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335. Cardiovascular risk after hypertensive disorders of pregnancy in women with and without inheritable thrombophilia, preliminary results
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Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
Sufficient data to construct a 2 2 diagnostic table. Results: PlGF has high sensitivity and low negative likelihood ratio in predictive screening of preeclampsia. But, the sensitivity is not enough for it to be recommended as a screening test for preeclampsia. It may help in making decision regarding hospitalization and follow-up in women at a high risk of preeclampsia. The use of PlGF may also decrease the anxiety and health care costs in managing patients with a negative test. Conclusion: This points to the need for larger cohort studies with uniformity in study criteria and involving diverse patient population. Studies disagree about cut-off, gestational age for screening, single or multiple testing, type of preeclampsia tested (early/late onset) and the eligible patient population. This is the first meta-analysis studying the potential of PlGF as a biomarker in predicting preeclampsia. doi:10.1016/j.preghy.2018.08.378
333. Prediction of preeclampsia-related complications in women with suspected/confirmed preeclampsia: Development and validation of a clinical prediction score Langeza Saleh, M. Alblas, Daan Nieboer, Yvonne Vergouwe, Eric Steegers, Jan Danser, Anton van den Meiracker, Willy Visser (Erasmus Medical Center, Rotterdam, The Netherlands) Introduction: A simple clinical prediction model that could reliably predict the risk of preeclampsia (PE)-related pregnancy complications does not exist. Objective: To develop and to validate a clinical score for predicting the risk of women presenting with suspected/confirmed PE for developing pregnancy complications in the subsequent 7, 14 and 30 days. Methods: Data from our previous study, a prospective, multicenter, observational cohort study of 384 women with suspected/confirmed PE were used to develop and to internally validate a clinical score to predict PE-related maternal and fetal complications in subsequent days. For the development of the risk score the possible contribution of clinical and standard laboratory variables as well as the biomarkers soluble FMS like tyrosine kinase-1 (sFlt1), placenta growth factor (PlGF) and their ratio were explored using multivariate regression analysis. We assessed the discriminative ability of the model with the concordance (c-) statistic. Bootstrapping procedure with 500 replications were used to correct the estimate of the risk score performance for optimism and to compute a shrinkage factor for the regression coefficients to correct for overfitting. Results: 96 women with suspected/confirmed PE had PE-related adverse outcomes at any time after hospital admission. Remaining significant predictors of PE-related outcomes included sFlt-1/PlGF ratio (continuous), gestational age at time of biomarker measurement (continuous) and protein-to-creatinine ratio (continuous). The c-statistic (corrected for optimism) for developing a PE-related complication within 7, 14 and 30 days was respectively 0.888, 0.881 and 0.870. There was no significant overfitting. Internal validation by means of bootstrap resampling resulted in a shrinkage factor of 0.908. Conclusions: We successfully developed an internally validated clinical prediction score with an excellent discriminative performance to predict short-term and longer term PE-related
complications. Its usefulness in clinical practice awaits further investigation. doi:10.1016/j.preghy.2018.08.379
335. Cardiovascular risk after hypertensive disorders of pregnancy in women with and without inheritable thrombophilia, preliminary results Noralie Schonewille, Carolien Abheiden, Anouk Bokslag, Abel Thijs, Johanna de Vries, Christianne de Groot, Marjon de Boer (VU University Medical Center, Amsterdam, The Netherlands) Introduction: Women who develop hypertensive disorders of pregnancy (HD) are at increased risk for cardiovascular disease later in life. Presence of inheritable thrombophilia is associated with poor placentation in HD. It is unknown whether the combination of inheritable thrombophilia and early-onset HD (HD < 34 weeks) influences the risk for cardiovascular disease later in life. Objective: To compare cardiovascular risk factors 12.5 years in women after early-onset HD with and without inheritable thrombophilia. Methods: We compared two prospective cohorts of women with a history of early-onset of HD. Women with inheritable thrombophilia (protein C deficiency, protein S deficiency, heterozygous factor V Leiden mutation and heterozygous prothrombin gene G20210A mutation) were compared to women without thrombophilia. Women with pre-existing hypertension were excluded. Physical examination was performed and cardiovascular parameters in serum were measured. Results: Sixteen women with inheritable thrombophilia and 98 without thrombophilia were included. Seventy-five percent of all women developed one or more cardiovascular risk factor(s). Hypertension was present in 31.3% of women with thrombophilia and 33.7% without (p = 1.000), increased body mass index >25 kg/ m[b] in 43.8% with thrombophilia and 53.1% without (p = 0.593) and hypercholesterolemia in 31.3% with thrombophilia and 43.9% without (p = 0.420). Differences were not significant. Discussion: Our preliminary findings demonstrated similar cardiovascular risk factors in women after early-onset HD with and without inheritable thrombophilia. It raises the question whether there is a difference between the pathophysiological origin of HD between women with and without thrombophilia. In general, the role of thrombophilia in the development of cardiovascular risk factors is unclear. However, in this subgroup of women with a history of early-onset HD, thrombophilia does not modify the development of cardiovascular risk factors. doi:10.1016/j.preghy.2018.08.380
336. Relationship between night time blood pressure measured using ambulatory monitoring and markers of placental function Emma Shawkat, Edward Johnstone, Catherine Chmiel, Jenny Myers (United Kingdom) Objective/hypothesis: The relationship between maternal blood pressure and placental development is poorly understood. We tested the hypothesis that night-time blood pressure would be associated with markers of abnormal placental development (uterine artery Doppler and placental growth factor (PlGF)) and to other vascular function markers, irrespective of pregnancy outcome. Methods: 88 women attending the Manchester Antenatal Vascular Service (MAViS) research clinic underwent ambulatory BP monitoring at 16 [range 6–26]. Pulse wave velocity (PWV) was measured
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
Sufficient data to construct a 2 2 diagnostic table. Results: PlGF has high sensitivity and low negative likelihood ratio in predictive screening of preeclampsia. But, the sensitivity is not enough for it to be recommended as a screening test for preeclampsia. It may help in making decision regarding hospitalization and follow-up in women at a high risk of preeclampsia. The use of PlGF may also decrease the anxiety and health care costs in managing patients with a negative test. Conclusion: This points to the need for larger cohort studies with uniformity in study criteria and involving diverse patient population. Studies disagree about cut-off, gestational age for screening, single or multiple testing, type of preeclampsia tested (early/late onset) and the eligible patient population. This is the first meta-analysis studying the potential of PlGF as a biomarker in predicting preeclampsia. doi:10.1016/j.preghy.2018.08.378
333. Prediction of preeclampsia-related complications in women with suspected/confirmed preeclampsia: Development and validation of a clinical prediction score Langeza Saleh, M. Alblas, Daan Nieboer, Yvonne Vergouwe, Eric Steegers, Jan Danser, Anton van den Meiracker, Willy Visser (Erasmus Medical Center, Rotterdam, The Netherlands) Introduction: A simple clinical prediction model that could reliably predict the risk of preeclampsia (PE)-related pregnancy complications does not exist. Objective: To develop and to validate a clinical score for predicting the risk of women presenting with suspected/confirmed PE for developing pregnancy complications in the subsequent 7, 14 and 30 days. Methods: Data from our previous study, a prospective, multicenter, observational cohort study of 384 women with suspected/confirmed PE were used to develop and to internally validate a clinical score to predict PE-related maternal and fetal complications in subsequent days. For the development of the risk score the possible contribution of clinical and standard laboratory variables as well as the biomarkers soluble FMS like tyrosine kinase-1 (sFlt1), placenta growth factor (PlGF) and their ratio were explored using multivariate regression analysis. We assessed the discriminative ability of the model with the concordance (c-) statistic. Bootstrapping procedure with 500 replications were used to correct the estimate of the risk score performance for optimism and to compute a shrinkage factor for the regression coefficients to correct for overfitting. Results: 96 women with suspected/confirmed PE had PE-related adverse outcomes at any time after hospital admission. Remaining significant predictors of PE-related outcomes included sFlt-1/PlGF ratio (continuous), gestational age at time of biomarker measurement (continuous) and protein-to-creatinine ratio (continuous). The c-statistic (corrected for optimism) for developing a PE-related complication within 7, 14 and 30 days was respectively 0.888, 0.881 and 0.870. There was no significant overfitting. Internal validation by means of bootstrap resampling resulted in a shrinkage factor of 0.908. Conclusions: We successfully developed an internally validated clinical prediction score with an excellent discriminative performance to predict short-term and longer term PE-related
complications. Its usefulness in clinical practice awaits further investigation. doi:10.1016/j.preghy.2018.08.379
335. Cardiovascular risk after hypertensive disorders of pregnancy in women with and without inheritable thrombophilia, preliminary results Noralie Schonewille, Carolien Abheiden, Anouk Bokslag, Abel Thijs, Johanna de Vries, Christianne de Groot, Marjon de Boer (VU University Medical Center, Amsterdam, The Netherlands) Introduction: Women who develop hypertensive disorders of pregnancy (HD) are at increased risk for cardiovascular disease later in life. Presence of inheritable thrombophilia is associated with poor placentation in HD. It is unknown whether the combination of inheritable thrombophilia and early-onset HD (HD < 34 weeks) influences the risk for cardiovascular disease later in life. Objective: To compare cardiovascular risk factors 12.5 years in women after early-onset HD with and without inheritable thrombophilia. Methods: We compared two prospective cohorts of women with a history of early-onset of HD. Women with inheritable thrombophilia (protein C deficiency, protein S deficiency, heterozygous factor V Leiden mutation and heterozygous prothrombin gene G20210A mutation) were compared to women without thrombophilia. Women with pre-existing hypertension were excluded. Physical examination was performed and cardiovascular parameters in serum were measured. Results: Sixteen women with inheritable thrombophilia and 98 without thrombophilia were included. Seventy-five percent of all women developed one or more cardiovascular risk factor(s). Hypertension was present in 31.3% of women with thrombophilia and 33.7% without (p = 1.000), increased body mass index >25 kg/ m[b] in 43.8% with thrombophilia and 53.1% without (p = 0.593) and hypercholesterolemia in 31.3% with thrombophilia and 43.9% without (p = 0.420). Differences were not significant. Discussion: Our preliminary findings demonstrated similar cardiovascular risk factors in women after early-onset HD with and without inheritable thrombophilia. It raises the question whether there is a difference between the pathophysiological origin of HD between women with and without thrombophilia. In general, the role of thrombophilia in the development of cardiovascular risk factors is unclear. However, in this subgroup of women with a history of early-onset HD, thrombophilia does not modify the development of cardiovascular risk factors. doi:10.1016/j.preghy.2018.08.380
336. Relationship between night time blood pressure measured using ambulatory monitoring and markers of placental function Emma Shawkat, Edward Johnstone, Catherine Chmiel, Jenny Myers (United Kingdom) Objective/hypothesis: The relationship between maternal blood pressure and placental development is poorly understood. We tested the hypothesis that night-time blood pressure would be associated with markers of abnormal placental development (uterine artery Doppler and placental growth factor (PlGF)) and to other vascular function markers, irrespective of pregnancy outcome. Methods: 88 women attending the Manchester Antenatal Vascular Service (MAViS) research clinic underwent ambulatory BP monitoring at 16 [range 6–26]. Pulse wave velocity (PWV) was measured