Serum activin A, inhibin A, and follistatin concentrations in preeclampsia or small for gestational age pregnancies

OBJECTIVE: To determine whether maternal serum activin A, inhibin A, and follistatin concentrations in idiopathic small for gestational age (SGA) pregnancies are similar to those in normal pregnancies or elevated as in preeclampsia. METHODS: Maternal serum activin A, inhibin A, and follistatin concentrations were determined in 1) nulliparous women with idiopathic SGA (birth weight <10th percentile; n = 18), preeclampsia (systolic blood pressure > or =140 mmHg or diastolic blood pressure > or =90 mmHg plus proteinuria > or =2+ or >0.3 g/24h; n = 22), and normotensive controls, matched for gestational age at sampling (n = 22), and 2) a longitudinal series of samples collected at five intervals throughout pregnancy from nulliparous women with idiopathic SGA (n = 19), preeclampsia (n = 22), preeclampsia plus SGA (n = 15), or who had uncomplicated pregnancies (n = 20). RESULTS: Serum concentrations of activin A and inhibin A were similar in idiopathic SGA pregnancies to controls. In preeclampsia, activin A and inhibin A levels were markedly increased compared with controls or women with idiopathic SGA (P <.001), particularly in those with early-onset disease. Follistatin concentrations were only modestly (相似文献   

Inhibin-A and superimposed preeclampsia in women with chronic hypertension

OBJECTIVE: To determine if maternal serum inhibin-A can be used as a marker for subsequent development of superimposed preeclampsia in women with chronic hypertension. METHODS: Serum for measurement of inhibin-A was obtained at monthly intervals in women with chronic hypertension requiring antihypertensive medications. Superimposed preeclampsia, the primary outcome of interest, was diagnosed when hypertensive women developed proteinuria (at least 300 mg per 24-hour urine specimen). Serum inhibin-A was considered abnormally elevated when the value exceeded the mean plus two standard deviations of the log for chronically hypertensive women who did not develop preeclampsia. RESULTS: A total of 61 women were enrolled in this study, and 21 (34%) developed superimposed preeclampsia. Inhibin-A levels increased with advancing gestational age. Ten women had abnormally increased inhibin-A levels; eight (80%) developed superimposed preeclampsia, compared with 13 of 51 (26%) women with normal inhibin-A levels (P <.001). Sensitivity and specificity were 38% and 95%, respectively, whereas the positive and negative predictive values were 80% and 75%, respectively. CONCLUSION: Although inhibin-A was abnormally increased an average of 3 weeks before the clinical onset of superimposed preeclampsia, the sensitivity of the test as a screen was too limited to be clinically useful.     

Serum levels of activin A and inhibin A are not related to the increased susceptibility to pre-eclampsia in type I diabetic pregnancies

BACKGROUND: Activin A and inhibin A have been found to be elevated in women without diabetes subsequently developing pre-eclampsia. The aim was to investigate whether activin A and inhibin A in serum were elevated in type I diabetic women after developing pre-eclampsia and, if so, were they clinically useful as predictors of pre-eclampsia. METHODS: In a prospective study, maternal serum was analyzed for activin A and inhibin A in 115 women with type 1 diabetes at 10, 14, 22, 28, and 33 weeks of gestation. RESULTS: Fourteen women (12%) developed pre-eclampsia (26-37 weeks of gestation) and 101 did not. The two groups were comparable regarding age, body mass index, and diabetes duration. There was no difference between serum concentrations of activin A and inhibin A in women developing pre-eclampsia and women who did not at any gestational period. CONCLUSIONS: Serum concentrations of activin A and inhibin A could not predict preeclampsia in type I diabetes.     

Maternal serum nitric oxide levels associated with biochemical and clinical parameters in hypertension in pregnancy

OBJECTIVES: To measure maternal serum concentrations of total nitrites, as an index of nitric oxide synthesis, in normal and hypertensive pregnant women, and to examine the correlation between these concentrations and several variables of clinical interest. STUDY DESIGN: A total of 60 women in four different groups were studied: 10 normotensive pregnant women, 17 pregnant women with preeclampsia, 18 pregnant women with gestational hypertension and 15 pregnant women with chronic hypertension. Serum nitrite levels were determined using the Griess reaction after reduction with nitrate reductase. RESULTS: Serum nitrite levels were higher in preeclamptic women (34.11+/-14 micromol/l, P=0.04), lower in chronic hypertensive women (19.56+/-6.46 micromol/l, P=0.04) and similar in women with gestational hypertension (26.97+/-9.44 micromol/l) in comparison to the control group (25.37+/-7.24 micromol/l). Serum nitrite levels in preeclamptic women had significant positive correlations with hematocrit, fasting insulinemia, and apolipoprotein B and negative correlations with platelet count, serum phosphorus and glucose:insulin ratio. In pregnant women with chronic hypertension a negative correlation was found between serum nitrite levels and active partial thromboplastin time. In pregnant women with gestational hypertension, serum nitrite levels had negative correlations with birthweight and 24-h urine calcium, and positive correlations with mean corspuscular hemoglobin, 24-h urine sodium and maternal age. CONCLUSIONS: We suggest that in women with preeclampsia, a higher maternal nitric oxide level may act as a compensatory mechanism against hemoconcentration and platelet aggregation and that nitric oxide production may be related to some metabolic events. In women with gestational hypertension, higher serum nitrite levels may be related to clinical and biochemical findings common in preeclampsia. In chronic hypertension, a lower maternal nitric oxide level is related to the status of coagulation.     

Inhibins and Activin A in hypertensive Disorders of Pregnancy and HELLP-Syndrome

OBJECTIVE: Are serum concentrations of the ovarian glycoproteins inhibin A, inhibin B, pro-alpha-C and activin A different in normotensive, chronical hypertensive or pregancies complicated by preeclampsia or HELLP-syndrome? What are the clinical consequences? METHODS: Serum concentrations of inhibin A, inhibin B, pro-alpha-C, and activin A of 99 women (37 normotensive patients, 23 patients with chronical hypertension, 25 women with preeclampsia and 14 patients with HELLP-syndrome) at different stages of pregnancy were determined by high specific ELISAS. RESULTS: During pregnancy serum levels of all parameters increased continually and fell rapidly within parturition. Activin A and inhibin B levels showed significant higher serum concentrations in patients with preeclampsia and - even more pronounced - in patients with HELLP-syndrome. Normotensive and chronically hypertensive patients were not different. CONCLUSION: Activin A and inhibin A appear to be viable candidates as laboratory parameters for detection of pregnancy induced hypertension. Maybe furthermore both parameters will allow the discrimination between chronic hypertension and hypertension induced by pregnancy.     

Inhibin-A levels and severity of hypertensive disorders due to pregnancy

OBJECTIVE: To evaluate the use of 3rd trimester inhibin-A levels as an adjunct to assess severity of hypertensive disorders due to pregnancy in women evaluated for preeclampsia. METHODS: Serum inhibin-A concentration was measured in a consecutive series of women evaluated for preeclampsia in the third trimester of pregnancy. RESULTS: Inhibin-A levels were significantly associated with the severity of proteinuric hypertensive disease due to pregnancy. Women with gestational hypertension or those with chronic hypertension without superimposed preeclampsia had levels comparable with normotensive women. The sensitivity to detect proteinuric hypertension was 16%. CONCLUSION: Although inhibin-A levels rise with increasing severity of disease, due to considerable overlap of normal and abnormal serum levels in women with and without preeclampsia, inhibin-A is not a useful adjunct for the classification of hypertensive disorders due to pregnancy.     

激活素A和卵泡休止素与先兆子痫的相关性研究

目的　探讨先兆子痫患者血清中激活素A和卵泡休止素水平及其mRNA在胎盘组织中的表达 ,及其与先兆子痫发病的关系。方法　 2 0例足月妊娠先兆子痫孕妇作为先兆子痫组 ,2 0例足月妊娠血压正常孕妇作为对照组。应用酶联免疫吸附试验 (ELISA)检测两组孕妇血清中激活素A和卵泡休止素水平。应用半定量逆转录 聚合酶链反应 (RT PCR)技术检测两组孕妇分娩后胎盘组织中激活素AmRNA和卵泡休止素mRNA的相对表达强度。将两组孕妇的胎盘组织激活素AmRNA的表达强度与血清激活素A水平进行直线相关分析。结果　 (1)先兆子痫组孕妇血清中激活素A水平为 (33 7± 6 6 ) μg/L ,明显高于对照组的 (9 9± 2 1) μg/L(P <0 0 1)。先兆子痫组孕妇血清中卵泡休止素水平为 (5 1± 0 6 ) μg/L ,与对照组的 (4 7± 0 3) μg/L比较 ,差异无显著性 (P >0 0 5 )。 (2 )先兆子痫组胎盘组织中激活素AmRNA为 1 11± 0 2 1,明显高于对照组的 0 6 1± 0 17(P <0 0 1)。先兆子痫组胎盘组织中卵泡休止素mRNA为 0 5 7± 0 31,与对照组的 0 5 4± 0 2 7比较 ,差异无显著性 (P >0 0 5 )。(3)在先兆子痫组和对照组孕妇中 ,血清中激活素A水平与胎盘组织激活素AmRNA相对表达强度呈正相关 [相关系数 (r) =0 89,P <0 0 1]。结论     

Adhesion molecules,activin and inhibin—candidates for the biochemical prediction of hypertensive diseases in pregnancy?

Background The aim of the prospective study was to compare standard parameters as Doppler ultrasound and 24-h blood pressure measurement with possible maternal serological markers regarding their prognostic value in predicting hypertensive diseases in pregnancy.Materials Twenty-four-hour blood pressure measurement was performed before and after 32+0 gestational week in 57 pregnant women with either chronic hypertension (n=13), preeclampsia (n=21), pregnancy-induced hypertension (PIH; n=12) or normotension (n=11). Blood samples were taken and the concentrations of soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), activin A and inhibin A were determined as well as serum uric acid, creatinine, total serum protein and serum albumin. Doppler ultrasound of the uterine arteries was examined before 32+0 gestational week in the same patients. For the statistical evaluation Kruskal-Wallis-Test and Mann-Whitney-U-Test were performed. Differences in the predictive value were evaluated by receiver-operating characteristics.Results VCAM-1 was significantly elevated in women developing hypertensive diseases as compared to normotensive women (preeclampsia: p<0.001; PIH: p<0.05; chronic hypertension: p<0.001). In early pregnancy activin A and inhibin A were significantly higher in preeclamptic patients than in the other groups (activin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.005) (inhibin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.01), thus suggesting them to be specific markers for the development of preeclampsia. Mean arterial pressure was significantly elevated in preeclampsia (p<0.001) and chronic hypertension (p<0.005) as compared to normotensives.Conclusion Twenty-four-hour blood pressure monitoring with determination of mean arterial pressure and measurement of VCAM-1, activin A and inhibin A as serum parameters can be suggested as useful tests in the specific prediction of different types of hypertensive diseases in pregnancy.Abbreviations AUC Area under the curve - ELISA Enzyme-linked immunosorbent assay - ICAM-1 Intercellular adhesion molecule-1 - MAP Mean arterial pressure - PI Pulsatility index - PIH Pregnancy-induced hypertension - ROC Receiver-operating characteristic - s Soluble - SD Standard deviation - VCAM-1 Vascular cell adhesion molecule-1 - g.w. Gestational week     

Comparison of maternal serum total activin A and inhibin A in normal, preeclamptic, and nonproteinuric gestationally hypertensive pregnancies.

OBJECTIVE: The aim of the study was to compare maternal serum levels of activin A and inhibin A in pregnancy complicated by preeclampsia, pregnancy complicated by gestational hypertension, and normal pregnancy from 25 to 42 weeks' gestation. STUDY DESIGN: Activin A and inhibin A levels were measured by 2-site enzyme-linked immunosorbent assay in 60 subjects with preeclampsia, 60 control normotensive pregnant women matched for gestational age, and 51 unmatched subjects with gestational hypertension. RESULTS: Activin A levels were higher in the preeclampsia group (median 31.5 ng/mL and interquartile range 10.5 ng/mL) than in the control group (median 10.6 ng/mL and interquartile range 9.5 ng/mL, P <.0001) and the gestational hypertension group (median 21.4 ng/mL and interquartile range 15.2 ng/mL, P <.003). Inhibin A levels were greater in the preeclampsia group (median 1833 pg/mL and interquartile range 1464 pg/mL) than in control subjects (median 698 pg/mL and interquartile range 583 pg/mL, P <.0001). Control levels were significantly related to gestational age. CONCLUSIONS: Levels of both analytes were greater in preeclampsia and activin A levels were greater in gestational hypertension than in normotensive pregnancy. These analytes may prove to be clinically useful laboratory markers for preeclampsia.     

Evaluation of natural coagulation inhibitor levels in various hypertensive states of pregnancy

OBJECTIVE: To evaluate the role of natural coagulation inhibitors in various classifications of pregnancy associated hypertension in Turkish population living in Trakya region of Turkey. STUDY DESIGN: Serum uric acid levels, plasma protein C (PC), protein S (PS), antithrombin III (AT III) activities and activated protein C resistance (APCR) were measured in 80 pregnant women with hypertension (preeclampsia, n = 32; severe preeclampsia, n = 25; eclampsia, n = 14; chronic hypertension, n = 9) and 58 healthy pregnant women. Tukey and Tamhane multiple comparison tests, Kruskal-Wallis, chi2 and Fisher's exact tests were performed for comparison of means and/or medians. RESULTS: Serum uric acid levels were significantly elevated in women with preeclampsia and severe preeclampsia, but PS activity decreased in women with severe preeclampsia (33.2 +/- 18.9% versus 50.4 +/- 22.7%, p = 0.015) and chronic hypertension (29.5 +/- 14.5% versus 50.4+ /- 22.7%, p = 0.045) compared to healthy controls. There was no significant difference in APCR, and PC or AT III activity between the groups. Platelet counts were significantly lower in women with severe preeclampsia, compared to controls and women with chronic hypertension. CONCLUSION(S): Serum uric acid levels and plasma protein S activity may be useful as indices of severity of pathology in pregnancy associated hypertension.     

Corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A in maternal serum: prediction of preterm delivery and response to glucocorticoids in women with symptoms of preterm labor

OBJECTIVE: The aim of this study was to determine prospectively whether serum concentrations of corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A (1) predict preterm birth within 10 days of hospital admission or at <37 weeks' gestation among women with symptoms of preterm labor and (2) are affected by glucocorticoid therapy. STUDY DESIGN: Serum concentrations of corticotropin-releasing hormone and activin A were measured in 94 women with symptoms of preterm labor between 24 and 34 weeks' gestation, and delivery outcomes were monitored. Corticotropin-releasing hormone-binding protein concentrations were measured in 71 of these women. In a subgroup of 15 women the serum analytes were assayed in conjunction with estriol before and 12 to 24 hours after administration of dexamethasone. RESULTS: Forty-six percent (6/13) of the women who were delivered within 10 days of hospital admission had a raised serum corticotropin-releasing hormone level, but the predictive relationship was not significant (chi(2) = 1.7; P =.2). Among the 31 women (including the 6 previously mentioned) who were delivered at <37 weeks' gestation, 39% (12/31) had a raised corticotropin-releasing hormone level. Although a raised corticotropin-releasing hormone concentration was positively associated with delivery at <37 weeks' gestation (chi(2) = 9; P =.003), the predictive diagnostic value was poor, with sensitivity, specificity, and positive and negative predictive values of 39%, 90%, 67%, and 75%, respectively. The serum concentrations of corticotropin-releasing hormone-binding protein and activin A were unrelated to gestational age at delivery. Dexamethasone markedly lowered the serum estriol level (P <.001) but had no effect on concentrations of corticotropinreleasing hormone, corticotropin-releasing hormone-binding protein, and activin A. CONCLUSION: Serum concentrations of corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A are not clinically useful for the prediction of preterm delivery among women with symptoms of preterm labor and are not affected by administration of glucocorticoids.     

Incidence of superimposed preeclampsia among pregnant Asian women with chronic hypertension

Objective: To determine the incidence and associated factors of superimposed preeclampsia among pregnant women with chronic hypertension.

Methods: A total of 300 pregnant women diagnosed with chronic hypertension were reviewed. Data were retrieved from medical records, including obstetric data, characteristics of hypertension, and pregnancy outcomes. Incidence of superimposed preeclampsia was estimated. Various characteristics were compared to determine associated risk factors.

Results: Mean age of the cohort was 34.3 years, 47% were nulliparous, 50% had hypertension before pregnancy, and the others presented with hypertension before 20 weeks. Incidence of superimposed preeclampsia was 43.3% (95% confidence interval (CI) 37.8–48.9). Women with superimposed preeclampsia were significantly more likely to have mean arterial pressure (MAP) ≥105 mmHg at 18–20 and 24–28 weeks. Adverse neonatal outcomes were significantly more common among women with superimposed preeclampsia, including small for gestational age, low birth weight, asphyxia, and neonatal intensive care unit admission. Logistic regression analysis demonstrated that only MAP ≥105 mmHg at 24–28 weeks was independently associated with the increased risk of superimposed preeclampsia by 1.8-fold (adjusted OR 1.8, 95% CI 1.1–3.1, p = 0.031).

Conclusion: Incidence of superimposed preeclampsia was 43.3% among pregnant women with chronic hypertension, with increased adverse neonatal outcomes. High MAP ≥105 mmHg during late second trimester might be an important predictor of the condition.     

PRORENIN CONCENTRATION IN THE HYPERTENSIVE DISORDERS IN PREGNANCY

Objective: To evaluate the plasma prorenin levels during the three trimesters of normal pregnancy, their prognostic value, and their correlation with hypertensive disorders of pregnancy.

Design: A prospective study in which plasma prorenin and renin levels were measured in 55 healthy pregnant women and 66 who developed gestational hypertension or preeclampsia. The patients were classified as mild preeclampsia (mild PE), severe preeclampsia (severe PE), chronic hypertension and superimposed preeclampsia upon chronic hypertension (superimposed PE).

Method: Venous blood samples were collected in the first, second and third trimesters and during delivery or cesarean. Plasma renin concentration (PRC) was measured by radioinmmunoassay before and after incubation with trypsin solution. The difference gave plasma prorenin concentration (PProRC).

Results: PRC and PProRC were significantly higher in pregnant women compared with healthy non-pregnant. PRC was significantly increased in the first trimester in the chronic hypertension group and a lower value was found in the first trimester in the superimposed PE compared with those in healthy pregnant women. No differences in other groups were found. PProRC showed a significant lower value in the first and third trimesters in the severe PE group. In the superimposed PE a low value of PProRC similar to those of non-pregnant women was found.

Conclusions: The results show that the different types of hypertension in pregnancy have different profiles of PProRC and PRC in relation to development of preeclampsia. The absence of increase of PProRC in the first trimester of superimposed PE may have a prognostic value.     

Homocysteine plasma concentration levels for the prediction of preeclampsia in women with chronic hypertension

OBJECTIVE: The purpose of this study was to evaluate prospectively midtrimester homocysteine concentration levels for the prediction of superimposed preeclampsia in women with chronic hypertension. STUDY DESIGN: Between March 1, 2000, and February 1, 2002, pregnancies that were complicated by chronic hypertension that required medication had homocysteine, vitamin B(12), and folate concentrations measured between 16 and 20 weeks of gestation. All women received folate supplementation. An upper limit threshold for increased homocysteine was defined as the mean value plus 2 SDs. RESULTS: Fifty-seven women were enrolled. Mean homocysteine concentration levels were 5.1+/-1.7 micromo/L for the 16 women who had preeclampsia compared with 4.7+/-1.3 micromo/L for the 41 women without preeclampsia (P=.56). Two of 16 women with preeclampsia (13%) had concentration levels that exceeded the 95th percentile (6.9 micromo/L) compared with 2 of 41 women (5%) without preeclampsia (P=.31). The sensitivity and specificity were 13% (95% CI, 1.6-38.3) and 95.1% (95% CI, 83.5-99.4), respectively. CONCLUSION: Second-trimester homocysteine concentration levels were not helpful in the prediction of preeclampsia in chronically hypertensive women.     

A prediction model for superimposed preeclampsia in women with chronic hypertension during pregnancy

OBJECTIVE: Women with chronic hypertension are at increased risk for superimposed preeclampsia. We developed a prediction algorithm for superimposed preeclampsia using clinical and laboratory information that were measured early in pregnancy. STUDY DESIGN: A secondary analysis of data that were collected from 110 women with chronic hypertension who were enrolled in a trial of calcium supplementation was performed. Blood pressure, the renin-angiotensin system, and calcium metabolism were assessed at 12, 20, 28, and 36 weeks of gestation and 6 weeks after delivery. Multivariable logistic regression was used to develop the predictive model. RESULTS: Thirty-seven women had superimposed preeclampsia. The final model included systolic blood pressure, serum uric acid, and plasma renin activity, which were all measured at 20 weeks of gestation. Women with high systolic blood pressure (>140 mm Hg), elevated uric acid (>3.6 mg/dL), and low plasma renin activity (<4 ng/mL/hr) had an 86% probability of having superimposed preeclampsia. Women with 2 risk factors had a 62% probability of superimposed preeclampsia, and women with only 1 risk factor had a 30% to 40% probability of superimposed preeclampsia. CONCLUSION: We developed a prediction algorithm that can be validated in future studies for superimposed preeclampsia for women with chronic hypertension.     

慢性高血压并发子痫前期的母儿结局分析

目的 了解慢性高血压并发子痫前期与非慢性高血压并发子痫前期患者的临床特征和母儿结局.方法 回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠诊断为子痫前期的病例资料.按是否为慢性高血压分为慢性高血压并发子痫前期组及非慢性高血压并发子痫前期组,分析两组的临床特征与...     

The possible role of endothelial cells in hypertensive disorders during pregnancy.

OBJECTIVE: To clarify the role of endothelial cells in pregnancy-related hypertensive disorders, we studied the cytotoxic effect of sera from normal pregnant women and from gravidas with various hypertensive complications of pregnancy. METHODS: We obtained serum samples from 84 Japanese women: 17 with preeclampsia, ten with gestational hypertension, six with chronic hypertension, five with chronic hypertension with superimposed preeclampsia, 21 normal gravidas, and 25 healthy nonpregnant women. Endothelial cell injury was measured by the release of radiolabeled chromium from the cells into the culture medium. RESULTS: The mean (+/- standard error of the mean) values of chromium 51 release in preeclampsia, gestational hypertension, chronic hypertension, chronic hypertension with superimposed preeclampsia, normal pregnancy, and healthy nonpregnant women were: 21.9 +/- 2.1, 10.0 +/- 2.0, 9.2 +/- 2.3, 12.9 +/- 0.8, 8.4 +/- 1.4, and 7.3 +/- 1.6%, respectively. Normal pregnant and nonpregnant subjects did not differ with respect to endothelial cell injury. Sera from women with preeclampsia demonstrated significantly greater endothelial cell injury than did sera from normal gravidas. Subjects with the three other categories of hypertensive disorders did not differ significantly from normal gravidas. CONCLUSION: Preeclampsia is characterized by the presence of a serum factor cytotoxic to endothelial cells. Therefore, the mechanism responsible for the increase in blood pressure differs between women with preeclampsia and those with other hypertensive disorders in pregnancy.     

Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia.

OBJECTIVE: The current literature emphasizes increased risk of adverse outcomes in the presence of proteinuria and hypertension. The objective of this study was to compare the frequency of adverse fetal outcomes in women who developed hypertensive disorders with or without proteinuria. STUDY DESIGN: The study design was a secondary analysis of data from women who had preeclampsia in a previous pregnancy (n = 598) who were enrolled in a multicenter trial of aspirin for the prevention of preeclampsia. The women had no history of chronic hypertension or renal disease and were normotensive at study inclusion. The maternal and perinatal outcome variables assessed were preterm delivery at <37 and <35 weeks of gestation, rate of small-for-gestational-age infants, and abruptio placenta. Data were analyzed by using the chi-square test, and women who remained normotensive or who had mild gestational hypertension were considered as a single group because they had similar outcomes. RESULTS: As compared to mild preeclampsia, women who developed severe gestational hypertension (without proteinuria) had higher rates of both preterm delivery at <37 weeks of gestation and small-for-gestational-age infants. In addition, when compared to women with mild preeclampsia, for women with severe gestational hypertension, gestational age and birth weight were significantly lower at delivery (P <.003 for both age and birth weight). Moreover, women who developed severe gestational hypertension had higher rates of preterm delivery at <37 weeks of gestation (54.2% vs 17.8%, P =.001) and at <35 weeks of gestation (25.0% vs 8.4%, P =.0161), and delivery of small-for-gestational-age infants (20.8% vs 6.5%, P =.024) when compared to women who remained normotensive or those who developed mild gestational hypertension. There were no statistically significant differences in perinatal outcomes between the normotensive/mild gestational hypertension and the mild preeclampsia groups. Overall, women who had severe gestational hypertension had increased rates of preterm delivery and delivery of small-for-gestational-age infants than women with mild gestational hypertension or mild preeclampsia. In the presence of severe hypertension, proteinuria did not increase the rates of preterm delivery or delivery of small-for-gestational-age infants. CONCLUSIONS: In women who have gestational hypertension or preeclampsia, increased rates of preterm delivery and delivery of small-for-gestational-age infants are present only in those with severe hypertension. In these women, the presence of proteinuria does not influence perinatal outcome.     

Circulating angiogenic factors and placental abruption

OBJECTIVE: Abnormalities in circulating angiogenic factors have been reported in diseases of abnormal placentation, such as preeclampsia and intrauterine growth restriction. Our objective was to determine whether circulating angiogenic factors are altered in another placental vascular disease, abruptio placentae. METHODS: In a nested case-control study of nulliparous pregnancies, we examined levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) in serum collected prospectively from 31 women who later developed placental abruption and from 31 normal control subjects. All serum specimens were collected before the onset of hypertension or abruption and before labor or delivery. Serum angiogenic factors were compared within 3 gestational age windows: early (20 weeks or less), middle (21-32 weeks), and late (33 weeks or more) pregnancy. RESULTS: During early pregnancy women who developed placental abruption had lower PlGF and higher sFlt-1 concentrations and higher sFlt-1/PlGF ratios than women with normal pregnancies. In mid-pregnancy these differences became greater, reaching statistical significance for PlGF concentration (431 versus 654 pg/mL, P<.01) and the sFlt-1/PlGF ratio (25.3 versus 2.5, P<.01). When the women with placental abruption were subdivided into those who did (n=10) and those who did not (n=21) develop preeclampsia or gestational hypertension, significant alterations in angiogenic factors were noted only in women who later developed hypertension in pregnancy. Among these women, PlGF concentrations were decreased in mid-pregnancy (160 versus 723 pg/mL, P<.001), and the mid-pregnancy sFlt-1/PlGF ratio was increased (70.1 versus 2.3, P=.001). CONCLUSION: Serum levels of the proangiogenic factor PlGF were decreased, and those of the antiangiogenic ratio sFlt-1/PlGF were increased in nulliparous women who subsequently developed hypertension and placental abruption.