- Email: [email protected]
O17. Hypertension in pregnancy and endothelial dysfunction: An emerging risk factor for cardiovascular disease
Lectures / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 1 (2011) 238–272
expression in pre-eclampsia compared with normal term pregnancy. Conclusions: Higher levels of expression of FR-a, RFC, PCFT, ABCB1, ABCC2 and BCRP in early pregnancy indicate that these transporters may have an important role in placental establishment and development. Reductions in FR-a and PCFT in pre-eclampsia may potentially represent a mechanism involved in the pathogenesis of pre-eclampsia by limiting placental folate uptake resulting in inadequate placental function and growth.
doi:10.1016/j.preghy.2011.08.048
O17. Hypertension in pregnancy and endothelial dysfunction: An emerging risk factor for cardiovascular disease G. Gagliardi b, N. Lazzarin a, G. Desideri d, Ferri d, H. Valensise c, D. Manfellotto a,b (a AFaR, University of Rome Tor Vergata Fatebenefatelli Hospital, Isola Tiberina, Rome, Italy, b Centro Fisiopatologia Clinica Sergio Vulterini, University of Rome Tor Vergata Fatebenefatelli Hospital, Isola Tiberina, Rome, Italy, c Department of Obstetrics and Gynecology, University of Rome Tor Vergata Fatebenefatelli Hospital, Isola Tiberina, Rome, Italy, d Department of Internal Medicine and of Geriatric Medicine, University of L’Aquila, Italy) Objective: Evidence has emerged over the year suggesting that women who develop hypertensive pregnancy disorders (PIH) should be considered at an increased risk for cardiovascular disease (CDV) later in life. Our objective was to determine whether a persistent endothelial dysfunction is present in women with a history of PIH with respect to women with uncomplicated pregnancy. Study design: Impaired endothelial function was assessed by measurements of the soluble adhesion molecules intercellular adhesion molecules 1 (ICAM-1), vascular cellular adhesion 1 (V-CAM-1), E-Selectin and P-Selectin in serum from 25 women with a history of PHI and from a matched control group of 25 subjects with previous uncomplicated pregnancies one month after delivery. Moreover, adhesion molecules were measured in 20 patients with HELLP syndrome up to 3 to 10 years after pregnancy and 20 controls matched as a group for time of index pregnancy, smoking habits and current body mass index. Results: Increased levels of soluble adhesion molecules were found in women with a history of PIH with respect to those observed in women with previous uncomplicated pregnancies short after delivery (one and three months after delivery). More significant differences were observed comparing adhesion molecules levels in women with a history of HELLP syndrome with respect to those found in control patients. Conclusions: Patients with a history of PIH show an abnormal activation of the endothelium persisting after pregnancy. This activation became of great magnitude in patients experiencing a severe form of this pathology such as HELLP syndrome. These observations may contribute to explain the increased risk for hypertension and CVD later in
265
life in patients experiencing PIH, especially in those women with a history of HELLP syndrome. doi:10.1016/j.preghy.2011.08.049
O18. Endothelial function and glucose metabolism in overweight and obese nondiabetic woman: A possible role of L-Arginine/Nitric Oxide pathway Elisabetta Petrella, Lucrezia Pignatti, Isabella Neri, Fabio Facchinetti (Mother-Infant Department, University of Modena and Reggio Emilia, Italy) Objective: Insulin resistance and hyperinsulinemia represent physiological characteristics of pregnancy, especially in the third trimester, but in obese woman this situation is exasperated and may be associated to the endothelial dysfunction. Glucose metabolism and vascular activity are both modulate by L-Arginine/NO pathway: insulin sensitivity and endothelial NO production are positively related. In obese patients this system seems blunted as demonstrating by increasing evidence. The increasing prevalence of obesity is an important public health concern. We have studied this regulatory system in overweight and obese woman during pregnancy. Methods: Eight normal weight pregnant women (BMI range 20.5–24.0 kg/m2) and 14 overweight/obese pregnant women (BMI range 26.3–45.2 kg/m2) were subjected twice during pregnancy (between 9 and 12 week and 24 and 27 week of gestation) to 30 g L-Arginine infusion (in 500 ml physiologic solution). At baseline and after 30, 60, 120 and 180 min serum assay of glucose, insulin and NO metabolites levels were performed. The ultrasound assessment of endothelial-dependent flow mediated vasodilation (FMD) of the brachial artery measured at the same weeks of gestation was also performed. Results: In normal weight woman, after 1 h L-Arginine infusion, there has been a glucose decline after 30 (p = 0.006) and 60 min (p = 0.005) and progressive and significantly insulin decline after 30 (p = 0.01), 60 (p = 0.001), 120 (p < 0.001) and 180 min (p = 0.003). During the second test, no significantly difference were detected between women with BMI< or >25 kg/m2 in glucose or insulin levels. In the normal weight pregnant woman, FMD after 5 min cuff release, expressed as the change in percentage of the baseline diameter in response to increased blood flow shear stress, was significantly higher at the first (p = 0.05) and second assessment (p = 0.003). Conclusions: In normal weight women, at the first trimester of pregnancy, the L-Arginine infusion was able to decrease glucose after 1 h (p = 0.003). In obese women LArginine infusion do not affect glucose and insulin levels. doi:10.1016/j.preghy.2011.08.050
MATERNAL, FETAL, NEONATAL CRITICAL CARE O19. Kidney transplantation and pregnancy: Maternal and fetal outcome
expression in pre-eclampsia compared with normal term pregnancy. Conclusions: Higher levels of expression of FR-a, RFC, PCFT, ABCB1, ABCC2 and BCRP in early pregnancy indicate that these transporters may have an important role in placental establishment and development. Reductions in FR-a and PCFT in pre-eclampsia may potentially represent a mechanism involved in the pathogenesis of pre-eclampsia by limiting placental folate uptake resulting in inadequate placental function and growth.
doi:10.1016/j.preghy.2011.08.048
O17. Hypertension in pregnancy and endothelial dysfunction: An emerging risk factor for cardiovascular disease G. Gagliardi b, N. Lazzarin a, G. Desideri d, Ferri d, H. Valensise c, D. Manfellotto a,b (a AFaR, University of Rome Tor Vergata Fatebenefatelli Hospital, Isola Tiberina, Rome, Italy, b Centro Fisiopatologia Clinica Sergio Vulterini, University of Rome Tor Vergata Fatebenefatelli Hospital, Isola Tiberina, Rome, Italy, c Department of Obstetrics and Gynecology, University of Rome Tor Vergata Fatebenefatelli Hospital, Isola Tiberina, Rome, Italy, d Department of Internal Medicine and of Geriatric Medicine, University of L’Aquila, Italy) Objective: Evidence has emerged over the year suggesting that women who develop hypertensive pregnancy disorders (PIH) should be considered at an increased risk for cardiovascular disease (CDV) later in life. Our objective was to determine whether a persistent endothelial dysfunction is present in women with a history of PIH with respect to women with uncomplicated pregnancy. Study design: Impaired endothelial function was assessed by measurements of the soluble adhesion molecules intercellular adhesion molecules 1 (ICAM-1), vascular cellular adhesion 1 (V-CAM-1), E-Selectin and P-Selectin in serum from 25 women with a history of PHI and from a matched control group of 25 subjects with previous uncomplicated pregnancies one month after delivery. Moreover, adhesion molecules were measured in 20 patients with HELLP syndrome up to 3 to 10 years after pregnancy and 20 controls matched as a group for time of index pregnancy, smoking habits and current body mass index. Results: Increased levels of soluble adhesion molecules were found in women with a history of PIH with respect to those observed in women with previous uncomplicated pregnancies short after delivery (one and three months after delivery). More significant differences were observed comparing adhesion molecules levels in women with a history of HELLP syndrome with respect to those found in control patients. Conclusions: Patients with a history of PIH show an abnormal activation of the endothelium persisting after pregnancy. This activation became of great magnitude in patients experiencing a severe form of this pathology such as HELLP syndrome. These observations may contribute to explain the increased risk for hypertension and CVD later in
265
life in patients experiencing PIH, especially in those women with a history of HELLP syndrome. doi:10.1016/j.preghy.2011.08.049
O18. Endothelial function and glucose metabolism in overweight and obese nondiabetic woman: A possible role of L-Arginine/Nitric Oxide pathway Elisabetta Petrella, Lucrezia Pignatti, Isabella Neri, Fabio Facchinetti (Mother-Infant Department, University of Modena and Reggio Emilia, Italy) Objective: Insulin resistance and hyperinsulinemia represent physiological characteristics of pregnancy, especially in the third trimester, but in obese woman this situation is exasperated and may be associated to the endothelial dysfunction. Glucose metabolism and vascular activity are both modulate by L-Arginine/NO pathway: insulin sensitivity and endothelial NO production are positively related. In obese patients this system seems blunted as demonstrating by increasing evidence. The increasing prevalence of obesity is an important public health concern. We have studied this regulatory system in overweight and obese woman during pregnancy. Methods: Eight normal weight pregnant women (BMI range 20.5–24.0 kg/m2) and 14 overweight/obese pregnant women (BMI range 26.3–45.2 kg/m2) were subjected twice during pregnancy (between 9 and 12 week and 24 and 27 week of gestation) to 30 g L-Arginine infusion (in 500 ml physiologic solution). At baseline and after 30, 60, 120 and 180 min serum assay of glucose, insulin and NO metabolites levels were performed. The ultrasound assessment of endothelial-dependent flow mediated vasodilation (FMD) of the brachial artery measured at the same weeks of gestation was also performed. Results: In normal weight woman, after 1 h L-Arginine infusion, there has been a glucose decline after 30 (p = 0.006) and 60 min (p = 0.005) and progressive and significantly insulin decline after 30 (p = 0.01), 60 (p = 0.001), 120 (p < 0.001) and 180 min (p = 0.003). During the second test, no significantly difference were detected between women with BMI< or >25 kg/m2 in glucose or insulin levels. In the normal weight pregnant woman, FMD after 5 min cuff release, expressed as the change in percentage of the baseline diameter in response to increased blood flow shear stress, was significantly higher at the first (p = 0.05) and second assessment (p = 0.003). Conclusions: In normal weight women, at the first trimester of pregnancy, the L-Arginine infusion was able to decrease glucose after 1 h (p = 0.003). In obese women LArginine infusion do not affect glucose and insulin levels. doi:10.1016/j.preghy.2011.08.050
MATERNAL, FETAL, NEONATAL CRITICAL CARE O19. Kidney transplantation and pregnancy: Maternal and fetal outcome