- Email: [email protected]
[299-POS]
148
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 53–156
combination strategies of screening and prevention, which found that providing calcium to all pregnant women without prior testing was the most cost-effective strategy. The BIA, on introducing a novel diagnostic test, concluded that the savings associated with this test would offset its initial cost. Conclusions: Novel biomarkers in screening for and diagnosing preeclampsia show promise as a cost-effective approach, from a payer perspective. Moreover, magnesium sulfate seemed to be a cost-effective option to manage seizures in preeclamptic women while delivery remains the ultimate efficient treatment, especially for women with term preeclampsia. Disclosures: N. Zakiyah: None. A.D. van Asselt: None. P.N. Baker: minority shareholder Metabolomic Diagnostics, a small biotech company seeking to develop screening tests for pre-eclampsia. M.J. Postma: Advisor, Commercial Interest: SHIRE, GSK, Roche, Boehringer Ingelheim, Pfizer, SPMSD. doi:10.1016/j.preghy.2014.10.304
[299-POS] First-trimester screening combining maternal risk factors and uterine artery Doppler indices is useful to predict hypertension in low-risk pregnant woman Alessandra C. Marcolin, Rosiane Maciel Scandiuzzi, Silvana Maria Quintana, Elaine Dantas Moisés, Ricardo Carvalho Cavalli, Geraldo Duarte (Faculty of Medicine of Ribeirao Preto – University of Sao Paulo, Ribeirao Preto, Brazil) Objectives: The objectives of the study were to analyze the influence of maternal demographic characteristics and uterine artery (UA) Doppler parameters on the occurrence of hypertension. Methods: This prospective cohort study included 162 lowrisk women with singleton pregnancies and no fetal diseases. Maternal demographic data and UA Doppler parameters were collected prospectively twice, first at 11–14 weeks of gestation and second at 20–24 weeks. The presence of an early diastolic notch in the waveform was noted, and the mean pulsatility and resistance indices were calculated during both intervals. Abnormal UA Doppler study was defined as the presence of bilateral uterine artery diastolic notches and/or a mean pulsatility index or resistance index above the 95th percentile for the gestational age. The primary outcome was the development of hypertension. Chi-square test, receiver operating characteristic curve, and multiple logistic regressions were used for statistical analyses. Results: Fifteen (9.25%) women developed a hypertensive disorder. Significant independent prediction of hypertension was provided by mean PI, mean RI, and parity. Parity of two was associated with an increase in risk for the condition (OR 5.9, 95% CI 1.01–34.44, p < 0.05). Compared with pregnancies with a normal UA resistance index at the first and second trimesters, pregnancies with an abnormal mean UA RI above the 95th centile only at the first trimester showed an increased risk for hypertension (OR 23.25, 95% CI
3.47–155.73, p < 0.01). Similar results were found for an abnormal mean UA PI above the 95th centile (OR 9.84, 95% CI 1.05–92.10, p < 0.05). A model using both maternal and mean UA RI had an area under the receiver operator curve of 0.81. Conclusions: First-trimester screening combining maternal factors and UA Doppler indices is useful to predict hypertension in a routine care setting and could be investigated for application of targeted prophylactic strategies. Disclosures: A.C. Marcolin: None. R.M. Scandiuzzi: None. S.M. Quintana: None. E.D. Moisés: None. R.C. Cavalli: None. G. Duarte: None. doi:10.1016/j.preghy.2014.10.305
[300-POS] Diet-induced endothelial stiffness, mechanotransduction, and the mechanism of hypertension Nancy R. Hart (Peace Health Medical Center, Bellingham, WA, USA) Objectives: Compared to the diets on which humans evolved, modern diets have increased membrane-stiffening components such as long-chain saturated and trans-fatty acids. Increased vascular stiffness, as measured by pulse wave velocity, is associated with increased incidence and severity of preeclampsia (Hausvater, 2012). As one of the determinants of arterial stiffness, vascular smooth muscle tone is regulated by many factors including endocrine signals as well as nitric oxide, salt, oxidant stress, and mechanical stimulation through cell stretch and calcium signaling. It is generally believed that mechanotransduction in endothelial cell membranes is initiated at the local force-membrane interface by inducing local conformational changes or unfolding of membrane-bound proteins, followed by a cascade of diffusion-based signaling in the cytoplasm (Hoffman, 2011). The objective of this study is to develop a model of how diet-induced endothelial membrane stiffness might impact membrane-based mechanotransduction and cause hypertension. Methods: Literature review. Results: Because the arterial intima functions as a sensor, blood pressure homeostatic response might be modulated by the flexibility of endothelial membranes. Factors that stiffen cell membranes (such as salt, trans-fatty acids, and sympathetic neurohormones) might restrict protein conformational shift and invoke an inappropriately high contraction response and increased blood pressure. Factors that increase membrane flexibility (such as polyunsaturated fatty acids) might heighten the sensitivity of endothelial membranes to stretch. Similarly to a diaphragm pressure transducer in a barometer, if the diaphragm material is stiff, the signal is attenuated; conversely, a flexible diaphragm makes the instrument more sensitive to pressure. Conclusions: Pulse wave velocity might provide a noninvasive method of measuring the success of dietary interventions in reducing endothelial stiffness and risk of preeclampsia.
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 53–156
combination strategies of screening and prevention, which found that providing calcium to all pregnant women without prior testing was the most cost-effective strategy. The BIA, on introducing a novel diagnostic test, concluded that the savings associated with this test would offset its initial cost. Conclusions: Novel biomarkers in screening for and diagnosing preeclampsia show promise as a cost-effective approach, from a payer perspective. Moreover, magnesium sulfate seemed to be a cost-effective option to manage seizures in preeclamptic women while delivery remains the ultimate efficient treatment, especially for women with term preeclampsia. Disclosures: N. Zakiyah: None. A.D. van Asselt: None. P.N. Baker: minority shareholder Metabolomic Diagnostics, a small biotech company seeking to develop screening tests for pre-eclampsia. M.J. Postma: Advisor, Commercial Interest: SHIRE, GSK, Roche, Boehringer Ingelheim, Pfizer, SPMSD. doi:10.1016/j.preghy.2014.10.304
[299-POS] First-trimester screening combining maternal risk factors and uterine artery Doppler indices is useful to predict hypertension in low-risk pregnant woman Alessandra C. Marcolin, Rosiane Maciel Scandiuzzi, Silvana Maria Quintana, Elaine Dantas Moisés, Ricardo Carvalho Cavalli, Geraldo Duarte (Faculty of Medicine of Ribeirao Preto – University of Sao Paulo, Ribeirao Preto, Brazil) Objectives: The objectives of the study were to analyze the influence of maternal demographic characteristics and uterine artery (UA) Doppler parameters on the occurrence of hypertension. Methods: This prospective cohort study included 162 lowrisk women with singleton pregnancies and no fetal diseases. Maternal demographic data and UA Doppler parameters were collected prospectively twice, first at 11–14 weeks of gestation and second at 20–24 weeks. The presence of an early diastolic notch in the waveform was noted, and the mean pulsatility and resistance indices were calculated during both intervals. Abnormal UA Doppler study was defined as the presence of bilateral uterine artery diastolic notches and/or a mean pulsatility index or resistance index above the 95th percentile for the gestational age. The primary outcome was the development of hypertension. Chi-square test, receiver operating characteristic curve, and multiple logistic regressions were used for statistical analyses. Results: Fifteen (9.25%) women developed a hypertensive disorder. Significant independent prediction of hypertension was provided by mean PI, mean RI, and parity. Parity of two was associated with an increase in risk for the condition (OR 5.9, 95% CI 1.01–34.44, p < 0.05). Compared with pregnancies with a normal UA resistance index at the first and second trimesters, pregnancies with an abnormal mean UA RI above the 95th centile only at the first trimester showed an increased risk for hypertension (OR 23.25, 95% CI
3.47–155.73, p < 0.01). Similar results were found for an abnormal mean UA PI above the 95th centile (OR 9.84, 95% CI 1.05–92.10, p < 0.05). A model using both maternal and mean UA RI had an area under the receiver operator curve of 0.81. Conclusions: First-trimester screening combining maternal factors and UA Doppler indices is useful to predict hypertension in a routine care setting and could be investigated for application of targeted prophylactic strategies. Disclosures: A.C. Marcolin: None. R.M. Scandiuzzi: None. S.M. Quintana: None. E.D. Moisés: None. R.C. Cavalli: None. G. Duarte: None. doi:10.1016/j.preghy.2014.10.305
[300-POS] Diet-induced endothelial stiffness, mechanotransduction, and the mechanism of hypertension Nancy R. Hart (Peace Health Medical Center, Bellingham, WA, USA) Objectives: Compared to the diets on which humans evolved, modern diets have increased membrane-stiffening components such as long-chain saturated and trans-fatty acids. Increased vascular stiffness, as measured by pulse wave velocity, is associated with increased incidence and severity of preeclampsia (Hausvater, 2012). As one of the determinants of arterial stiffness, vascular smooth muscle tone is regulated by many factors including endocrine signals as well as nitric oxide, salt, oxidant stress, and mechanical stimulation through cell stretch and calcium signaling. It is generally believed that mechanotransduction in endothelial cell membranes is initiated at the local force-membrane interface by inducing local conformational changes or unfolding of membrane-bound proteins, followed by a cascade of diffusion-based signaling in the cytoplasm (Hoffman, 2011). The objective of this study is to develop a model of how diet-induced endothelial membrane stiffness might impact membrane-based mechanotransduction and cause hypertension. Methods: Literature review. Results: Because the arterial intima functions as a sensor, blood pressure homeostatic response might be modulated by the flexibility of endothelial membranes. Factors that stiffen cell membranes (such as salt, trans-fatty acids, and sympathetic neurohormones) might restrict protein conformational shift and invoke an inappropriately high contraction response and increased blood pressure. Factors that increase membrane flexibility (such as polyunsaturated fatty acids) might heighten the sensitivity of endothelial membranes to stretch. Similarly to a diaphragm pressure transducer in a barometer, if the diaphragm material is stiff, the signal is attenuated; conversely, a flexible diaphragm makes the instrument more sensitive to pressure. Conclusions: Pulse wave velocity might provide a noninvasive method of measuring the success of dietary interventions in reducing endothelial stiffness and risk of preeclampsia.