Prophylaxis of recurrent preeclampsia: low-molecular-weight heparin plus low-dose aspirin versus low-dose aspirin alone.

OBJECTIVE: To verify whether prophylaxis with low-molecular-weight heparin (LMWH) and low-dose aspirin (LDA) could positively affect pregnancy outcome in women with a history of severe preeclampsia. METHODS: We compared 23 pregnancies treated with LDA alone to 31 pregnancies treated with LMWH plus LDA. RESULTS: Women treated with LMWH-LDA (n = 31) showed a better pregnancy outcome than those treated with LDA alone (n = 23) in terms of gestational age at delivery (p < 0.05), birth weight (p < 0.01), birth weight percentile (p < 0.01), and rate of preeclampsia (p < 0.01). Furthermore, comparing the intra-group outcome variation between previous and index pregnancies, an improvement appeared in each group, but a more pronounced gain was noted in the LMWH-LDA group in terms of gestational age at delivery (p< 0.005), birth weight (p < 0.005), and birth weight percentile (p < 0.005). CONCLUSIONS: Thromboprophylaxis with LMWH plus LDA can improve pregnancy outcome in women with previous severe preeclampsia.     

Recurrence and severity of abnormal pregnancy outcome in patients treated by low-molecular-weight heparin: a prospective pilot study

Objective: This prospective pilot study assesses the recurrence rate and severity of abnormal pregnancy outcome (APO), excluding early pregnancy complications, in pregnant patients, without acquired thrombophilia, treated by prophylactic doses of low-molecular-weight heparin (LMWH), independently from their congenital thrombophilic condition. Methods: We recruited a cohort of 128 pregnant patients with previous APO; 100 of whom with APO and intrauterine growth restriction (IUGR) and 28 with maternal APO only. LMWH treatment was started at recruitment. Composite cross-over recurrence rate IUGR, gestational hypertension, preeclampsia, help syndrome, abruptio placenta were analyzed. The main outcome measure was severe APOs with iatrogenic delivery ≤ 32 weeks of gestation. Results: Median gestational age at LMWH treatment was 20 weeks. Severe APO decreased in treated pregnancies from 45% to 4% (relative risk = 0.3, confidence interval 95% = 0.2–0.8). This value was not significantly different in thrombophilic and nonthrombophilic patients. When severe and minor complications were analyzed altogether, the recurrence rate was 28%. In patients with APO and fetal growth restriction (FGR) in the index pregnancy, newborn weights were significantly better in the treated pregnancy: 1090 g (1035–1145) vs. 850 g (535–1200), p < 0.01. Conclusions: Prophylactic regimen of LMWH significantly reduced the recurrence rate of severe composite APO in pregnancies affected in the index pregnancy by APO and FGR or small for gestational age newborns. This result was independent from the patients’ inherited thrombophilic conditions.     

Mid-Trimester Placentation Assessment in High-Risk Pregnancies Using Maternal Serum Screening and Uterine Artery Doppler

Objective. To determine the value of uterine artery velocimetry and mid-trimester maternal serum AFP/hCG measurements in predicting pregnancy complications in a high-risk group of pregnant patients. Methods. Eighty-eight patients with chronic hypertension, previous preeclampsia, and thrombophilia were included. Maternal serum AFP/hCG was examined between 15–16 weeks gestation. Levels > 3 multiple of median (MoM) for hCG and > 2 MoM for AFP were considered abnormal. Color Doppler ultrasound was performed at 23–24 weeks gestation. Diastolic notching and pulsatilty index (PI) above the 95th percentile were considered abnormal. Results. Thirty-three patients had abnormal uterine artery waveform: 8 patients had abnormal maternal serum hCG and 5 had abnormal maternal serum AFP. Bilateral abnormal uterine artery waveform was associated with pregnancies complicated by lower gestational age at delivery (p = 0.05) and birth weight (p < 0.01), higher rates of preeclampsia (p = 0.006), SGA (p = 0.0001), preterm delivery (p = 0.0001), and cesarean section rate (p < 0.0001) in comparison to patients with normal uterine artery Doppler. Pregnant women with elevated hCG had higher rates of preeclampsia (p = 0.006); preterm delivery (p = 0.005) and SGA (P = 0.03) and, lower birth weight (p = 0.001). No significant differences were noted for clinical outcomes according to AFP data. Conclusions. Abnormal uterine artery waveform is superior to maternal serum hCG for identification of placental pathology leading to preterm delivery, low birth weight, and preeclampsia in high-risk pregnant patients.     

Maternal and neonatal outcomes in women with twin pregnancies with excessive gestational weight gain

Objective: To determine if an excessive rate of gestational weight gain (GWG) in twin pregnancies is associated with adverse obstetric outcomes.

Methods: Retrospective cohort study of twin pregnancies delivered at the University of California, San Diego 2001–2014. Women were included if they had adequate or excessive rates of GWG as determined by Institute of Medicine guidelines. Demographic and outcome variables were collected by chart review.

Results: Four hundred and eighty-nine twin pregnancies met inclusion criteria. Of which, 40.5% had adequate rates of GWG and 41.5% had excessive rates of GWG. The rates of preterm birth and gestational diabetes were similar between the two groups. Gestational hypertension and preeclampsia were more common in women with excessive GWG (37.9% versus 19.7%; p?<?0.01). This finding persisted in multivariate analysis. The mean birth weight percentiles were higher in the excessive GWG group and these women were also less likely to have an infant with a birth weight <10th percentile (21.4% versus 35.9%, p?<?0.01).

Conclusions: Excessive GWG is associated with a higher risk for gestational hypertension and preeclampsia, but no other adverse perinatal outcomes. Infants born to mothers with excessive GWG are less likely to be small for gestational age than those born to women with adequate GWG.     

The outcome of pregnancy with new onset proteinuria without hypertension: retrospective observational study

Objective: The aim of this study was to evaluate preeclampsia progression of isolated proteinuria and associations with pregnancy outcome.

Method: We performed a retrospective analysis in patients who were hospitalized for evaluation of new onset proteinuria without hypertension after 20 weeks of gestation between January 2012 and January 2014. One hundred fifty-seven patients who met the inclusion criteria were enrolled the study.

Results: After detection of new onset proteinuria, 53 of 157 (33.7%) patients developed preeclampsia and the incidence of gestational proteinuria was found to be 0.33%. Twenty-four hours urine proteinuria testing results were significantly higher in preeclampsia (PE) group compared with the gestational proteinuria (GP) group (p?<?0.01). Patients who developed preeclampsia delivered significantly earlier than the GP group (p?<?0.01). The weights of the infants born to mothers in the PE group were significantly lower than the other group (p?<?0.01).

Conclusion: The incidence of gestational proteinuria was lower than the previous studies. Preeclampsia developed in 33% of patients with new onset proteinuria in pregnancy. In patients who developed PE had significantly higher proteinuria, lower delivery time and birth weight in their infants. Therefore, patients with new onset proteinuria should be followed-up for preeclampsia development and associated morbidities.     

Perinatal outcomes in oocyte donor pregnancies

Abstract

Objective: To assess the obstetric outcomes of pregnancy following intracytoplasmic sperm injection (ICSI) using donor oocytes.

Methods: Twenty-six deliveries from oocyte donor ICSI (d-ICSI) were compared to the next two consecutive deliveries from homologous ICSI (h-ICSI group) (n?=?52) and with the two consecutive deliveries from women older than 40 years (Advanced Maternal Age: AMA) (n?=?52). We evaluated the occurrence of gestational hypertension (GH), preeclampsia (PE), fetal growth restriction (IUGR), gestational diabetes mellitus (GDM), preterm premature rupture of membranes (pPROM), preterm birth, placental anomalies, mode of delivery, hemorrhage, gestational age at birth and birth weight.

Results: d-ICSI had significantly more PE (d-ICSI 19.2%, h-ICSI 0%, AMA 0%, p?<?0.001); higher rates of IUGR than AMA pregnancies (d-ICSI 19.2%, AMA 3.8%, p?<?0.025). Placental accretism was found only in the d-ICSI group (15.4%, p?<?0.043). No postpartum bleeding was observed.

Conclusions: This is the first study that compares the obstetric outcomes of donor pregnancies to the outcomes of h-ICSI and AMA. Obstetricians who deal with pregnancies from oocyte donation need to be aware of the more severe obstetric outcomes, especially placenta accreta and preeclampsia. All women who conceive through oocyte donation should be counseled as early as the pre-conception period and referred to specific centers for high-risk pregnancies.     

Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies

Abstract

Objective: To examine pre-gravid body mass index (BMI) and gestational BMI change impact on preeclampsia and gestational diabetes mellitus (GDM).

Methods: Retrospective population-based cohort study. Data from Slovenian National Perinatal Information System were analyzed for the period 2002–2011. Three singleton controls were matched by parity and maternal age to each twin pregnancy delivered at >36 weeks. Student’s t test was used to compare pre-gravid BMI and gestational BMI change in different groups (p?<?0.05 significant).

Results: 2046 twin and 6138 singleton pregnancies were included. Twin and singleton patients with preeclampsia or GDM had higher pre-gravid BMI (p?<?0.001). Gestational BMI change was smaller in twins with GDM (p?<?0.001), and not associated with preeclampsia (p?=?0.07). Smaller gestational BMI change in singleton pregnancies was associated with GDM (p?<?0.001), and greater BMI change with preeclampsia (p?=?0.004).

Conclusions: Pre-gravid BMI is more strongly associated with preeclampsia and GDM in twin and singleton pregnancies than gestational BMI change. Smaller gestational BMI change in GDM pregnancies reflect the importance of dietary counseling.     

Low molecular weight heparin treatment and impact of inherited thrombophilia type in pregnancies with previous adverse outcome

Objective: To assess the impact of low molecular weight heparin (LMWH) treatment in 50 pregnancies of women with inherited thrombophilia and adverse pregnancy outcome (APO) in previous untreated pregnancies. The impact of “Conventional” (FVL, PT, AT, PC, PS) and “Novel” (MTHFR, PAI-1, ACE) thrombophilias on APO was investigated.

Methods: The primary outcomes (PO) were: early and late pregnancy loss (EPL, LPL), preterm birth (PTB) or term birth (TB) compared to the last untreated pregnancies of the same women. Secondary outcomes (SO) were APO in LMWH treated and last untreated pregnancies ended with birth. PO and SO were compared in relation to the thrombophilia type.

Results: LMWH decreased EPL and LPL rate and improved TB rate compared with last untreated pregnancies (p?<?0.001). There were less PTB (p?=?0.019) and no cases of intrauterine fetal death (IUFD) (p?=?0.0019) in LWMH-treated pregnancies. The division to Conventional and Novel thrombophilias showed: (a) difference between pregnancy losses and birth rate (p?=?0.0069) and (b) no difference in the prevalence of APO in untreated pregnancies ended with birth.

Conclusions: LMWH treatment improves pregnancy outcome in women with inherited thrombophilia and APO in previous pregnancies. Novel thrombophilias have the equal impact on the pregnancy outcome compared to the Conventional thrombophilias.     

Low molecular weight heparin treatment during subsequent pregnancies of women with inherited thrombophilia and previous severe pregnancy complications

Objectives.?The aim of this study was to investigate the effect of low molecular weight heparin (LMWH) on incidence of adverse outcome in women with thrombophilias and previous severe pregnancy complications.

Materials and methods.?The study included 116 women with history of severe preeclampsia, fetal growth restriction (FGR)?≤5th percentile, severe placental abruption and stillbirth?>20 weeks carrying factor V Leiden or prothrombin mutations, or protein S or C deficiency. Eighty-seven women referred to us for follow-up were treated with LMWH starting from weeks 5–15 (study group, A). Twenty-nine non-treated women referred only for delivery in our institution constituted the control group (B).

Results.?The incidence of severe pregnancy complications in previous pregnancies was similar in both groups. Following treatment with LMWH, the incidence of severe preeclampsia was 4.6% in group A compared to 21% in group B, p?=?0.007. The incidence of FGR was 2.3% in group A compared to 21% in group B, p?=?0.03. The incidence of stillbirth or placental abruption was 0% in group A compared to 7% in group B, p?=?0.06. The total incidence of adverse outcome was 7% in group A compared to 55% in group B, p?=?0.0001.

Conclusion.?LMWH treatment of women with previous severe pregnancy complications and thrombophilias significantly reduces the rate of recurrence.     

Low maternal concentrations of soluble vascular endothelial growth factor receptor-2 in preeclampsia and small for gestational age

Objectives. Preeclampsia is considered an anti-angiogenic state. A role for the anti-angiogenic factors soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and soluble endoglin in preeclampsia has been proposed. Soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) has been detected in human plasma, and the recombinant form of this protein has anti-angiogenic activity. There is a paucity of information about maternal plasma sVEGFR-2 concentrations in patients with preeclampsia and those without preeclampsia with small for gestational age (SGA) fetuses. This study was conducted to determine whether: (1) plasma sVEGFR-2 concentration changes throughout pregnancy; and (2) preeclampsia and SGA are associated with abnormalities in the maternal plasma concentration of sVEGFR-2.

Study design. This cross-sectional study included non-pregnant women (n = 40), women with normal pregnancies (n = 135), women with an SGA fetus (n = 53), and women with preeclampsia (n = 112). SGA was defined as an ultrasound-estimated fetal weight below the 10^th percentile for gestational age that was confirmed by neonatal birth weight. Plasma concentrations of sVEGFR-2 were determined by ELISA.

Results. (1) There was no significant difference in the mean plasma concentration of sVEGFR-2 between non-pregnant women and those with normal pregnancies (p = 0.8); (2) patients with preeclampsia and those without preeclampsia with SGA fetuses had a lower mean plasma concentration of sVEGFR-2 than that of women with normal pregnancies (p < 0.001 for both); and (3) there was no significant difference in the mean plasma concentration of sVEGFR-2 between patients with preeclampsia and those without preeclampsia with SGA (p = 0.9).

Conclusions. Preeclampsia and SGA are associated with low plasma concentrations of sVEGFR-2. One interpretation of the findings is that plasma sVEGFR-2 concentration could reflect endothelial cell function.     

The impact of total parenteral nutrition support on pregnancy outcome in women with hyperemesis gravidarum

Abstract

Objective: To assess pregnancy outcome among women with hyperemesis gravidarum (HEG) with and without total parenteral nutrition (TPN) support.

Study design: A retrospective study of all pregnant women with singleton pregnancies who were hospitalized due to HEG between 1997 and 2011. Pregnancy outcome was compared with a control group without HEG matched by maternal age and parity in a 3:1 ratio.

Results: Overall 599 women were admitted during the study period with the diagnosis of HEG and subsequently delivered in our center. Of those, 122 (20.4%) received TPN support. Women in the HEG group were characterized by a higher rate of severe preeclampsia (1.3% versus 0.5%, p?=?0.04), and a higher rate of preterm delivery at less than 37 and 34 weeks (10.9% versus 6.9%, p?<?0.001 and 4.7% versus 1.6%, p?<?0.001, respectively). Neonates in the HEG group were characterized by a lower birth weight (3074?±?456?g versus 3248?±?543?g, p?<?0.001), higher rate of birth weight?<?10th percentile (12.7% versus 6.8%, p?<?0.001), and a higher rate of neonatal morbidity (8.7% versus 3.8%, p?<?0.001). These associations persisted after adjustment for potential confounders, and were of most notable among women with HEG who did not receive TPN support.

Conclusion: HEG is an independent risk factor for adverse pregnancy outcome. TPN support during early pregnancy is associated with a decreased risk for perinatal morbidity.     

Obesity and adverse pregnancy outcomes in twin pregnancies

Abstract

Objective: To compare pregnancy outcomes in twin pregnancies based on maternal pre-pregnancy body mass index (BMI).

Methods: Historical cohort study of all twin pregnancies >24 weeks managed by one maternal-fetal medicine practice from 2005 to 2012. We compared pregnancy outcomes between pre-pregnancy obese (BMI ≥30?kg/m²) and normal weight women (BMI 18.5–24.99?kg/m²). We also compared pre-pregnancy normal weight women to overweight women (BMI 25–29.99?kg/m²) and underweight women (BMI <18.5?kg/m²). Chi square, Fisher’s exact test, Student’s t-test, and one-way ANOVA were used as appropriate. A p value of <0.05 was considered significant.

Results: Five hundred fourteen patients with twin pregnancies were included. Pre-pregnancy obesity was associated with gestational hypertension (34.1% versus 17.9%, p?=?0.011), preeclampsia (27.3% versus 14.4%, p?=?0.028), and gestational diabetes (22.2% versus 4.7%, p?<?0.001). Pre-pregnancy overweight was associated with gestational diabetes (13.7% versus 4.7%, p?=?0.002). Pre-pregnancy underweight was not associated with any adverse pregnancy outcomes. Comparing outcomes across normal weight, overweight, and obese women, the rates of gestational diabetes and gestational hypertension increased significantly across the three groups.

Conclusion: In patients with twin pregnancy, pre-pregnancy obesity is associated with adverse pregnancy outcomes, including gestational diabetes, gestational hypertension, and preeclampsia.     

Lipid concentration in small for gestational age (SGA)pregnancies and hypertensive disorders

ObjectiveLow maternal serum lipid and high maternal serum lipid have both been associated with some complications in pregnancy. The lipid profiles in pregnancies complicated by small for gestational age (SGA) or hypertension disorders have been compared with those of normal pregnancies.MethodIn a prospective study, 900 pregnant women between 13 and 23 weeks of pregnancy were studied. Primarily, serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, were measured. Ultimately, the serum lipid levels at 13–23 weeks of pregnancies were compared between the women who later suffered from hypertension disorders or SGA and the matched women with normal pregnancies.ResultsAt 13–23 weeks of pregnancy, the mean triglyceride levels were significantly higher in the women who later experienced preeclampsia when compared with normal, matched pregnancies with an appropriate weight for gestational age and women who had gestational hypertension (p = 0.001 and p = 0.014, respectively). Also, triglyceride levels were significantly higher in women with neonates with large for gestational age (LGA) in comparison with those who gave birth to neonates with SGA (p = 0.012) and with uncomplicated matched pregnant women who gave birth to neonates with weight >10th and <90th percentile for their gestational age (p = 0.007).ConclusionOnly the levels of TG and not any other lipids evaluated were found to be different in pregnancies complicated by preeclampsia when compared to pregnancies complicated by SGA.     

Association between first-trimester placental volume and birth weight

Objective

To estimate the correlation between first-trimester placental volume, birth weight, small-for-gestational-age (SGA), and preeclampsia.

Methods

A prospective study of women with singleton pregnancy at 11–13 weeks of gestation was conducted. First-trimester placental volume was measured using three-dimensional ultrasound and reported as multiple of median (MoM) for gestational age. Participants were followed until delivery where birth weight, placental weight, and occurrence of preeclampsia were collected. Non-parametric analyses were performed.

Results

We reached a complete follow-up for 543 eligible women. First-trimester placental volume was significantly correlated with birth weight (correlation coefficient: 0.18; p < 0.0001) and placental weight (cc: 0.22; p < 0.0001) adjusted for gestational age. First-trimester placental volume was smaller in women who delivered SGA neonates (median MoM: 0.79; interquartile range: 0.62–1.00; p < 0.001) and greater in women who delivered large-for-gestational-age neonates (median MoM: 1.13; 0.95–1.49; p < 0.001) when compared to women with neonates between the 10th and 90th percentile (median MoM: 1.00; 0.81–1.25). First-trimester placental volume was not associated with the risk of preeclampsia (cc: 0.01; p = 0.87).

Conclusion

First-trimester placental volume is strongly associated with fetal and placental growth. However, we did not observe a correlation between placental volume and the risk of preeclampsia.     

Obstetric and neonatal outcomes of adolescent primiparous singleton pregnancies: a cohort study in the South of Reunion Island,Indian Ocean

Objectives: To describe the maternal and neonatal outcomes of a large cohort of adolescent pregnancies in a tertiary care hospital at Reunion Island. Methods: Retrospective study of all primiparous singleton pregnancies over 10.5 years. Adolescent (<18 years) were compared to 18–29 years pregnancies. The maternal outcomes were obstetric illness, labor complications, and way of delivery. Neonatal outcomes were preterm birth, low birth weight (LBW), small for gestational age, birth asphyxia, need for mechanical ventilation, and mortality. Results: We analyzed 1839 adolescent pregnancies and 11,445 controls. Adolescents had worse prenatal care than older mothers, (4.4 vs. 1.4%; p < 0.0001), higher rates of smoking and alcohol assumption (13 vs. 11% and 0.7 vs. 0.4%, both p < 0.05). They showed less pregnancy-related illness and labor complications and higher rates of normal vaginal delivery (80 vs. 69%; p < 0.0001), without increased risk of episiotomy or postpartum hemorrhage. Offspring mortality, preterm birth, and LBW were higher in adolescent pregnancies (3.3 vs. 2.2%; p = 0.001, 14 vs. 12%; p = 0.0008; 17 vs. 14%; p = 0.002). Conclusions: In this population, adolescents had an obstetrical outcome better than controls, but their offspring short-term outcomes were unfavorable. Furthers studies are needed to better elucidate the link between adolescent pregnancy and impaired neonatal outcome.     

The "weight" of fetal growth restriction in 437 hypertensive pregnancies

Objective Our objective was to evaluate the outcomes of the hypertensive and preeclamptic pregnancies with or without fetal growth restriction (FGR).Methods We retrospectively studied 437 hypertensive pregnant women treated by calcium antagonists and divided in four groups: Gestational hypertension (GH) with or without FGR (GH-AGA: 244; GH-FGR: 78) and preeclampsia (PE) with or without FGR (PE-AGA: 76; PE-FGR: 39). Outcomes considered were: the need for a second-line treatment, prolongation of the pregnancy after diagnosis, duration of treatment in puerperium, gestational age at delivery, neonatal birth weight, perinatal mortality and neonatal malformations.Results A second line treatment was added in: GH-AGA: 15.4% vs. GH-FGR: 32.8%; PE-AGA: 28% vs. PE-FGR: 50%. We found a significant difference in delivery delay after diagnosis (31.3±5.4 vs. 20.7±3.4 days and 35.3±4.5 vs. 22.2±3.1; p<0.001). Gestational age at delivery was (p<0.001): 35.5±2.3 vs. 35.6±2.5 and 34.4±1.7 vs. 33.1±2.3. A significant difference in birth weight was (p<0.001): 2,271±759.1 vs. 1,817.59±396.9 and 2,196±685.17 vs. 1,465.80±441.7. Mortality was 2.56% (2 cases) for GH-FGR and 10.2% (4 cases) for PE-FGR. No neonates showed malformations.Conclusions Gestational hypertension and preeclampsia increase the risk of low birth weight, on the other hand the fetal growth restriction is a determinant factor for the outcome of hypertensive and preeclamptic pregnancy, perinatal morbidity and mortality of the fetus and for the management and treatment efficacy of the mother.     

Sequelae of unrecognized gestational diabetes

OBJECTIVE: Prior studies have suggested that macrosomia is the only morbid condition associated with gestational diabetes and that this association is the result of confounding by maternal obesity rather than a result of gestational diabetes itself. We sought to determine whether unrecognized gestational diabetes is an independent predictor of macrosomia and other perinatal morbid conditions after controlling for confounding variables. STUDY DESIGN: A retrospective analysis of 472 consecutive cases of gestational diabetes diagnosed between 24 and 30 weeks' gestation was undertaken including 16 prospectively identified but clinically unrecognized cases, 297 cases treated with diet alone, and 76 treated with diet plus insulin. Unrecognized cases were matched to 64 nondiabetic controls for race, age, body mass index, parity, pregnancy weight gain, and gestational age at delivery. RESULTS: In the unrecognized gestational diabetes group versus the nondiabetic control versus gestational diabetes diet groups rates of large for gestational age infants (44% vs 5% vs 9%, p < 0.0005), macrosomia (44% vs 8% vs 15%, p < 0.01), shoulder dystocia (19% vs 3% vs 3%, p < 0.05), and birth trauma (25% vs 0% vs 0.3%, p < 0.001) were all significantly increased. These differences remained significant after controlling for maternal age, race, parity, body mass index, pregnancy weight gain, and gestational age at delivery. CONCLUSIONS: This study suggests that unrecognized gestational diabetes increases risks of large for gestational age infants, macrosomia, shoulder dystocia, and birth trauma independent of maternal obesity and other confounding variables. Clinical recognition and dietary control of gestational diabetes are associated with a reduction in these perinatal morbid conditions. (Am J Obstet Gynecol 1998;178:1321-32.)     

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     

Differences in amniotic fluid patterns and fetal biometric parameters in third trimester pregnancies with and without diabetes

Objective.?The amniotic fluid index (AFI) has been increasingly used in the assessment of fetal well-being. We conducted the study to evaluate and compare the amniotic fluid index in third trimester normal and diabetic human pregnancy and to assess the correlation between the AFI and the fetal biometric parameters.

Methods.?Real-time ultrasound was performed to evaluate the AFI (four-quadrant technique), and to measure the biparietal diameter, head circumference, abdominal circumference, and femur length in 225 normal and 120 diabetic pregnant women from 27 to 42 weeks of gestation. Each patient was studied only once.

Results.?AFI in normal pregnancies was less than that in diabetic pregnancies throughout the gestational ages studied (27–42 weeks). In normal pregnancy, the mean AFI was 14.0 cm at 27 weeks and decreased to 11.4 cm at 42 weeks (r = 0.25, p = 0.0005), whereas in diabetic pregnancies, the values remained stable throughout the gestational ages studied. There exist significant differences in AFI, estimated fetal weight, estimated fetal weight %, abdominal circumference, abdominal circumference %, and head circumference to abdominal circumference ratio between the two groups. In both normal and diabetic pregnancies, there is a positive correlation between the AFI and the percentile of abdominal circumference (p < 0.0001), and between the AFI and the percentile of estimated fetal weight (p < 0.0001).

Conclusion.?This study provides gestational age-specific values of the AFI in normal and diabetic pregnancies. Diabetic pregnancy has greater AFI values than normal pregnancy between 27 and 42 weeks. The AFI correlates to the percentile of the estimated fetal weight and the abdominal circumference in both groups, suggesting that there may be a relationship between increased AFI and large for gestational age fetus independent of diabetes.     

Population-Based Analysis of Hypertensive Disorders in Pregnancy

Objective: To determine the population-based incidence of hypertensive diseases in pregnancy in Western New York. Methods: A database of 77,358 women with singleton pregnancies was analyzed using birth certificate data. The incidence of pregnancies complicated by gestational hypertension, preeclampsia, and eclampsia was determined. Results: The overall incidence of pregnancy-associated hypertensive disease varied slightly from 1999 to 2003. The incidence of preeclampsia decreased from 1.8% to 1.1% (p < 0.01). This decrease persisted over time, despite controlling for known risk factors, such as body mass index, age, ethnicity, parity, smoking, diabetes, and chronic hypertension. Conclusion: The incidence of pregnancy-related hypertensive disorders slightly decreased in our population in the last 5 years, with a decline in the rate of preeclampsia accounting for this change. Further analysis may provide additional insights into the population-based incidence of preeclampsia.