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317: Vitamin D supplementation decreased blood pressure in a model of CHTN during pregnancy
Poster Session II
Hypertension, Diabetes, Prematurity, Physiology
www.AJOG.org
317 Vitamin D supplementation decreased blood pressure in a model of CHTN during pregnancy
318 Decreased respiratory morbidity in very low birth weight infants of hypertensive mothers
Marie Darby1, Kedra Wallace1, Krystal Frazier1, Justin Porter2, Janae Moseley2, Judith Heath2, James Martin1, Christine Purser2, Rodney Baker2, Michelle Owens1, Babbette LaMarca2
Kathryn Davidson1, David Burchfield2, Robert Egerman1, Oluseyi Ogunleye1, Anthony Gregg1
1
University of Mississippi Medical Center, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jackson, MS, 2University of Mississippi Medical Center, Pharmacology and Toxicology, Jackson, MS
OBJECTIVE: To clarify if Vitamin D (VitD) deficiency/supplementation affects hypertensive human pregnancy, we compared circulating VitD in patients with chronic hypertension (CHTN) and normal pregnancy (NP); and determined effects of VitD supplementation on human placental cytokine secretion and blood pressure (MAP) in a pregnant rat model of CHTN. STUDY DESIGN: Blood and placentas from NP and CHTN women were collected following cesarean delivery. Circulating 1,25(OH)2D (VitD) was extracted from plasma by HPLC and measured via mass spectrometry. Placental explants were cultured with or without VitD media supplementation and ELISAs performed to determine cytokine secretion. To investigate a role for VitD supplementation on CHTN in pregnancy, MAP was measured in NP and Angiotensin II infused (Ang II) rats with or without VitD2 or VitD3 supplemented daily by gavage. RESULTS: Although not significant, circulating VitD decreased approximately 50% in pregnant CHTN(3.3 +/-0.6; n¼7) compared to NP (6.0 +/-1.2; n¼12), p¼0.1262. Cytokines were elevated in CHTN placentas (n¼4) compared to NP (n¼3); IL-6 [3030 NP vs. 2119611.3pg/mL CHTN, p¼0.027], IL-10 [4.121.9 NP vs. 525343.8 CHTN, p¼0.26], sFlt [17376.53 NP vs. 1582591.8pg/mL CHTN, p¼0.1] and TNF-a [24.316.6 NP vs. 45.728.1pg/mL in CHTN, p¼0.58]; but were not altered by VitD supplementation of media. MAP increased from 99.22.4mmHg in NP rats (n¼9) to 112.71.7mmHg in AngII rats (n¼7), (p¼0.0003). MAP decreased after supplementation with VitD to 1053.6mmHg in AngII+50mL/mL D2 (n¼7), p¼0.0545 and to 107.13.6mmHg in AngII+50mL/ML D3 (n¼7), p¼0.16. CONCLUSION: CHTN have lower circulating VitD and greater placental cytokine secretion than NP. Daily supplementation with either VitD2 or VitD3 improved hypertension in response to chronic AngII infusion in pregnant rats. These data support the hypothesis that Vit D supplementation could prove to be beneficial therapy for preexisting hypertension in pregnancy.
1 University of Florida, Obstetrics and Gynecology, Gainesville, FL, 2University of Florida, Neonatology, Gainesville, FL
OBJECTIVE: We hypothesized that very low birth weight (VLBW) infants of hypertensive mothers (IHM) have decreased respiratory morbidity as had previously been observed in late preterm IHM. STUDY DESIGN: We reviewed our institution’s Vermont Oxford Network database entries of VLBW infants (<1500 grams) from 2008-2013. We compared IHM (including chronic and gestational hypertension, de novo and superimposed pre-eclampsia) to normotensive controls. Outcome variables included need for endotracheal intubation in the delivery room, respiratory distress syndrome (RDS), and oxygen requirement at 28 days of life or at the time of discharge from our NICU. We then explored a sub-cohort controlled for possible confounders of respiratory morbidity. Statistical analysis included t-tests and Pearson chi-squared tests. RESULTS: We identified 243 IHM and 562 control patients. Gestational age and birth weight were similar between groups (see table). The IHM had decreased rates of need for endotracheal intubation in the delivery room, RDS, and oxygen requirement at 28 days of life or at the time of discharge from our NICU (see table). These groups, however, differed significantly in their rates of antenatal steroid use (86% vs. 70%, p<0.001), chorioamnionitis (10% vs. 29%, p<0.001), vaginal delivery (90% vs. 60%, p<0.001), and multi-fetal gestation (16% vs. 27%, p¼0.001). A sub-cohort controlled for these differences and excluding extremes of periviability ( 24w and 450g) included 128 IHM and 68 control patients. Gestational age and birth weight were similar between groups. Although rates of RDS and oxygen requirement at 28 days no longer differed significantly, rates of intubation in the delivery room and oxygen requirement at discharge from our NICU did (Table). CONCLUSION: After controlling for possible confounders, very low birth weight infants of hypertensive mothers have decreased respiratory morbidity.
Characteristics and outcomes
The original cohort included all VLBW database entries 21w and 401g. The sub cohort included those that had received antenatal steroids, were delivered vaginally, were singletons, did not have chorioamnionitis, and were 24w and 450g.
319 The association of maternal plasma vitamin D with expression of angiogenic factors in early onset severe preeclamptic (EOSPE) placenta Angela Hawk1, Eugene Chang1, Satomi Kohno2, Donna Johnson1, Christopher Robinson3 1
Medical University of South Carolina, Obstetrics and Gynecology, Charleston, SC, 2Medical University of South Carolina, Hollings Marine
S166 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
Hypertension, Diabetes, Prematurity, Physiology
www.AJOG.org
317 Vitamin D supplementation decreased blood pressure in a model of CHTN during pregnancy
318 Decreased respiratory morbidity in very low birth weight infants of hypertensive mothers
Marie Darby1, Kedra Wallace1, Krystal Frazier1, Justin Porter2, Janae Moseley2, Judith Heath2, James Martin1, Christine Purser2, Rodney Baker2, Michelle Owens1, Babbette LaMarca2
Kathryn Davidson1, David Burchfield2, Robert Egerman1, Oluseyi Ogunleye1, Anthony Gregg1
1
University of Mississippi Medical Center, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jackson, MS, 2University of Mississippi Medical Center, Pharmacology and Toxicology, Jackson, MS
OBJECTIVE: To clarify if Vitamin D (VitD) deficiency/supplementation affects hypertensive human pregnancy, we compared circulating VitD in patients with chronic hypertension (CHTN) and normal pregnancy (NP); and determined effects of VitD supplementation on human placental cytokine secretion and blood pressure (MAP) in a pregnant rat model of CHTN. STUDY DESIGN: Blood and placentas from NP and CHTN women were collected following cesarean delivery. Circulating 1,25(OH)2D (VitD) was extracted from plasma by HPLC and measured via mass spectrometry. Placental explants were cultured with or without VitD media supplementation and ELISAs performed to determine cytokine secretion. To investigate a role for VitD supplementation on CHTN in pregnancy, MAP was measured in NP and Angiotensin II infused (Ang II) rats with or without VitD2 or VitD3 supplemented daily by gavage. RESULTS: Although not significant, circulating VitD decreased approximately 50% in pregnant CHTN(3.3 +/-0.6; n¼7) compared to NP (6.0 +/-1.2; n¼12), p¼0.1262. Cytokines were elevated in CHTN placentas (n¼4) compared to NP (n¼3); IL-6 [3030 NP vs. 2119611.3pg/mL CHTN, p¼0.027], IL-10 [4.121.9 NP vs. 525343.8 CHTN, p¼0.26], sFlt [17376.53 NP vs. 1582591.8pg/mL CHTN, p¼0.1] and TNF-a [24.316.6 NP vs. 45.728.1pg/mL in CHTN, p¼0.58]; but were not altered by VitD supplementation of media. MAP increased from 99.22.4mmHg in NP rats (n¼9) to 112.71.7mmHg in AngII rats (n¼7), (p¼0.0003). MAP decreased after supplementation with VitD to 1053.6mmHg in AngII+50mL/mL D2 (n¼7), p¼0.0545 and to 107.13.6mmHg in AngII+50mL/ML D3 (n¼7), p¼0.16. CONCLUSION: CHTN have lower circulating VitD and greater placental cytokine secretion than NP. Daily supplementation with either VitD2 or VitD3 improved hypertension in response to chronic AngII infusion in pregnant rats. These data support the hypothesis that Vit D supplementation could prove to be beneficial therapy for preexisting hypertension in pregnancy.
1 University of Florida, Obstetrics and Gynecology, Gainesville, FL, 2University of Florida, Neonatology, Gainesville, FL
OBJECTIVE: We hypothesized that very low birth weight (VLBW) infants of hypertensive mothers (IHM) have decreased respiratory morbidity as had previously been observed in late preterm IHM. STUDY DESIGN: We reviewed our institution’s Vermont Oxford Network database entries of VLBW infants (<1500 grams) from 2008-2013. We compared IHM (including chronic and gestational hypertension, de novo and superimposed pre-eclampsia) to normotensive controls. Outcome variables included need for endotracheal intubation in the delivery room, respiratory distress syndrome (RDS), and oxygen requirement at 28 days of life or at the time of discharge from our NICU. We then explored a sub-cohort controlled for possible confounders of respiratory morbidity. Statistical analysis included t-tests and Pearson chi-squared tests. RESULTS: We identified 243 IHM and 562 control patients. Gestational age and birth weight were similar between groups (see table). The IHM had decreased rates of need for endotracheal intubation in the delivery room, RDS, and oxygen requirement at 28 days of life or at the time of discharge from our NICU (see table). These groups, however, differed significantly in their rates of antenatal steroid use (86% vs. 70%, p<0.001), chorioamnionitis (10% vs. 29%, p<0.001), vaginal delivery (90% vs. 60%, p<0.001), and multi-fetal gestation (16% vs. 27%, p¼0.001). A sub-cohort controlled for these differences and excluding extremes of periviability ( 24w and 450g) included 128 IHM and 68 control patients. Gestational age and birth weight were similar between groups. Although rates of RDS and oxygen requirement at 28 days no longer differed significantly, rates of intubation in the delivery room and oxygen requirement at discharge from our NICU did (Table). CONCLUSION: After controlling for possible confounders, very low birth weight infants of hypertensive mothers have decreased respiratory morbidity.
Characteristics and outcomes
The original cohort included all VLBW database entries 21w and 401g. The sub cohort included those that had received antenatal steroids, were delivered vaginally, were singletons, did not have chorioamnionitis, and were 24w and 450g.
319 The association of maternal plasma vitamin D with expression of angiogenic factors in early onset severe preeclamptic (EOSPE) placenta Angela Hawk1, Eugene Chang1, Satomi Kohno2, Donna Johnson1, Christopher Robinson3 1
Medical University of South Carolina, Obstetrics and Gynecology, Charleston, SC, 2Medical University of South Carolina, Hollings Marine
S166 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014