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444: Routine urine dipsticks not necessary at every prenatal visit
SMFM Abstracts
www.AJOG.org 441
DO ELEVATED NT-PROBNP LEVELS OF HYPERTENSIVE PREGNANT WOMEN REFLECT CARDIAC DYSFUNCTION? TAE KOO1, 1Society for Maternal-Fetal Medicine, Taegu, South Korea OBJECTIVE: NT-proBNP is synthesized in cardiac ventricles in response to volume expansion. This study is to evaluate if elevated NT-proBNP levels of hypertensive pregnant women reflect cardiac dysfunction or there is a significant level requiring further evaluation. STUDY DESIGN: 18 hypertensive pregnancy women who were composed of 13 severe preeclamptis, 3 mild preeclamptics, 1 gestational hypertension and 1 superimposed severe preeclamptic took echocardiogram within 24 hours from sampling for NT-proBNP. The correlations between NT-proBNP and variables associated with cardiac function were verified. RESULTS: On the correlation coefficients between NT-proBNP level and each variable, It was -0.29 with left ventricular ejection fraction, 0.13 with left ventricular end diastolic volume, 0.07 with left ventricular end systolic volume, 0.32 with left ventricular diastolic dimension, 0.57 with Sa and 0.33 with left ventricular filling pressure. CONCLUSION: Elevated NT-proBNP levels in hypertensive pregnant woman don=t seem to correctly reflect cardiac dysfunction.
443
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.460
442
NT-PROBNP LEVELS IN HYPERTENSIVE DISORDERS COMPLICATING PREGNANCY TAE KOO1, 1Society for Maternal-Fetal Medicine, Taegu, South Korea OBJECTIVE: NT-proBNP is synthesized in cardiac ventricles in response to volume expansion. This study evaluated NT-proBNP levels to determine clinical correlation with the severity of hypertensive disorders complicating pregnancy. STUDY DESIGN: NT-proBNP levels of 95 pregnant women who composed of 26 severe preeclamptics, 15 mild preeclamptics, 9 gestational hypertensive patients and 45 normal controls were determined using the electrochemiluminescence immunoassay done by MODULAR ANALYTICS E 170(Roche). RESULTS: Comparisons of mean values on NT-proBNP levels had statistic significances according to severity of desease; 1766.43⫾4197.39 pg/mL in severe preeclampsia (median; 339.8 pg/mL), 214.97 ⫾ 226.35 pg/mL(median; 152.3 pg/mL) in mild preeclampsia, 39.75 ⫾24.85 pg/mL(median; 34.09) in gestational hypertension and : 78.78 ⫾ 81.56 pg/mL(median; 48.54) in normal control. The NTproBNP levels of mild and severe preeclamptic patients were significantly higher than those on gestational hypertension and normal control patients. There was no significance between mild and severe preeclampsia(p⫽0.17). CONCLUSION: In mild and severe preeclampsia, NT-proBNP levels are elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.461
BIOMARKERS OF PREECLAMPSIA: SHOULD WE BE CONSIDERING RACE? SINDHU SRINIVAS1, JAMIE BASTEK1, JACOB LARKIN1, ELLA OFORI2, CHRISTINA ANDRELA1, MICHAL ELOVITZ1, 1University of Pennsylvania, Philadelphia, Pennsylvania, 2University of Pennsylvania, Pennsylvania OBJECTIVE: Utilizing angiogenic proteins as biomarkers to predict preeclampsia (PRE) has been the focus of recent research. It is reported that black race increases PRE risk, however, studies to date have not determined if these biomarkers differ by race. STUDY DESIGN: Cases are prospectively identified with PRE based on ACOG criteria. Controls are women presenting for delivery at term. Clinical data and serum were collected for all subjects. sFlt1, Endgolin (ENG) and PGF were measured by ELISA assays. Maternal race was obtained by patient report at enrollment. Women with chronic hypertension by report or increase in BP before 20 wks were excluded. Nonparametric comparisons between sFlt, ENG, and PGF and maternal race (Black (BL) vs. non Black (nBL)) in cases vs. controls and within cases and controls were made using Kruskal-Wallis and Wilcoxon rank sum tests. RESULTS: 99 cases (78 BL and 21 nBL) and 151 controls (113 BL and 38 nBL) were evaluated. In stratified analyses by race, endoglin and PGF differed between cases and controls. However, sFlt levels only differed between BL cases and BL controls (Table). There was no difference in sFlt and PGF levels between BL and nBL cases or BL and nBL controls. However, there was a difference in endoglin level between BL and nBL cases (p⫽0.02) and BL and nBL controls (0.06). CONCLUSION: In limited populations, angiogenic biomarkers have shown some promise in predicting preeclampsia (NEJM). However, these levels, particularly sFlt and endoglin, may have less utility in certain racial populations. Further exploration of these biomarkers in diverse populations must occur prior to adopting these tests into practice. Angiogenic factors in cases and controls by race Factor (med)
BL case
BL cont
p-value
nBL case
nBL cont
p-value
sFLT ENG PGF
7.3 15.8 48.6
5.5 10.4 139.5
0.01 ⬍0.001 ⬍0.001
9.9 27.6 44.3
6.1 13.6 93
0.28 0.007 0.006
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.462
444
ROUTINE URINE DIPSTICKS NOT NECESSARY AT EVERY PRENATAL VISIT MATTHEW BORGMEYER1, MICHAEL RUMA1, JOHN THORP1, 1University of North Carolina at Chapel Hill, Obstetrics and Gynecology, Chapel Hill, North Carolina OBJECTIVE: Routine urine dipsticks are a time-honored tradition of prenatal care. We sought to assess the ability of routine urine dipstick for proteinuria to identify preeclampsia in low-risk pregnancy. STUDY DESIGN: A secondary analysis was completed from the Pregnancy, Infection and Nutrition (PIN) study, a prospective cohort of healthy, pregnant women enrolled at less than 20 weeks= gestation. Low-risk patients were defined as healthy, normotensive pregnant women without medical comorbidities. Exclusion criteria included hypertension (preexisting or gestational), diabetes, and multiple gestation. Preeclampsia was defined as blood pressure ⬎ 140/90 with ⱖ 1⫹ proteinuria. Sensitivity, specificity, and predictive values (95% CI) were calculated for routine urine dipsticks with ⱖ 1⫹ proteinuria to predict preeclampsia among low-risk women during any prenatal visit. RESULTS: 1660 women were analyzed. 329 (20%) patients developed ⱖ 1⫹ proteinuria. 45 (3%) women developed preeclampsia. Of the preeclamptic patients, 30 (66%) developed hypertension prior to the onset of proteinuria. While the remaining 15 (33%) had proteinuria precede the onset of hypertension. Therefore, the usage of urine protein dipsticks was useful in the prediction of preeclampsia in 0.9% of this low-risk population. The sensitivity, specificity, positive and negative predictive values of urine dipstick with ⱖ 1⫹ protein in the setting of a normotensive pregnancy to predict preeclampsia are illustrated in the Table. CONCLUSION: The finding of ⱖ 1⫹ proteinuria in low-risk patients is a poor predictor of preeclampsia. Urine dipsticks for proteinuria are not effective as a screening test for preeclampsia in low-risk prenatal patients. Value of routine urine dipstick to predict preeclampsia Sensitivity Specificity Positive predictive value Negative predictive value Data presented as % (95% CI).
33.3 (19.6, 47.1) 80.6 (78.6, 82.5) 4.6 (2.3, 6.8) 97.7 (96.1, 99.3)
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.463
Supplement to DECEMBER 2007 American Journal of Obstetrics & Gynecology
S131
www.AJOG.org 441
DO ELEVATED NT-PROBNP LEVELS OF HYPERTENSIVE PREGNANT WOMEN REFLECT CARDIAC DYSFUNCTION? TAE KOO1, 1Society for Maternal-Fetal Medicine, Taegu, South Korea OBJECTIVE: NT-proBNP is synthesized in cardiac ventricles in response to volume expansion. This study is to evaluate if elevated NT-proBNP levels of hypertensive pregnant women reflect cardiac dysfunction or there is a significant level requiring further evaluation. STUDY DESIGN: 18 hypertensive pregnancy women who were composed of 13 severe preeclamptis, 3 mild preeclamptics, 1 gestational hypertension and 1 superimposed severe preeclamptic took echocardiogram within 24 hours from sampling for NT-proBNP. The correlations between NT-proBNP and variables associated with cardiac function were verified. RESULTS: On the correlation coefficients between NT-proBNP level and each variable, It was -0.29 with left ventricular ejection fraction, 0.13 with left ventricular end diastolic volume, 0.07 with left ventricular end systolic volume, 0.32 with left ventricular diastolic dimension, 0.57 with Sa and 0.33 with left ventricular filling pressure. CONCLUSION: Elevated NT-proBNP levels in hypertensive pregnant woman don=t seem to correctly reflect cardiac dysfunction.
443
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.460
442
NT-PROBNP LEVELS IN HYPERTENSIVE DISORDERS COMPLICATING PREGNANCY TAE KOO1, 1Society for Maternal-Fetal Medicine, Taegu, South Korea OBJECTIVE: NT-proBNP is synthesized in cardiac ventricles in response to volume expansion. This study evaluated NT-proBNP levels to determine clinical correlation with the severity of hypertensive disorders complicating pregnancy. STUDY DESIGN: NT-proBNP levels of 95 pregnant women who composed of 26 severe preeclamptics, 15 mild preeclamptics, 9 gestational hypertensive patients and 45 normal controls were determined using the electrochemiluminescence immunoassay done by MODULAR ANALYTICS E 170(Roche). RESULTS: Comparisons of mean values on NT-proBNP levels had statistic significances according to severity of desease; 1766.43⫾4197.39 pg/mL in severe preeclampsia (median; 339.8 pg/mL), 214.97 ⫾ 226.35 pg/mL(median; 152.3 pg/mL) in mild preeclampsia, 39.75 ⫾24.85 pg/mL(median; 34.09) in gestational hypertension and : 78.78 ⫾ 81.56 pg/mL(median; 48.54) in normal control. The NTproBNP levels of mild and severe preeclamptic patients were significantly higher than those on gestational hypertension and normal control patients. There was no significance between mild and severe preeclampsia(p⫽0.17). CONCLUSION: In mild and severe preeclampsia, NT-proBNP levels are elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.461
BIOMARKERS OF PREECLAMPSIA: SHOULD WE BE CONSIDERING RACE? SINDHU SRINIVAS1, JAMIE BASTEK1, JACOB LARKIN1, ELLA OFORI2, CHRISTINA ANDRELA1, MICHAL ELOVITZ1, 1University of Pennsylvania, Philadelphia, Pennsylvania, 2University of Pennsylvania, Pennsylvania OBJECTIVE: Utilizing angiogenic proteins as biomarkers to predict preeclampsia (PRE) has been the focus of recent research. It is reported that black race increases PRE risk, however, studies to date have not determined if these biomarkers differ by race. STUDY DESIGN: Cases are prospectively identified with PRE based on ACOG criteria. Controls are women presenting for delivery at term. Clinical data and serum were collected for all subjects. sFlt1, Endgolin (ENG) and PGF were measured by ELISA assays. Maternal race was obtained by patient report at enrollment. Women with chronic hypertension by report or increase in BP before 20 wks were excluded. Nonparametric comparisons between sFlt, ENG, and PGF and maternal race (Black (BL) vs. non Black (nBL)) in cases vs. controls and within cases and controls were made using Kruskal-Wallis and Wilcoxon rank sum tests. RESULTS: 99 cases (78 BL and 21 nBL) and 151 controls (113 BL and 38 nBL) were evaluated. In stratified analyses by race, endoglin and PGF differed between cases and controls. However, sFlt levels only differed between BL cases and BL controls (Table). There was no difference in sFlt and PGF levels between BL and nBL cases or BL and nBL controls. However, there was a difference in endoglin level between BL and nBL cases (p⫽0.02) and BL and nBL controls (0.06). CONCLUSION: In limited populations, angiogenic biomarkers have shown some promise in predicting preeclampsia (NEJM). However, these levels, particularly sFlt and endoglin, may have less utility in certain racial populations. Further exploration of these biomarkers in diverse populations must occur prior to adopting these tests into practice. Angiogenic factors in cases and controls by race Factor (med)
BL case
BL cont
p-value
nBL case
nBL cont
p-value
sFLT ENG PGF
7.3 15.8 48.6
5.5 10.4 139.5
0.01 ⬍0.001 ⬍0.001
9.9 27.6 44.3
6.1 13.6 93
0.28 0.007 0.006
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.462
444
ROUTINE URINE DIPSTICKS NOT NECESSARY AT EVERY PRENATAL VISIT MATTHEW BORGMEYER1, MICHAEL RUMA1, JOHN THORP1, 1University of North Carolina at Chapel Hill, Obstetrics and Gynecology, Chapel Hill, North Carolina OBJECTIVE: Routine urine dipsticks are a time-honored tradition of prenatal care. We sought to assess the ability of routine urine dipstick for proteinuria to identify preeclampsia in low-risk pregnancy. STUDY DESIGN: A secondary analysis was completed from the Pregnancy, Infection and Nutrition (PIN) study, a prospective cohort of healthy, pregnant women enrolled at less than 20 weeks= gestation. Low-risk patients were defined as healthy, normotensive pregnant women without medical comorbidities. Exclusion criteria included hypertension (preexisting or gestational), diabetes, and multiple gestation. Preeclampsia was defined as blood pressure ⬎ 140/90 with ⱖ 1⫹ proteinuria. Sensitivity, specificity, and predictive values (95% CI) were calculated for routine urine dipsticks with ⱖ 1⫹ proteinuria to predict preeclampsia among low-risk women during any prenatal visit. RESULTS: 1660 women were analyzed. 329 (20%) patients developed ⱖ 1⫹ proteinuria. 45 (3%) women developed preeclampsia. Of the preeclamptic patients, 30 (66%) developed hypertension prior to the onset of proteinuria. While the remaining 15 (33%) had proteinuria precede the onset of hypertension. Therefore, the usage of urine protein dipsticks was useful in the prediction of preeclampsia in 0.9% of this low-risk population. The sensitivity, specificity, positive and negative predictive values of urine dipstick with ⱖ 1⫹ protein in the setting of a normotensive pregnancy to predict preeclampsia are illustrated in the Table. CONCLUSION: The finding of ⱖ 1⫹ proteinuria in low-risk patients is a poor predictor of preeclampsia. Urine dipsticks for proteinuria are not effective as a screening test for preeclampsia in low-risk prenatal patients. Value of routine urine dipstick to predict preeclampsia Sensitivity Specificity Positive predictive value Negative predictive value Data presented as % (95% CI).
33.3 (19.6, 47.1) 80.6 (78.6, 82.5) 4.6 (2.3, 6.8) 97.7 (96.1, 99.3)
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.463
Supplement to DECEMBER 2007 American Journal of Obstetrics & Gynecology
S131