of Bangladesh: A Descriptive Study

Background: Pre-eclampsia (PE), a hypertensive disorder of pregnancy is estimated to complicate 2%-8% of pregnancies and remains a principal cause of maternal and fetal morbidity and mortality. The identification of its predisposing factors in the pre-pregnancy and initial stage of pregnancy will help in reducing the morbidity and mortality. Aim: The aim of this study is to determine the risk factors for PE among pregnant women in a tertiary level hospital. Methods: This study was conducted in the Department of Obstetrics and Gynaecology of Shaheed Suhrawardy Medical College & Hospital, a tertiary care hospital in Dhaka, Bangladesh, from January to December 2019. A total number of 50 pregnant women with pre-eclampsia, who got admitted in this hospital were selected as study group. This was a hospital based descriptive study. Results: Most of the participants were within 35-45 years of age group and mean age 38.92 ± 2.21. The factors that were found to be significant predictors of risk for development of PE were primigravida, inadequate education, low socio-economic status, past history of PE or hypertension and family history of PE or hypertension. J Shaheed Suhrawardy Med Coll 2021; 13(1): 3-7

Is arginine supplementation effective in preventing preeclampsia in pregnant women?

Objectives: The objective of this study was to review data from randomized controlled trials to assess whether or not the supplementation of L-Arginine (L-Arg) is effective in reducing the incidence of preeclampsia (PE) in pregnancies at risk of developing the disorder. Methods: We aimed to systematic review randomized controlled trials, including those which compared L-Arg supplementation with placebo in pregnant women at high risk of PE development, analyzing PE incidence as the main outcome. Data were collected from MEDLINE/ Pubmed, EMBASE/ Elsevier, LILACS/ BVS and Cochrane. Results: A total of 46 papers were identified in the primary search. After analysis of eligibility, inclusion and exclusion criteria, two articles (which respected in detail all the stages of evaluation) were included in the present review. A risk of bias assessment was performed. Data analysis revealed that the incidence of PE was significantly lower in both studies, and no major adverse effects were reported. The limitations of this study were the lack of standardization between the trials analyzed and the relative low number of studies included. Conclusions: The supplementation with L-Arg appears to reduce the incidence of PE in pregnant women with high risk for its development.

Elevated mid-pregnancy plasma levels of angiotensin-converting enzyme 2 in women prior to the development of preeclampsia

Preeclampsia and cardiovascular disease (CVD) share multiple features and risk factors. Circulating angiotensin-converting enzyme 2 (ACE2) is increased in CVD and mediates SARS-CoV-2 entry into host cells, causing COVID-19 infection. The role of ACE2 in preeclampsia pathophysiology is unknown. We hypothesized that circulating ACE2 is increased in mid-pregnancy in women later developing preeclampsia. We included 296 women later developing preeclampsia (cases) and 333 women with a continuous healthy pregnancy (controls). Circulating ACE2 was measured with an immunoassay based on proximity extension assay technology, with levels being expressed as relative quantification on a log2 scale. Median (interquartile range) ACE2 levels were higher in cases than in controls; 3.84 (3.50–4.24) vs. 3.72 (3.45–4.04), p = 0.002. Adjusted logistic regression models showed a 60% increased risk for later development of preeclampsia with one unit elevation of ACE2 (adjusted odds ratio (aOR) 1.60, 95% confidence intervals (CI) 1.17–2.18). Preterm preeclampsia (diagnosis before 37 gestational weeks, n = 97) seemed to have a stronger ACE2 association than term preeclampsia, n = 199 (aORs, 95% Cis 2.14, 1.15–3.96 and 1.52, 1.04–2.23, respectively). Circulating ACE2 is increased at mid-pregnancy in women later developing preeclampsia, particularly preterm preeclampsia. Thus, our finding indicates a partly shared pathophysiological pathway between preeclampsia and CVD.

The prediction of different phenotypes of preeclampsia in the first trimester of pregnancy (two-center retrospective study)

AIM: The aim of this study was to determine the effectiveness of predicting the development of placental or maternal preeclampsia (PE) by clinical and anamnestic risk factors and results of the combined screening in first trimester of pregnancy.
 MATERIALS AND METHODS: This two-center retrospective case-control study included the data analysis of somatic status, the obstetric and gynecologic anamnesis, and the results of the combined screening of 373 women in the first trimester of pregnancy. The control group consisted of 200 women with physiological course of pregnancy and labor. The main group comprised 173 patients whose pregnancy was complicated by early-onset (n = 44, 25%) or severe late-onset (n = 129, 75%) PE. We analyzed more than 100 clinical and anamnestic risk factors for PE implementation and evaluated the risk of developing PE at 11.0-13.6 weeks of gestation using the Fetal Medicine Foundation calculator.
 RESULTS: Maternal risk factors for PE development are identical for clinical phenotypes, except for the family anamnesis of arterial vascular accidents in first-line relatives under 45 years of age, which are significantly interfaced to risk of placental PE development (OR 6.38, 95% CI 2.002.28; p = 0.0017). A comprehensive assessment of clinical and anamnestic data at 11.0-13.6 weeks of gestation allows for predicting the implementation of maternal severe PE in 36.7% of cases and placental PE in 29.6% of cases with an identical false positive rate of 10.5%. Carrying out the combined screening in the first trimester allows for determining the risk of PE development up to 37 weeks without differentiation by clinical phenotypes, with a test sensitivity of 53.9% at a false positive rate of 34.7%.
 CONCLUSIONS: The prediction of placental or maternal PE development in the first trimester of pregnancy is possible only by maternal, clinical and anamnestic risk factors with a low predictive value of the test. Carrying out the combined screening with the inclusion of maternal risk factors, uterine artery pulsation index and pregnancy-associated plasma protein-A level increases the predictive value of the test for PE development up to 37 weeks from 37.6% to 53.6% at a high rate of false positive results. Validation of medical technologies for predicting clinical PE phenotypes in the population of women, taking into account a territorial origin and risk factors, will allow for defining the shortcomings of the model and improving its predictive value.

Novelelectronic health records applied for prediction of pre-eclampsia: Machine-learning algorithms.

To predict risk of pre-eclampsia (PE) in women using machine learning (ML) algorithms, based on electronic health records (EHR) collected at the early second trimester. A total of 3759 cases of pregnancy who received antenatal care at Xinhua hospital Chongming branch Affiliated to Shanghai Jiaotong University were included in this retrospective EHR-based study. Thirty-eight candidate clinical parameters routinely available at the first visit in antenatal care were collected by manual chart review. Logistic regression (LR), random forest (RF), support vector machine (SVM) and extreme gradient boosting (XGBoost) were used to construct the prediction model. Features that contributed to the model predictions were identified using XGBoost. The performance of ML models to predict women at risk of PE was quantified in terms of accuracy, precision, recall, false negative score, f1_score, brier score and the area under the receiver operating curve (auROC). The XGboost model had the best prediction performance (accuracy=0.920, precision=0.447, recall=0.789, f1_score=0.571, auROC=0.955). The most predictive feature of PE development was fasting plasma glucose, followed by mean blood pressure and body mass index. An easy-to-use model that a patient could answer independently still enabled accurate prediction, with auROC of 0.83. risk of PE development can be predicted with excellent discriminative ability using ML algorithms based on EHR collected at the early second trimester. Future studies are needed to assess the real-world clinical utility of the model.

Some features of the hemostasis system in pregnant women at risk of developing preeclampsia

The objective: a study of the hemostasis system in pregnant women with a risk of preeclampsia development.Materials and methods. 100 pregnant women with the risk for preeclampsia (main group) were examined. The risk factors were determined according to the Guideline “Hypertensive Disorders During Pregnancy”, Order No. 676 of the Ministry of Health of Ukraine. The control group contained of 50 healthy women with physiological pregnancy. The groups were representative in age and reproductive history.The following indicators of hemostasis were studied: the platelet system (the number of platelets, their aggregation ability and the total platelet aggregation index (TPAI), the coagulation system (autocoagulation test, thrombin time, prothrombin index, fibrinogen concentration) and the state of the fibrinolysis system which was determined by such indicators: plasma level of free heparin, activity of antithrombin III, indicators of ethanol and protamine sulfate tests, concentration of soluble fibrin in blood plasma.Results. In pregnant women with a risk of preeclampsia, there are changes in platelet hemostasis indicators: a significant decrease in the number of platelets and a significant (p<0.05) increase in platelet aggregation ability, there is a tendency to an increase in TPAI indicators. In the main group a significant increase in the fibrinogen concentration, plasma lysis indicators and a tendency to an increase of the free heparin concentration, a decrease of antithrombin III and, in comparison with the indicators in healthy women, a 3-fold increase in the content of soluble fibrin (p<0.05) were found.Conclusions. In pregnant women with a risk of preeclampsia development, there are disorders in the vascular-platelet hemostasis, coagulation and fibrinolytic blood systems, namely, a significant tension in the platelet link of the system, an increase in thrombogenic potential, and a sharp inhibition of the fibrinolytic link of hemostasis.

Low Dose Aspirin in high-risk pregnancies: The volatile effect of acetylsalicylic acid on the inhibition of platelets uncovered by G. Born’s light transmission aggregometry

Preeclampsia still represents a life-threatening pregnancy complication, associated with severe maternal and neonatal morbidity and mortality. Low-dose Aspirin is advised to avoid preeclampsia in high-risk pregnancies worldwide. As Aspirin does not cover all women at risk, the prescription raises questions concerning optimal target population, dosage, and onset of therapy.The aim of this study was to test platelet responsiveness on Aspirin by optical aggegrometry, to gain robust biochemically assessment data of Aspirin in an obstetric cohort. 248 women at high risk for development of preeclampsia were included in the study. Aspirin-prophylaxis was administered either in 100 mg (n = 229) or 150 mg (n = 90) daily. Dosing of 100 mg Aspirin was maintained if testing revealed a sufficient platelet inhibition. If platelet inhibition was insufficient, dosage was increased to 150 mg Aspirin and re-testing was advised. 91 patients (91/229 = 39.7%) presented a sufficient inhibitory Aspirin effect at a dosage of 100 mg, but in 138 patients LTA showed an inadequate Aspirin response (138/229 = 60.3%). In 19 women 150 mg Aspirin was administered as starting dose due to new recommendations. Of all women at 150 mg Aspirin 64 did not properly respond (35.4%). The overall rate of sufficient responding women regardless the Aspirin dose was 64.6%.This study demonstrates still an insufficient inhibition of platelet aggregation in about 1/3 of women even with a dosage of 150 mg Aspirin daily, who might potentially benefit from further increase. These data show, that there is a need for further research to allow a personalized approach for individualized Aspirin therapy, maximizing the preventive benefit for mother and child.

Low-dose aspirin in pregnancy: who? when? how much? and why?

The use of low dose aspirin (LDA) has become routine in prenatal care for a variety of diagnoses, most importantly in women with a history of preeclampsia and associated poor pregnancy outcomes. Although LDA is currently indicated in patients considered to be at risk for development of preeclampsia, optimal dosing, timing of treatment initiation, and persons of benefit are under investigation. Several studies have also looked at LDA treatment and its effect on other maternal and fetal outcomes. This review summarizes the current guidelines for the use of LDA, incorporating the most recent research findings, and offers possible future implications of LDA treatment. Over 10 years ago, the American College of Obstetricians and Gynecologists, the World Health Organization, and the United States Preventive Service Task Force began publishing guidelines focused on the use of LDA in pregnancy. Since the release of these guidelines, several large studies have re-evaluated the use of LDA with a focus on initiation of treatment and dosing. The combined results of these studies suggest a decreased rate of preeclampsia at aspirin doses >100 mg when treatment is initiated prior to 16 weeks of gestation. Overall, early initiation of LDA has been shown to decrease the development of preeclampsia in patients considered at increased risk. Current literature suggests increasing the recommended dose to >100 mg to optimize these risk reductions. Although LDA use seems promising for other outcomes like preterm delivery and intrauterine growth restriction, further studies to strengthen recommendations are warranted.

Association of Four Missense SNPs with Preeclampsia in Saudi Women.

Objective:The objective of this study was to investigate the association of rs1051740, rs2234922 (in microsomal epoxide hydrolase 1; EPHX1), rs268 (in lipoprotein lipase; LPL) and rs6025 (in Factor V Leiden; F5) genetic variants with the risk of preeclampsia development in Saudi women.Materials and Methods:This case–control study recruited 233 Saudi women (94 preeclampsia cases and 139 healthy controls) who visited the Gynecology and Obstetrics Departments of two hospitals in Jeddah, Saudi Arabia, for routine postpregnancy clinical follow-ups. All the women underwent thorough clinical and biochemical investigations conducted according to the standard clinical guidelines. Genotyping of the study participants was done using real-time polymerase chain reaction-based TaqMan allelic discrimination assay. The strength of the association between genetic variants and disease development was assessed using chi-square, odds ratio, 95% confidence interval and multifactor dimensionality reduction tests.Result:The minor alleles “G” in rs268 (LPL) and “A” in rs6025 (F5) were absent in Saudi women. The frequencies of rs1051740 and rs2234922 of EPHX1, both in the homozygous and allelic forms, were not significantly different between preeclampsia patients and healthy controls (for all tests, P > 0.05). The multifactor dimensionality reduction analysis also indicated that the interaction between the four studied single-nucleotide polymorphisms (SNPs) had no significant association with preeclampsia risk.Conclusion:This study found that none of the studied genetic variants (neither the single SNP nor the SNP–SNP interactions) explain the development of preeclampsia in the Saudi population. These findings not only underscore the disease heterogeneity but also highlight the need to develop population-specific diagnostic genetic biomarkers for preeclampsia.

Evaluation of vitamin D status, parathyroid hormone, and calcium among Iranian pregnant women with preeclampsia: A case-control study.

BackgroundPreeclampsia is considered as a serious life-threatening condition that could affect both maternal and fetal outcome. Many studies have examined the association of nutritional factors with the incidence of preeclampsia. However, little is known about the possible role of vitamin D in the development of preeclampsia among the Iranian population.ObjectiveThe aim of the present study was to evaluate the association between vitamin D status and preeclampsiaMaterials and MethodsA total of 120 pregnant women who were referred to Kamali and Alborz General Hospital located in the Karaj City were enrolled in this study and categorized into preeclamptic and control groups (n = 60/each). The clinical details of patients such as demographic characteristics and laboratory findings were obtained from the patients. The serum levels of vitamin D, calcium, phosphorus, and parathormone were also measured. Multivariate logistic regression analysis was used to assess for independent predictors of preeclampsia.ResultsThe mean age among pregnant women with preeclampsia and control group were 31.48 5.25 and 29.01 5.28, respectively. The mean body mass index among the preeclamptic group was 27.92 4.98, which was significantly higher compared to the control group (p 0.001). The serum vitamin D levels were significantly lower in women with preeclampsia compared to the control subjects (p = 0.007). Moreover, no correlation between vitamin D deficiency and predisposing factors of preeclampsia was observed after adjusting for confounding factors.ConclusionOur study revealed that serum vitamin D level is significantly lower in among the pregnant women diagnosed with preeclampsia compared to the healthy subjects. However, no correlation was observed between the vitamin D status and the risk of preeclampsia development.

Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study.

BackgroundFMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting.ObjectiveThis study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity.MethodsThis was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test.ResultsA total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate.ConclusionsWe conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

18. Absence of the corpus luteum in early pregnancy increases the risk of preeclampsia

Introduction Assisted reproductive technology is associated with an increased risk of preeclampsia, but the reasons are poorly understood. The corpus luteum (CL) produces multiple vasoactive hormones in the first trimester of pregnancy which could affect initial placentation and later development of preeclampsia. Hypothesis We hypothesized that non-physiologic states present in in-vitro fertilization (IVF) such as absence of the CL could increase the risk of preeclampsia. Methods 892 infertile women were enrolled in this prospective cohort study. Four categories based on CL status were defined: (1) absence of the CL; (2) single CL; (3) multiple CL associated with ovulation induction; (4) multiple CL associated with controlled ovarian stimulation for IVF and fresh embryo transfer. Analysis focused on singleton pregnancies conceived with autologous oocytes resulting in live birth (n = 683). Multivariable logistic regression was used to control for covariates. Results Compared with conceptions occurring in the presence of one CL, conceptions occurring in the absence of a CL were associated with a higher incidence of preeclampsia (12.8% vs 4.8%, P = 0.02) and preeclampsia with severe features (9.6% vs 1.4%, P = Discussion Among singleton pregnancies after infertility resulting in live birth, those conceived in the absence of a CL were at increased risk for development of preeclampsia and preeclampsia with severe features.

223. CD163-mediated hemoglobin-scavenging system, haptoglobin phenotype and preeclampsia risk

Introduction Preeclampsia (PE) is a multisystemic disorder which complex pathophysiology involves both oxidative stress and endothelial dysfunction as key factors. The CD163-mediated haptoglobin (HP) hemoglobin-scavenging system has been proposed as an important pathway for diverse disease states due to its anti-inflammatory and pro-angiogenic effects. The human HP locus is polymorphic, yielding three distinct phenotypes characterized by different antioxidant and pro-angiogenic properties. Objective We aimed to determine whether HP phenotype was associated with PE risk and to assess the relationship between HP phenotype and first-trimester concentrations of HP, soluble form of the hemoglobin-scavenger receptor CD163 (sCD163), placental growth-factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). Methods Case-control study of 452 pregnant women selected from a prospective cohort of singleton pregnancies that underwent first-trimester aneuploidy screening in a routine care low-risk setting. The study sample included 204 women who subsequently developed PE and 248 women with normal pregnancies who were matched for gestational age. HP phenotypes were determined by polyacrylamide gel electrophoresis (PAGE). First-trimester serum PlGF, sFlt-1 and HP concentrations were determined by automated electrochemiluminescence/immunoturbidimetric methods (Roche Diagnostics), while sCD163 levels were determined by enzyme-linked immunosorbent assay (R&D Systems). Results Although HP phenotype alone did not affect overall PE risk, we found significantly higher HP concentrations between preeclamptic and normal women with HP2-1 (122.0/107.1 mg/dL, P = 0.01) and HP2-2 (101.0/82.0 mg/dL, P = 0.001) phenotypes. HP2-2 phenotype was also associated with high levels of sCD163 (472.6/418.6 ng/mL, P = 0.02) that were significantly higher among women who subsequently developed PE (511.5/430.8 ng/mL, P = 0.04). Finally, PlGF and sFlt-1 levels presented significantly different patterns between preeclamptic and normal pregnancies, being the strongest association in women with HP2-1 and HP2-2 phenotypes. Conclusion These findings suggest that HP phenotype could be useful in combination with first-trimester inflammatory and angiogenic markers to identify subsets of women with increased risk of PE development since early pregnancy.

Toll-like receptors signaling network in pre-eclampsia: An updated review.

Toll-like receptors (TLRs) are innate immune cells receptors. They are expressed on leukocytes, epithelial cells, and more particularly on placental immune cells and chorion trophoblast. Upregulation of innate immune response occurs during normal pregnancy, but its excessive activity is involved in the pathology of pregnancy complications including pregnancy-induced hypertension and pre-eclampsia (PE). The recent studies about the overmuch inflammatory responses and aberrant placentation are associated with increased expression of TLRs in PE patients. This review has tried to focus on the relationship between some activities of TLRs and the risk of preeclampsia development.

New approaches to the prognosis of pre-eclampsia in pregnant woman

Objective: development and evaluation of the effectiveness of the method for predicting pre-eclamapsia in pregnant women by testing thrombophilia genes, measuring the levels of antibodies to β2 glycoprotein-1, D-dimer and coefficient of atherogenicity.Materials and methods: This retrospective, case-control study was conducted on 156 patients who were in third trimester of pregnancy: 112 with PE and 44 healthy normotensive pregnant women. A combined approach to the prognosis of preeclampsia which is based on the level of D-dimer (immunоturbodimetric analysis), the value of the atherogenicity coefficient, the number of antibodies to β2 glycoprotein-1 (ELISA-analysis), the presence of polymorphism 455 G → A in the gene of fibrinogen β and 675 4G/5G in the gene of the plasminogen activator inhibitor type 1 (PCR) was proposed.Results: It was established that the sensitivity of the proposed prognostic model was 82.5 % (95 % CI 74.2-88.9 %), specificity 90.9 % (95 % CI 78.3-97.5 %). The model takes into account the role in pre-eclampsia development not only of each individual factor, but also of their combination. Approbation of the prognostic model in the group of pregnant women in the first trimester of pregnancy showed its high efficacy: the incidence of PE in the group with a predicted low risk of developing PE was 2.5 % versus 57.1 % in the group with a predictable high risk (p<0.05).Conclusions. The proposed model has good prognostic features, which allow assessing the risk of pre-eclampsia development in pregnant women with high probability beginning from first trimester of pregnancy.

Prepregnancy liver enzyme levels and risk of preeclampsia in a subsequent pregnancy: A population-based cohort study.

Preeclampsia is a serious multisystemic disorder leading to maternal and neonatal adverse outcomes. However, little is known about the early markers of this disease. The aim of this study was to investigate the association between prepregnancy liver function and the development of preeclampsia. We enrolled 192571 Korean women who had their first delivery between January 1, 2008, and December 31, 2014, and had undergone a national health screening examination through the National Health Insurance Corporation during 1-2years before delivery. Preeclampsia developed in 3973 (2.0%) women. The rate of development of preeclampsia was higher in women with abnormal prepregnancy liver enzyme levels than in those with normal liver enzyme levels before pregnancy. On multivariate analysis, women with abnormal alanine aminotransferase level before pregnancy had a 1.21-fold increased risk of developing preeclampsia than those with normal alanine aminotransferase level before pregnancy, after adjusting for age, family history of hypertension, hepatitis B virus carrier status, smoking, alcohol status, prepregnancy body mass index and blood pressure. Prepregnancy γ-glutamyltransferase and aspartate aminotransferase levels were not associated with the risk of preeclampsia development. Abnormal prepregnancy alanine aminotransferase level was associated with the development of preeclampsia in a subsequent pregnancy. Further studies are needed to evaluate whether early intervention for liver function before pregnancy can decrease the risk of preeclampsia.

ATHEROGENIC PARAMETERS AND CARDIAC INDICES IN PROGNOSTICATION OF DEVELOPMENT OF PRE-ECLAMPSIA AND ITS CARDIOMETABOLIC CONSEQUENCES

Aim of the work. The study of interconnection between atherogenic parameters of the blood serum and cardiac indices during pregnancy with the risk of pre-eclampsia development and prognostication of remote cardio-vascular and/or metabolic pathology among pregnant. Materials and methods. The indices of lipid metabolism in the blood serum of 267 pregnant women were studied using diagnostic sets of reagents. The blood sampling was carried out in II (16-24 gestational weeks) trimester. The general cholesterol (GC) and triglycerides (TG) were determined by colorimetric and enzymatic method; high-density lipoproteins – HDL – by homogenous method of direct determination of HDL-cholesterol concentration in the blood serum without preliminary processing and centrifugation, low-density lipoproteins – LDL – by the direct method. VLDL concentration was calculated by Friedewald formula: LDL = TG/2,2. For evaluation of GC-VLDL concentration TG/2,2 parameter is used, if TG concentration is expressed in mmol/l (or TG/5, if concentration is expressed in mg/100 ml). Cardiac indices were calculated taking into account the lipid parameters according to the correspondent mathematical formulas. Lactate and LDH concentrations were determined by optimized method using diagnostic reagents. Lactate concentration was determined at the use of diagnostic set for determination of lactate concentration, and DLH was also determined by diagnostic set for determination of LDH (DL) activity by optimized method, elaborated taking into account the recommendations of German Association of clinical chemistry (DGKC) after correspondent calibration of automatic analyzer ACCENT-200 II GEN. Depending on the development of clinical presentation of PE 43 women were divided in groups with light and middle severity of course of this pathology. Results and discussion. Among the women with PE development was observed the essential changes in II trimester in the aspect of atherogenic parameters and cardiac indices mainly at the expense of progressing increase of TG in the blood serum (mmol/l: I group - 1,73 ± 0,14, II group - 1,86 ± 0,18 comparing with III control group - 1,51 ± 0,06. The gradual growth of cardiac (atherogenic) indices - AIP, CR and CА and connection between AIP and the levels of maternal serumal TG and arterial pressure were observed in women with PE development at the absence of such connection among the women of control group (p &lt;0,05) . LDH level grew with the progressing of PE severity: for the women of I group LDH level was - 389 ± 1,6 U/l at 778 ± 0,25 in women of II group and 265 ± 0,19 in the control group (p &lt;0,05). Conclusions. It was demonstrated, that hypertriglyceridemia at pregnancy is a predicator relative to PE development and together with progressive growth of atherogenic indices can be considered as prognostic factor for cardiometabolic pathology, especially in women with undergone severe forms of this pathology. It was established, that the increase of LDH level since the second trimester can also testify to the development of PE and remote cardiac pathology in this category of women.

Validity of platelet indices in predicting the risk of developing preeclampsia

The aim of this study was to evaluate the validity of platelet count (PC) and indices, including mean platelet volume (MPV), platelet distribution width (PDW) and platelet crit (PCT), in identifying the pregnancies at risk for preeclampsia. Demographic data and laboratory tests for PC, MPV, PDW and PCT of 250 pregnant women (100 normotensive pregnants, 121 pregnants with severe preeclampsia and 29 pregnants with mild preeclampsia) were retrospectively analyzed. Platelet counts and indices were compared between the study groups. MPV and PDW were significantly higher in preeclamptic pregnant women when compared to the normal group (p=0.006, p=0.046) and area under ROC curve for MPV was found statistically significant. PC, MPV and PCT were found significantly increased in late-onset preeclampsia (p<0.05) whereas there was no significant difference in these three indices in terms of severity of the disease. ROC analysis for MPV levels to differentiate earlyonset and late-onset preeclamptic cases was also found statistically significant. Measurement of MPV may contribute to identify the pregnants at risk for preeclampsia and assess the onset-time. PDW may be also useful in detection of the pregnant at risk for preeclampsia.

Utility of Placental Laterality and Uterine Artery Doppler Abnormalities for Prediction of Preeclampsia.

To find out whether placental laterality and abnormal uterine artery waveform and resistance index, as determined by antenatal ultrasonography and Doppler, can be used as a predictor for the development of preeclampsia. This prospective observational cohort study was conducted from August 2013 to October 2014. Two hundred and one (201) normotensive, primigravida women with singleton pregnancies attending the antenatal clinics without any high-risk factor for development of hypertension were subjected to ultrasonography at 18-22weeks of gestation to determine the placenta location. All the subjects with lateral placentas were subjected to Doppler ultrasonography to look for abnormal Doppler waveform and resistance index. They were followed for the development of preeclampsia till 40weeks of gestation or delivery. Out of the total 201 women, 71 (24.5%) had laterally located placentas and of them 37 (52%) developed preeclampsia, while the remaining 130 (75.5%) had centrally located placentas and of them 14 (10.8%) developed preeclampsia (p<0.001). In subjects with lateral placentas alone (n=33), 2 (6%) developed preeclampsia while as those with lateral placentas with Doppler abnormality (n=38), 35 (92%) developed preeclampsia (p<0.001). The overall risk of developing preeclampsia with laterally located placenta was 9.27 (odds ratio), and 95% confidence interval was (4.30-19.98). Pregnant women with lateral placentas are at significant risk for development of preeclampsia. Lateral placentas when associated with uterine artery Doppler abnormality, risk for development of preeclampsia increases significantly as compared to lateral placentas alone.