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791: Effect of 2nd and 3rd trimester blood pressure control in gravidas with chronic hypertension
Poster Session V
ajog.org
studies are warranted to evaluate the relationship between early inflammatory dysregulation and preeclampsia.
791 Effect of 2nd and 3rd trimester blood pressure control in gravidas with chronic hypertension Daniel N. Pasko1, Alan Tita1, Ying Tang1, Robin Steele1, Joseph Biggio1, Lorie Harper1 1
University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL
790 The early pregnancy bioinflammatory milieu and hypertensive disorders of pregnancy Niraj Chavan1, Kristin Ashford2, Amanda Wiggins2, Andrea McCubbin2, Janine Barnett2, John M. O’Brien1 1
University of Kentucky College of Medicine, Lexington, KY, 2University of Kentucky College of Nursing, Lexington, KY
OBJECTIVE: The inflammatory milieu may play an important role in
the development of preeclampsia. This study was undertaken to evaluate differences in inflammatory cytokines in serum and cervicovaginal fluid (CVF) in women who develop hypertensive disorders. STUDY DESIGN: This was a secondary analysis of a prospective multicenter study of women with a singleton gestation. All patients were screened to exclude pre-existing hypertensive disorders. Maternal serum and CVF specimens were collected during each trimester. Cytokines (IL-1a, IL-1b, IL-2, IL-6, IL-8, IL-10, TNFa, CRP and MMP-8) were measured on a Luminex IS-100. Hypertensive disorders were diagnosed using ACOG clinical and laboratory criteria. Univariate and multivariate regression analyses were performed evaluating differences in cytokine levels and change in cytokine levels in correlation to the development of hypertensive disorders, while adjusting for socio-demographic characteristics such as age, race, income, education, as well as smoking status. Statistical analysis was performed using SAS 9.3. RESULTS: 37 patients (14.1%) of 264 patients developed hypertensive disorders. Serum cytokine data was available for 206, 208 and 190 patients in the 1st, 2nd and 3rd trimester respectively, whereas CVF cytokine data was available for 230, 212 and 189 patients in each trimester respectively. Patients who developed hypertensive disorders were noted to have significantly higher 1st trimester serum IL-6 (p ¼ 0.02), and CVF IL-10 (p ¼ 0.025), IL-1a (p ¼ 0.028), IL-1b (p ¼ 0.015). These patients were also noted to have higher 2nd trimester serum IL - 6 (p ¼ 0.05) and 3rd trimester MMP - 8 (p ¼ 0.038). The change in serum IL-6 (p ¼ 0.042) from 1st to 2nd trimester was also noted to be significantly associated with incident hypertensive disorders. After adjusting for socio-demographic characteristics and smoking status, the multivariate regression analyses for these cytokines however failed to reach statistical significance for predicting incident hypertensive disorders. CONCLUSION: In our cohort, a greater number of pro-inflammatory serum cytokines were significantly different early in pregnancy suggesting this source may be preferred for further testing. Further
OBJECTIVE: Routine treatment of blood pressure (BP) <160/105-110 in gravidas with chronic hypertension (cHTN) is not recommend due to lack of benefit and concerns for fetal growth restriction. We assessed differences in pregnancy outcomes based on average BP in the 2nd and 3rd trimesters in women with cHTN. STUDY DESIGN: Retrospective cohort of all singletons with cHTN at a tertiary care center from 2000 to 2014. Women were categorized by average BP <140/90 versus 140-159/90-109 at GA ranges 24.0-27.9, 28.0-31.9, and 32.0-35.9. Women were excluded for fetal anomalies, medical problems unrelated to cHTN or diabetes, and BP 160/110. Women were excluded from the analysis if they were diagnosed with preeclampsia (PE) or developed average BP 140/90 prior to the GA period of interest. The primary outcome was a composite of perinatal death, assisted ventilation, cord pH <7, 5-minute Apgar 3, and seizures. Secondary neonatal outcomes were small for gestational age (SGA) and preterm birth (PTB) <35 weeks. Maternal outcomes were PE, severe PE, admission for rule-out PE, and GA at diagnosis of PE. Groups were compared using Student’s t-test, Wilcoxon rank-sum test, and c2 test. Logistic regression was used to adjust for confounders. RESULTS: 753 women were included. At <32 weeks, higher BP was associated with increased odds of the neonatal composite (Table 1). The odds of SGA were similar between BP groups across all GA ranges. Elevated BP was consistently associated with increased odds of PTB <35 weeks. Although the incidence of PE was similar, higher BP was associated with a greater likelihood of admission for rule-out PE across all GA ranges. Elevated BP at 24.0-27.9 was associated with earlier GA at diagnosis of PE among women prescribed antihypertensives. CONCLUSION: Our study suggests a potential to improve outcomes without increasing SGA with BP control <140/90. These findings require validation in an RCT.
792 The association between first trimester prehypertension and hypertensive disorders of pregnancy Sarah S. Osmundson1, Mary E. Norton2 1
Vanderbilt University, Nashville, TN, 2University of California San Francisco, San Francisco, CA
OBJECTIVE: To examine the association between first trimester prehypertension (preHTN) and the subsequent development of hypertensive disorders of pregnancy (HDP). STUDY DESIGN: This is a secondary analysis of the Factor V Leiden (FVL) study, a prospective observational study that screened women
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S413
ajog.org
studies are warranted to evaluate the relationship between early inflammatory dysregulation and preeclampsia.
791 Effect of 2nd and 3rd trimester blood pressure control in gravidas with chronic hypertension Daniel N. Pasko1, Alan Tita1, Ying Tang1, Robin Steele1, Joseph Biggio1, Lorie Harper1 1
University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL
790 The early pregnancy bioinflammatory milieu and hypertensive disorders of pregnancy Niraj Chavan1, Kristin Ashford2, Amanda Wiggins2, Andrea McCubbin2, Janine Barnett2, John M. O’Brien1 1
University of Kentucky College of Medicine, Lexington, KY, 2University of Kentucky College of Nursing, Lexington, KY
OBJECTIVE: The inflammatory milieu may play an important role in
the development of preeclampsia. This study was undertaken to evaluate differences in inflammatory cytokines in serum and cervicovaginal fluid (CVF) in women who develop hypertensive disorders. STUDY DESIGN: This was a secondary analysis of a prospective multicenter study of women with a singleton gestation. All patients were screened to exclude pre-existing hypertensive disorders. Maternal serum and CVF specimens were collected during each trimester. Cytokines (IL-1a, IL-1b, IL-2, IL-6, IL-8, IL-10, TNFa, CRP and MMP-8) were measured on a Luminex IS-100. Hypertensive disorders were diagnosed using ACOG clinical and laboratory criteria. Univariate and multivariate regression analyses were performed evaluating differences in cytokine levels and change in cytokine levels in correlation to the development of hypertensive disorders, while adjusting for socio-demographic characteristics such as age, race, income, education, as well as smoking status. Statistical analysis was performed using SAS 9.3. RESULTS: 37 patients (14.1%) of 264 patients developed hypertensive disorders. Serum cytokine data was available for 206, 208 and 190 patients in the 1st, 2nd and 3rd trimester respectively, whereas CVF cytokine data was available for 230, 212 and 189 patients in each trimester respectively. Patients who developed hypertensive disorders were noted to have significantly higher 1st trimester serum IL-6 (p ¼ 0.02), and CVF IL-10 (p ¼ 0.025), IL-1a (p ¼ 0.028), IL-1b (p ¼ 0.015). These patients were also noted to have higher 2nd trimester serum IL - 6 (p ¼ 0.05) and 3rd trimester MMP - 8 (p ¼ 0.038). The change in serum IL-6 (p ¼ 0.042) from 1st to 2nd trimester was also noted to be significantly associated with incident hypertensive disorders. After adjusting for socio-demographic characteristics and smoking status, the multivariate regression analyses for these cytokines however failed to reach statistical significance for predicting incident hypertensive disorders. CONCLUSION: In our cohort, a greater number of pro-inflammatory serum cytokines were significantly different early in pregnancy suggesting this source may be preferred for further testing. Further
OBJECTIVE: Routine treatment of blood pressure (BP) <160/105-110 in gravidas with chronic hypertension (cHTN) is not recommend due to lack of benefit and concerns for fetal growth restriction. We assessed differences in pregnancy outcomes based on average BP in the 2nd and 3rd trimesters in women with cHTN. STUDY DESIGN: Retrospective cohort of all singletons with cHTN at a tertiary care center from 2000 to 2014. Women were categorized by average BP <140/90 versus 140-159/90-109 at GA ranges 24.0-27.9, 28.0-31.9, and 32.0-35.9. Women were excluded for fetal anomalies, medical problems unrelated to cHTN or diabetes, and BP 160/110. Women were excluded from the analysis if they were diagnosed with preeclampsia (PE) or developed average BP 140/90 prior to the GA period of interest. The primary outcome was a composite of perinatal death, assisted ventilation, cord pH <7, 5-minute Apgar 3, and seizures. Secondary neonatal outcomes were small for gestational age (SGA) and preterm birth (PTB) <35 weeks. Maternal outcomes were PE, severe PE, admission for rule-out PE, and GA at diagnosis of PE. Groups were compared using Student’s t-test, Wilcoxon rank-sum test, and c2 test. Logistic regression was used to adjust for confounders. RESULTS: 753 women were included. At <32 weeks, higher BP was associated with increased odds of the neonatal composite (Table 1). The odds of SGA were similar between BP groups across all GA ranges. Elevated BP was consistently associated with increased odds of PTB <35 weeks. Although the incidence of PE was similar, higher BP was associated with a greater likelihood of admission for rule-out PE across all GA ranges. Elevated BP at 24.0-27.9 was associated with earlier GA at diagnosis of PE among women prescribed antihypertensives. CONCLUSION: Our study suggests a potential to improve outcomes without increasing SGA with BP control <140/90. These findings require validation in an RCT.
792 The association between first trimester prehypertension and hypertensive disorders of pregnancy Sarah S. Osmundson1, Mary E. Norton2 1
Vanderbilt University, Nashville, TN, 2University of California San Francisco, San Francisco, CA
OBJECTIVE: To examine the association between first trimester prehypertension (preHTN) and the subsequent development of hypertensive disorders of pregnancy (HDP). STUDY DESIGN: This is a secondary analysis of the Factor V Leiden (FVL) study, a prospective observational study that screened women
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S413