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340. Quercetin protects against the vascular contractile effect of placental secreted messengers released under placental hypoxia
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Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
interviewing pregnant women and reviewing antenatal records. A pregnant woman was considered as not screened for HDP if she did not benefit for blood pressure measurement, proteinuria testing and assessment for at least one of clinical risk factors from the American College of Obstetricians and Gynecologists. To identify factors associated to the lack of screening for HDP, we carried out a multivariate logistic regression model using generalized estimating equation. Results: Of 580 pregnant women included, 73% were not tested for proteinuria, 41% were not assessed for risk factors, and 7% did not have their blood pressure checked. In total, 74% of pregnant women were not screened for HDP. In the multivariate analysis, being nulliparous (AOR = 1.98; 95%CI, 1.19–3.29, p < 0.001), primary level of education (AOR = 1.63; 95%CI, 1.02–2.63, p = 0.048), attending in a public clinic (AOR = 4.86; 95%CI, 1.79–13.2, p < 0.01) or in a primary health clinic ((AOR = 2.4; 95%CI, 1.05–5.49, p < 0.038) were significantly associated with the lack of sreening for HDP. Discussion: The majority of pregnant women attending antenatal care in Kinshasa are not screened for HDP. There is a need of increasing awareness of health providers in the screening for HDP to improve pregnancy outcomes in Kinshasa. doi:10.1016/j.preghy.2018.08.384
340. Quercetin protects against the vascular contractile effect of placental secreted messengers released under placental hypoxia Astrid Bruekers, Dominique Pellaers, Philippe Vangrieken, Paul Schiffers, Salwan al-Nasiry (Maastricht University Medical Centre, Maastricht, The Netherlands) Introduction: Hypoxia is a crucial factor in the pathogenesis of preeclampsia resulting in hypoxic stress in the placenta. Upon this stress the placenta will release placenta secreted messengers (PSMs) which will cause maternal endothelial dysfunction. Previous research suggests that the antioxidant quercetin exerts anti-hypertensive effects and endothelial relaxation via NO release. Objective: To determine the vascular effect of PSMs released under hypoxia and to study the protective effect of quercetin on this process. Methods: In this study 44 non-complicated placentas (GA > 37 weeks) were used. PSMs were generated by exposing healthy term placentas to hypoxia. Chorionic arteries were incubated with these PSMs +/ quercetin 3 and 20 lM and contractile responses were recorded over a two-hour period. PSMs generated under normoxic conditions were used as control. Endothelial dysfunction induced by PSMs was assessed by analyzing changes in contractile responses to KCl (62.5 mM) before and after exposure to the PSMs. Results: PSMs released under hypoxia induced an increased contraction in chorionic arteries compared to PSMs released in the presence of quercetin and normoxic conditions (39.1 lm ± 5.9 vs. quercetin 3 lM: 17.5 lm ± 1.6 vs. quercetin 20 lM: 8.5 lm ± 2.2 vs. normoxic: 0.5 lm ± 0.8, p < 0.001). A decreased change in contractile response to KCl (62.5 mM) was observed for PSMs released in the presence of quercetin (20 lM) (72.5 lm ± 6.0 vs. quercetin 3 lM: 40.1 lm ± 3.3, p < 0.05 and quercetin 20 lM: 3.5 lm ± 0.6, p < 0.001). No changes in contractile response to KCl was observed for the control condition (0.0 ± 0.2, p < 0.001). Discussion: Quercetin shows promising results for the protection against the PSMs released under preeclampsia-like stress conditions like placental hypoxia, which could eventually be used for prevention and/or treatment of preeclampsia. doi:10.1016/j.preghy.2018.08.385
341. The additional value of fetal growth velocity parameters and maternal biochemical biomarkers for the detection of small- forgestational-age neonates? Astrid Bruekers, Manouk Hendrix, Judith Bons, Salwan al-Nasiry (Maastricht University Medical Centre, Maastricht, The Netherlands) Introduction: Small-for-gestational age (SGA) neonates are a major cause of perinatal morbidity. The detection of SGA needs to be improved. Objective/hypothesis: To evaluate the value of adding fetal growth velocity parameters to maternal biochemical biomarkers for the detection of SGA neonates. Methods: A retrospective cohort study of 1094 singleton pregnancies (SGA and AGA), in the Maastricht University Medical Centre (MUMC) between 2011 and 2016. All women had ultrasound data of fetal growth from two periodes: 18–22 and 30–34 weeks. In a subgroup the PAPP-A, b-hCG, PlGF and sFlt-1 at 11–13 weeks were measured. Differences in maternal biochemical biomarkers and fetal growth velocities (mm/week) of the abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and femur length (FL) were compared between the AGA (birth weight percentiles 10–90)), and SGA (birth weight percentiles <10), using one-way ANOVA and post hoc. Results: Compared to AGA (n = 1049) as reference group, SGA (n = 45) had significant lower growth velocities ACv (10.08 ± 0.98 vs. 11.26 ± 1.00, p < 0.0001) BPDv (2.78 ± 0.29 vs.3.08 ± 0.27, p < 0.0001), HCv (9.98 ± 0.83 vs 10.67 ± 0.82, p < 0.0001) and FLv (2.34 ± 0.252 vs. 2.52 ± 0.20, p < 0.0001). SGA compared with optimal AGA had lower PAPP-a MoM (0.87 ± 0.48 vs 1.13 ± 0.70, p = 0.015), higher Sflt-1 (1283.96 ± 699.36 vs. 1088.21 ± 480.80, p = 0.048), and a higher PlGF/ sFlt-1 ratio (50.16 ± 41.56 vs. 35.67 ± 19.68, 0.002). Combining all maternal biomarkers resulted in an AUC of 0.762 (0.655–0.869) for prediction of SGA. The combination of growth velocities resulted in an AUC of 0.729 (0.631– 0.828). However, the addition of fetal growth velocities to the maternal biomarkers, improves the prediction of SGA with an AUC of 0.823 (0.741–0.906) sensitivity 92.3% (95%CI 79.4–97.7%); specificity 50.0% (95%CI 43.7–56.3%); and NPV 97.3% (95%CI 92.3–99.2%). Discussion: Detection of small-for-gestational neonates can be improved using the combination of fetal growth velocity parameters and maternal biochemical markers. A larger prospective study including serial maternal biochemical markers is needed. doi:10.1016/j.preghy.2018.08.386
343. Management and pregnancy outcomes in women with hypertensive disorders of pregnancy in University of Calabar Teaching Hospital (UCTH), Calabar. Nigeria: – One year preliminary review Patience Odusolu, Useneno Okon (University of Calabar, Calabar, Nigeria) Introduction: Hypertensive disorders in pregnancy (HDP) is one of the leading causes of maternal mortality in Nigeria contributing over 23%. There is no locally available guideline that directs care for women with HDPs during the postnatal period. Population Council under the Ending Eclampsia project proposed a study across the six geo-political zones of Nigeria that will recruit women with HDP around the time of delivery and prospectively follow them for up to 1 year afterwards. UCTH Calabar is one of the centers, and this is a one year preliminary review of data before commencement of the study. Objective: To assess service delivery gaps and pregnancy outcome of women with hypertensive disorders in pregnancy.
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
interviewing pregnant women and reviewing antenatal records. A pregnant woman was considered as not screened for HDP if she did not benefit for blood pressure measurement, proteinuria testing and assessment for at least one of clinical risk factors from the American College of Obstetricians and Gynecologists. To identify factors associated to the lack of screening for HDP, we carried out a multivariate logistic regression model using generalized estimating equation. Results: Of 580 pregnant women included, 73% were not tested for proteinuria, 41% were not assessed for risk factors, and 7% did not have their blood pressure checked. In total, 74% of pregnant women were not screened for HDP. In the multivariate analysis, being nulliparous (AOR = 1.98; 95%CI, 1.19–3.29, p < 0.001), primary level of education (AOR = 1.63; 95%CI, 1.02–2.63, p = 0.048), attending in a public clinic (AOR = 4.86; 95%CI, 1.79–13.2, p < 0.01) or in a primary health clinic ((AOR = 2.4; 95%CI, 1.05–5.49, p < 0.038) were significantly associated with the lack of sreening for HDP. Discussion: The majority of pregnant women attending antenatal care in Kinshasa are not screened for HDP. There is a need of increasing awareness of health providers in the screening for HDP to improve pregnancy outcomes in Kinshasa. doi:10.1016/j.preghy.2018.08.384
340. Quercetin protects against the vascular contractile effect of placental secreted messengers released under placental hypoxia Astrid Bruekers, Dominique Pellaers, Philippe Vangrieken, Paul Schiffers, Salwan al-Nasiry (Maastricht University Medical Centre, Maastricht, The Netherlands) Introduction: Hypoxia is a crucial factor in the pathogenesis of preeclampsia resulting in hypoxic stress in the placenta. Upon this stress the placenta will release placenta secreted messengers (PSMs) which will cause maternal endothelial dysfunction. Previous research suggests that the antioxidant quercetin exerts anti-hypertensive effects and endothelial relaxation via NO release. Objective: To determine the vascular effect of PSMs released under hypoxia and to study the protective effect of quercetin on this process. Methods: In this study 44 non-complicated placentas (GA > 37 weeks) were used. PSMs were generated by exposing healthy term placentas to hypoxia. Chorionic arteries were incubated with these PSMs +/ quercetin 3 and 20 lM and contractile responses were recorded over a two-hour period. PSMs generated under normoxic conditions were used as control. Endothelial dysfunction induced by PSMs was assessed by analyzing changes in contractile responses to KCl (62.5 mM) before and after exposure to the PSMs. Results: PSMs released under hypoxia induced an increased contraction in chorionic arteries compared to PSMs released in the presence of quercetin and normoxic conditions (39.1 lm ± 5.9 vs. quercetin 3 lM: 17.5 lm ± 1.6 vs. quercetin 20 lM: 8.5 lm ± 2.2 vs. normoxic: 0.5 lm ± 0.8, p < 0.001). A decreased change in contractile response to KCl (62.5 mM) was observed for PSMs released in the presence of quercetin (20 lM) (72.5 lm ± 6.0 vs. quercetin 3 lM: 40.1 lm ± 3.3, p < 0.05 and quercetin 20 lM: 3.5 lm ± 0.6, p < 0.001). No changes in contractile response to KCl was observed for the control condition (0.0 ± 0.2, p < 0.001). Discussion: Quercetin shows promising results for the protection against the PSMs released under preeclampsia-like stress conditions like placental hypoxia, which could eventually be used for prevention and/or treatment of preeclampsia. doi:10.1016/j.preghy.2018.08.385
341. The additional value of fetal growth velocity parameters and maternal biochemical biomarkers for the detection of small- forgestational-age neonates? Astrid Bruekers, Manouk Hendrix, Judith Bons, Salwan al-Nasiry (Maastricht University Medical Centre, Maastricht, The Netherlands) Introduction: Small-for-gestational age (SGA) neonates are a major cause of perinatal morbidity. The detection of SGA needs to be improved. Objective/hypothesis: To evaluate the value of adding fetal growth velocity parameters to maternal biochemical biomarkers for the detection of SGA neonates. Methods: A retrospective cohort study of 1094 singleton pregnancies (SGA and AGA), in the Maastricht University Medical Centre (MUMC) between 2011 and 2016. All women had ultrasound data of fetal growth from two periodes: 18–22 and 30–34 weeks. In a subgroup the PAPP-A, b-hCG, PlGF and sFlt-1 at 11–13 weeks were measured. Differences in maternal biochemical biomarkers and fetal growth velocities (mm/week) of the abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and femur length (FL) were compared between the AGA (birth weight percentiles 10–90)), and SGA (birth weight percentiles <10), using one-way ANOVA and post hoc. Results: Compared to AGA (n = 1049) as reference group, SGA (n = 45) had significant lower growth velocities ACv (10.08 ± 0.98 vs. 11.26 ± 1.00, p < 0.0001) BPDv (2.78 ± 0.29 vs.3.08 ± 0.27, p < 0.0001), HCv (9.98 ± 0.83 vs 10.67 ± 0.82, p < 0.0001) and FLv (2.34 ± 0.252 vs. 2.52 ± 0.20, p < 0.0001). SGA compared with optimal AGA had lower PAPP-a MoM (0.87 ± 0.48 vs 1.13 ± 0.70, p = 0.015), higher Sflt-1 (1283.96 ± 699.36 vs. 1088.21 ± 480.80, p = 0.048), and a higher PlGF/ sFlt-1 ratio (50.16 ± 41.56 vs. 35.67 ± 19.68, 0.002). Combining all maternal biomarkers resulted in an AUC of 0.762 (0.655–0.869) for prediction of SGA. The combination of growth velocities resulted in an AUC of 0.729 (0.631– 0.828). However, the addition of fetal growth velocities to the maternal biomarkers, improves the prediction of SGA with an AUC of 0.823 (0.741–0.906) sensitivity 92.3% (95%CI 79.4–97.7%); specificity 50.0% (95%CI 43.7–56.3%); and NPV 97.3% (95%CI 92.3–99.2%). Discussion: Detection of small-for-gestational neonates can be improved using the combination of fetal growth velocity parameters and maternal biochemical markers. A larger prospective study including serial maternal biochemical markers is needed. doi:10.1016/j.preghy.2018.08.386
343. Management and pregnancy outcomes in women with hypertensive disorders of pregnancy in University of Calabar Teaching Hospital (UCTH), Calabar. Nigeria: – One year preliminary review Patience Odusolu, Useneno Okon (University of Calabar, Calabar, Nigeria) Introduction: Hypertensive disorders in pregnancy (HDP) is one of the leading causes of maternal mortality in Nigeria contributing over 23%. There is no locally available guideline that directs care for women with HDPs during the postnatal period. Population Council under the Ending Eclampsia project proposed a study across the six geo-political zones of Nigeria that will recruit women with HDP around the time of delivery and prospectively follow them for up to 1 year afterwards. UCTH Calabar is one of the centers, and this is a one year preliminary review of data before commencement of the study. Objective: To assess service delivery gaps and pregnancy outcome of women with hypertensive disorders in pregnancy.