Microalbuminuria is a predictor of adverse pregnancy outcomes including preeclampsia

ObjectivesAbnormal urinary protein loss is a marker associated with a diverse range of renal diseases including preeclampsia. Current measures of urine protein used in the diagnostic criteria for the diagnosis of preeclampsia includes urine protein:creatinine ratio and 24-h urine protein. However very little is known about the value of urine albumin:creatinine ratio (uACR) in pregnancy. In this study we examined the prognostic value of microalbuminuria detected antepartum to predict adverse pregnancy outcomes.DesignThis is a single-centre retrospective analysis of 84 pregnant women over the age of 16 attending a tertiary ‘high-risk’ pregnancy outpatient clinic between July 2010 and June 2013. Utilising medical records, antepartum peak uACR level and pregnancy maternal and fetal outcomes were recorded.FindingsThe primary outcome was a composite of poor maternal and fetal outcomes including preeclampsia, maternal death, eclampsia, stillbirth, neonatal death, IUGR, premature delivery and placental abruption. As the antepartum peak uACR level (in mg/mmol) increased from normoalbuminuria (uACR < 3.5) to microalbuminuria (uACR 3.5–35) to macroalbuminuria (>35), the percentage of women with the primary composite outcome increased in a stepwise fashion (13.8% to 24.1% to 62.1% respectively, p < 0.001). After adjusting for covariates including history of hypertension, chronic kidney disease and aspirin therapy during pregnancy, micro- and macroalbuminuria remained significant predictors of the primary outcome.ConclusionsWe have shown that antepartum peak uACR is a useful simple marker to help predict adverse maternal and fetal outcomes. Further studies are required to utilise uACR as a prognostic tool in pregnancy before it can be applied in clinical practice.     

Risk for recurrence of preeclampsia and outcome of subsequent pregnancy in women with preeclampsia in their first pregnancy

Objective: To assess subsequent pregnancy outcome and to identify risk factors for recurrence of preeclampsia (PET) in women with PET in their first pregnancy. Methods: A retrospective cohort study of all nulliparous women diagnosed with PET during the years 1996–2008 (PET group, N = 600). Outcome of subsequent pregnancy was compared with a control group of nulliparous women without PET matched by maternal age in a 3:1 ratio (N = 1800). Results: Subsequent pregnancies in the PET group were characterized by a higher rate of preterm delivery at less than 37 and 34 weeks (15.2% vs. 5.7%, p < 0.001 and 3.8% vs. 0.8%, p < 0.001, respectively), placental abruption (1.7% vs. 0.2%, p = 0.004), IUGR (2.8% vs. 0.9%, p = 0.016), and PET (5.9% vs. 0.8%, p < 0.001). Risk factors for PET and adverse outcome in the subsequent pregnancy included: PET complicated by placental abruption in the index pregnancy (OR = 10.8, 95%-CI = 1.8–34.6), PET requiring delivery prior to 34 weeks in the index pregnancy (OR = 6.5, 95%-CI = 1.6–22.5), chronic hypertension (OR = 5.3, 95%-CI = 1.9–12.7), and maternal age > 35 (OR = 4.3, 95%-CI = 1.2–20.5). Conclusion: PET in the first pregnancy is independently associated with an increased risk for adverse pregnancy outcome and recurrence of PET in the subsequent pregnancy in a manner that is related to the severity of PET in the first pregnancy.     

子痫前期再妊娠问题

患有子痫前期再次妊娠女性为子痫前期的高危人群,再次妊娠时面临诸多问题,应给予高度重视。提高产前保健水平和产科诊治能力是临床重要课题,努力做到早预防、早发现以及早治疗。     

子痫前期再发与初发的临床特点及妊娠结局的研究

目的:探讨子痫前期(PE)再发与初发的临床特点及相关影响因素。方法:回顾分析2010年8月至2015年5月在我院住院并分娩的PE孕产妇的临床资料,其中PE再发组(RPE组)50例,经产妇初发组(MPE组)173例,初产妇初发组(PPE组)230例。结果:RPE组与MPE组的家族史、体重指数(BMI)、疾病严重程度及新生儿情况、不良妊娠结局(胎儿生长受限、胎盘早剥、HELLP综合征)、产检情况、分娩方式等均无明显差异(P0.05)。RPE组的分娩孕周早于MPE组,其中合并慢性高血压及糖尿病要多于MPE组,差异有统计学意义(P0.05)。RPE组与PPE组的分娩孕周、诊断孕周、BMI、合并慢性高血压、最高收缩压、舒张压及S/D比值、分娩方式、新生儿出生1min Apgar评分及是否规律产检比较,差异均有统计学意义(P0.05);MPE组与PPE组比较时,这些差异仍存在。结论:子痫前期再发组的分娩孕周、诊断孕周与初次发生子痫前期患者相比缩短,疾病严重程度明显高于初发初产组,且内科合并症及不良妊娠结局增加,新生儿出生情况较差。此外,BMI增加以及不规律产检也是其再发的影响因素。     

早孕期口服地屈孕酮与新鲜周期辅助生殖单胎孕妇子痫前期发生的关联性

目的探究早孕期口服地屈孕酮与新鲜周期辅助生殖单胎孕妇子痫前期发病的关联性。方法收集2008年1月—2016年6月接受胚胎移植新鲜周期辅助生殖且本院分娩的756例单胎孕妇病例资料进行回顾性队列研究。按照早孕期孕激素黄体支持是否加用地屈孕酮,分为地屈孕酮组(黄体酮/雪诺酮+地屈孕酮)196例和对照组(黄体酮/雪诺酮)560例,比较组间孕妇子痫前期的发病率。采用Logistic回归分析,探究地屈孕酮与子痫前期发生的关联关系。结果地屈孕酮组子痫前期发病率(1.0%)低于对照组(4.5%,P=0.025)。地屈孕酮组配偶年龄≥40岁、孕妇合并症的比例均高于对照组(P值分别为0.037、0.048)。将地屈孕酮、配偶年龄及孕妇合并症纳入Logistic回归分析。多因素分析显示仅地屈孕酮和子痫前期有统计学意义的关联(OR=0.221,95%CI=0.052~0.940,P=0.041)。结论早孕期口服地屈孕酮是新鲜周期辅助生殖孕妇子痫前期发生的保护因素。     

Calcium level during the first trimester of pregnancy as a predictor of preeclampsia

Objective: To examine the association between calcium levels during the first trimester of pregnancy and preeclampsia. Methods: The study population included registered births (n?=?5233) in a tertiary medical center between 2001 and 2011. A comparison was performed between women with and without hypocalcemia during the first trimester of pregnancy. A second analysis was performed after correcting calcium levels for albumin. Multiple logistic regression models were used to control for confounders. Receiver operating characteristic curve analysis graphs were used to describe the relationship between the true-positive rate (sensitivity) and the false-positive rate for different values of calcium during the first half of pregnancy in the prediction of preeclampsia. Results: Of 5233 deliveries, 841 (16%) had hypocalcemia and 4392 (84%) had a normal calcium level. No significant difference were found between the groups regarding mild preeclampsia [odds ratio (OR) = 1.216; 95% confidence interval (CI) 0.831–1.779; p?=?0.312], severe preeclampsia (OR?=?1.618; 95% CI 0.919–2.849; p?=?0.092) and any hypertensive disorders (OR?=?1.324; 95% CI 0.963–1.821; p?=?0.083). Conclusions: Hypocalcemia during the first trimester of pregnancy is not a risk factor for preeclampsia.     

高龄孕妇子痫前期并发胎盘早剥妊娠结局分析

目的 探讨高龄对子痫前期并发胎盘早剥母儿结局的影响.方法 回顾性分析2017年1月至2019年12月在广州医科大学附属第三医院住院分娩的子痫前期并发胎盘早剥、单胎妊娠患者40例,以年龄≥35岁者为高龄组(14例),年龄<35岁者为对照组(26例),比较两组患者的临床资料特点、生化指标及围产儿结局.结果(1)两组孕妇一般...     

Plasma hemopexin activity in pregnancy and preeclampsia.

OBJECTIVE: Plasma hemopexin activity, associated with increased vascular permeability, was evaluated in healthy pregnant and non-pregnant women and in pre-eclamptic women. METHODS: Hemopexin activity and the hemopexin inhibitor, extracellular ATP, were assayed in plasma from pregnant (n = 10), preeclamptic (n = 9), and non-pregnant women (n = 10) using standard methods. Abdominal fascia tissue fragments from preeclamptic and pregnant women were immunohistochemically stained for vascular ecto-apyrase or ecto-5'nucleotidase. RESULTS: The data show significantly enhanced Hx activity exclusively in plasma from pregnant women and significantly enhanced plasma ATP in pre-eclamptic women compared with the other groups. Dephosphorylation of preeclamptic plasma resulted in reactivation of Hx activity. Fascia tissue-samples from preeclamptic women showed reduced ecto-apyrase activity and enhanced ecto-5'nucleotidase activity compared to pregnant women. CONCLUSION: Enhanced hemopexin activity may be associated with normal pregnancy, but not with preeclampsia. Decreased hemopexin in pre-eclamptic patients may be due to enhanced plasma ATP, which is possibly promoted by diminished activity of vascular ecto-apyrase.     

多胎妊娠如何预防子痫前期

子痫前期是妊娠期的严重并发症,可引起多器官功能损害。随着辅助生殖技术的应用、二孩政策的放开,多胎妊娠发生率呈上升趋势。由于多胎妊娠的特殊生理变化,其子痫前期发生率高于单胎妊娠。目前,关于单胎妊娠中子痫前期的发生、预测与预防的研究较多,但关于多胎妊娠的研究较少。文章将对多胎妊娠中子痫前期的风险预测、预防及治疗进行阐述。     

孕早期双胎妊娠甲状腺功能减退对妊娠结局的影响

Objective?To investigate the impact of hypothyroidism of twin pregnancy in first trimester on pregnancy outcomes. Methods?A total of 1 203 cases of twin pregnant women were enrolled in this retrospective study and divided into three groups based on maternal TSH concentration in first trimester. Normal TSH group contained twin pregnant women with TSH levels between 0.01 to 3.35 mIU/L in first trimester, TSH>3.35 group contained twin pregnant women whose TSH concentrations between 3.35 to 4 mIU/L, TSH>4 group included those with TSH levels beyond 4 mIU/L. The pregnancy outcomes were analyzed between three groups. Results?Logistics analysis between maternal TSH levels and pregnancy outcomes of twin pregnancy showed TSH beyond 4 mIU/L in first trimester was corelated with the incidence of gestational diabetes mellitus (GDM), and its OR was 3.48, 95% CI was 1.27~9.55. Conclusion?The risk of GDM in twin pregnant women with hypothyroidism in first trimester may increase and TSH>4 mIU/L was one of independent risk factors of GDM.     

子痫前期并发胎儿生长受限的临床特征及妊娠结局分析

目的 探讨子痫前期并发胎儿生长受限(fetal growth restriction,FGR)的临床特征及母儿结局.方法 回顾性分析2009年1月1日至2019年12月31日在广州医科大学附属第三医院产科就诊并分娩的单胎子痫前期患者的病例资料,根据是否合并FGR,分为FGR组和对照组,分析两组的临床特征及母儿结局.结果...     

Reduced dose of Rh immunoglobulin following first trimester pregnancy termination.

The efficacy and safety of a 50-microgram dose of Rh immune globulin for prevention of Rh isosensitization following first trimester vacuum abortion are evaluated in this study. A total of 1027 women undergoing abortion at three outpatient facilities participated in the study; 755 (73.5%) completed follow-up serologic screening 6 months after termination of pregnancy. None showed serologic evidence of Rh sensitization at the time of followup. No serious adverse reactions to the drug were observed.     

Changes in circulating alphafetoprotein following administration of mifepristone in first trimester pregnancy.

The occurrence of fetomaternal haemorrhage was investigated in 30 women by measuring maternal serum alphafetoprotein (AFP) levels before and after the administration of mifepristone (RU 486) for termination of first trimester pregnancy. A significant rise in AFP levels was seen in 21 women (70%), the increase ranging from 6 to 660% of baseline levels. The apparent frequency of fetomaternal haemorrhage was similar to that reported previously for surgical termination of first trimester pregnancies.     

Obstetric outcomes subsequent to intrauterine death in the first pregnancy

Objective  To compare obstetric outcomes in the pregnancy subsequent to intrauterine death with that following live birth in first pregnancy.
Design  Retrospective cohort study.
Setting  Grampian region of Scotland, UK.
Population  All women who had their first and second deliveries in Grampian between 1976 and 2006.
Methods  All women delivering for the first time between 1976 and 2002 had follow up until 2006 to study their next pregnancy. Those women who had an intrauterine death in their first pregnancy formed the exposed cohort, while those who had a live birth formed the unexposed cohort.
Main outcome measures  Maternal and neonatal outcomes in the second pregnancy, including pre-eclampsia, placental abruption, induction of labour, instrumental delivery, caesarean delivery, malpresentation, prematurity, low birthweight and stillbirth.
Results  The exposed cohort ( n = 364) was at increased risk of pre-eclampsia (OR 3.1, 95% CI 1.7–5.7); placental abruption (OR 9.4, 95% CI 4.5–19.7); induction of labour (OR 3.2, 95% CI 2.4–4.2); instrumental delivery (OR 2.0, 95% CI 1.4–3.0); elective (OR 3.1, 95% CI 2–4.8) and emergency caesarean deliveries (OR 2.1, 95% CI 1.5–3.0); and prematurity (OR 2.8, 95% CI 1.9–4.2), low birthweight (OR 2.8, 95% CI 1.7–4.5) and malpresentation (OR 2.8, 95% CI 2.0–3.9) of the infant as compared with the unexposed cohort ( n = 33 715). The adjusted odds ratio for stillbirth was 1.2 and 95% CI 0.4–3.4.
Conclusion  While the majority of women with a previous stillbirth have a live birth in the subsequent pregnancy, they are a high-risk group with an increased incidence of adverse maternal and neonatal outcomes.     

First trimester sex hormone-binding globulin and subsequent development of preeclampsia or other adverse pregnancy outcomes.

OBJECTIVE: To investigate whether first trimester maternal serum sex hormone-binding globulin (SHBG) concentrations are altered in women who subsequently develop preeclampsia or other pregnancy complications. POPULATION: Women undergoing first trimester combined ultrasound and biochemical screening for chromosomal anomalies. We searched the database and identified 32 pregnancies resulting in miscarriage, 64 pregnancies with preexisting or gestational diabetes mellitus, 107 with fetal growth restriction, 103 with preeclampsia, 64 with pregnancy-induced hypertension, and 26 with spontaneous preterm delivery. We also selected 400 controls from among the population of pregnancies that had a delivery of a normal baby with no pregnancy complications. METHODS: Maternal serum SHBG concentrations were measured retrospectively using a competitive chemiluminescent immunoassay. The levels between those with normal outcome and those resulting in adverse outcome were compared. RESULTS: The median maternal serum SHBG concentration was not significantly different from controls, in those that subsequently developed preeclampsia (median MoM 1.05), non-proteinuric hypertension (median MoM 0.94) or preterm delivery (median MoM 1.15). The levels were significantly lower in those with diabetes (median MoM, 0.81 p=0.0005) and those pregnancies resulting in miscarriage (median MoM 0.80, p=0.008). CONCLUSION: First trimester maternal serum SHBG concentrations are no different from controls in women who subsequently develop preeclampsia, pregnancy-induced hypertension, fetal growth restriction, or preterm delivery. Levels are reduced in those who subsequently miscarry or in those presenting with diabetes.