- Email: [email protected]
781: Severe preeclampsia is associated with abnormal trace elements concentrations in maternal and fetal blood
Poster Session V
Fetus Diabetes, etc
778 Risk indicators for eclampsia in women with gestational hypertension or mild preeclampsia at term: a case-control study Corine M Koopmans1, Joost J Zwart2, Henk Groen3, Kitty WM Bloemenkamp2, Ben Willem J Mol4, Maria G Van Pampus1, Jos Van Roosmalen2 1
University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, Netherlands, 2Leiden University Medical Center, Department of Obstetrics and Gynaecology, Leiden, Netherlands, 3University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands, 4Academic Medical Center, Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, Netherlands
OBJECTIVE: To evaluate whether eclampsia can be predicted in women with gestational hypertension or mild preeclampsia at term. STUDY DESIGN: We performed a nationwide case-control study in the Netherlands. Cases were women in whom pregnancy was complicated by eclampsia, and selected from the LEMMoN study, a nationwide cohort study on severe maternal morbidity (Zwart JJ et al. BJOG 2008). Controls were women who had a pregnancy complicated by gestational hypertension or mild preeclampsia, but who did not develop eclampsia. These controls were collected from a multicentre randomized controlled trial (HYPITAT trial), in which we compared induction of labor to expectant monitoring in women with gestational hypertension or mild preeclampsia at term (Koopmans CM et al. Lancet 2009). Risk indicators studied included data from clinical characteristics and laboratory findings. Multivariable logistic regression analysis was performed to develop a model for the prediction of eclampsia. The predictive capacity of our model was assessed with receiver-operating-characteristic (ROC) analysis. RESULTS: We compared 83 cases to 1153 controls. In the multivariable analysis maternal age (OR 0.93 per year), ethnicity (OR 0.31 for Caucasian ethnicity), systolic blood pressure (1.1 per mm Hg), proteinuria (OR 3.9 and 7.5 for 2⫹ and 3⫹ respectively), platelets (OR 0.99 per unit), uric acid (OR 1.8 per unit), creatinin (OR 1.02 per unit), aspartate aminotransferase (OR 1.03 per unit), lactate dehydrogenase (OR 1.01 per unit) and prophylactic use of magnesium sulphate (OR 0.30) showed a statistically significant association with the occurrence of eclampsia. Other variables included in the model were fetal loss in history (OR 3.6) and miscarriage in history (OR 0.57). The area under the ROC-curve of this model was 0.92. CONCLUSION: In women with gestational hypertension or mild preeclampsia at term, eclampsia can be predicted. The identified predictors may provide physicians guidance to start prophylactic treatment with magnesium sulphate or to induce labor without delay. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.795
779 Role of preeclampsia and BMI in determining baroreceptor Keith Williams1, France Galerneau2, Linda Elgart3 1
Yale University, New Haven, Connecticut, 2Yale University School of Medicine, OB/GYN, New Haven, Connecticut, 3Hospital of St Raphael, Women and Children, New Haven, Connecticut
OBJECTIVE: Elevated sympathetic activity in pregnant patients might contribute to vasoconstriction in preeclampsia (PET). Baroreflex sensitivity (BRS) has become a powerful tool to assess autonomic nervous system control in cardiac cases. We previously demonstrated that BRS is diminished in preeclampsia because of increased sympathetic activity. We investigated whether Body Mass Index (BMI) and preeclampsia were independent risk factors for the changes in BRS. STUDY DESIGN: We measured continuously beat to beat outputs of blood pressure (pilot 9200) for 5 minutes. Time series of systolic beatto-beat pressure values and RR intervals were extracted to analyze and assess BRS in forty pregnant patients at increased risk for PET. We divided patients into two groups (BMI ⬍35 and group two BMI ⬎35). We measured BRS by the Linear Spontaneous Sequence Technique assessing spontaneous sequences of 3 cycles and calculating the linear
S280
www.AJOG.org regression slope between BP and RR interval. Statistical significance was at the (p ⬍ .05) RESULTS: We used a two-way ANOVA to evaluate the interaction between BRS and the variables of PET and BMI. There was no interaction of PET and BMI (p⬎.05) on BRS. There was a significant main effect of PET and BMI on BRS (p⬍.05). Seven women developed PET. BRS was significantly reduced in the seven PET patients compared to the group that remained normotensive (10.7 ⫹ 4 vs 4.4 ⫹2) P⬍.05. CONCLUSION: A significant reduction in BRS is related to the development of PET and the degree of obesity. This indicates an altered autonomic nervous activity towards parasympathetic inhibition and sympathetic activation. BRS analysis may provide a useful marker of preeclampsia but has to be correlated with other factors including obesity. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.796
780 D6 decoy receptor in preeclampsia Geum Joon Cho1, Min Jeong Oh1, Hyun Joo Seol2, Hyun Chul Jeong1, Young Sun Yoon1, Yu Chin Paek1, Soon Cheol Hong1, Hai Joong Kim1 1 Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, South Korea, 2Department of Obstetrics and Gynecology, College of Medicine, Kyunghee University, South Korea
OBJECTIVE: Chemokines play a major role in the induction of inflam-
matory reactions and development of an appropriate immune response by coordinating leukocyte recruitment. D6 is a promiscuous decoy receptor defined as non-signalling receptor that can bind to the chemokines and target them to degradation resulting in inhibition of inflammation. In placenta, D6 is strongly expressed by invading extravillous trophoblast and on the apical side of syncytiotrophoblast cells, at the very interface between maternal blood and fetus. It has been reported that exposure of D6⫺/⫺ mice to LPS resulted in increased levels of inflammatory chemokines and increased leukocyte infiltrate in placenta causing an increased rate of fetal loss. Preeclampsia is associated with a more vigorous systemic inflammatory response than normal pregnancy. The purpose of this study was to investigate the expression of D6 decoy receptor in placentas from preeclamptic pregnancies and normal placentas. STUDY DESIGN: A study was carried out in 35 pregnant women (7 patients with mild preeclampsia, 16 patients with severe preeclampsia and 12 healthy normotensive pregnant women) during the third trimester of pregnancy. The expression of D6 mRNA and protein was determined with real time RT-PCR and Western blotting, respectively. RESULTS: The mRNA and protein expression of D6 decoy receptor were detected in all of placentas from preeclamptic pregnancies and normal placentas. Placental D6 mRNA expression was significantly lower in preeclampsia than in normal pregnancy. Western blot analysis revealed a decreased protein expression in preeclampsia. CONCLUSION: The expression of D6 decoy receptor in preeclamptic placenta was significantly lower than that of normal pregnancy. Decreased expression of D6 decoy receptor may involve an exaggeration of systemic inflammation in preeclampsia. Thus D6 decoy receptor in placenta might play an important role in the pathogenesis of preeclampsia. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.797
781 Severe preeclampsia is associated with abnormal trace elements concentrations in maternal and fetal blood Ohad Katz1, Ofra Paz-Tal2, Tal Lazer1, Barak Aricha-Tamir1, Moshe Mazor1, Arnon Wiznitzer1, Eyal Sheiner1 1 Soroka Uneversity Medical Center, Obstetrics and Gynecology, Be’’er Sheva, Israel, 2Nuclear Research Center Negev, Israel
OBJECTIVE: To compare trace elements concentrations in women with
and without severe preeclampsia (PET). STUDY DESIGN: A prospective case control study, comparing 42
women with PET and 80 healthy women and their newborns, matched for gestational age. Inductively coupled plasma mass spec-
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Fetus Diabetes, etc
www.AJOG.org trometry by an Elan-6000 (Perkin-Elmer/Sciex, Thornton) was used for the determination of zinc (Zn), copper (Cu), selenium (Se), manganes (Mn), and magnesium (Mg) concentrations in maternal as well as arterial and venous umbilical cord serum. RESULTS: Mg and Zn levels were significantly higher in the PET group. Mn, Se and Cu levels were significantly lower in the PET group expect for Cu levels in maternal blood which were significantly higher (Table). These differences remained significant while controlling for the mode of delivery (vaginal vs cesarean delivery). CONCLUSION: Severe preeclampsia is associated with abnormal concentrations of trace elements. Trace elements may play a role in the pathogenesis of PET.
Poster Session V
terize the relationship between BMI and serum angiogenic markers. Algorithms that incorporate these markers for the prediction of PE may need to consider the impact of maternal BMI.
Table 1: sFlt-1 by BMI, F test
Trace elements levels Elements
Blood source
Severe PET
Control
P value
Mg (mcg/dL)
Maternal - venous
3332.1 ⫾ 1027
1499.1 ⫾ 375
⬍0.001
Cord - artery
3326.9 ⫾ 856
1618.9 ⫾ 290
⬍0.001
Cord - vein
3300.3 ⫾ 886
1564.9 ⫾ 291
⬍0.001
.......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
Mn (mcg/L)
Maternal - venous
0.270 ⫾ 0.5
2.664 ⫾ .0.9
⬍0.001
Cord - artery
0.283 ⫾ 0.4
3.648 ⫾ 2.1
⬍0.001
0.262 ⫾ 0.4
⬍0.001
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
Cord - vein
2.533 ⫾ 1.0
..........................................................................................................................................................................................
Cu (mcg/L)
2264.6 ⫾ 751
1048.0 ⫾ 851
Cord - artery
581.6 ⫾ 367
949.0 ⫾ 788
0.001
Cord - vein
608.3 ⫾ 418
866.9 ⫾ 812
0.022
Maternal - venous
652.7 ⫾ 668
575.5 ⫾ 215
0.346
Cord - artery
947.3 ⫾ 42
543.1 ⫾ 226
⬍0.001
Cord - vein
⬍0.001
Maternal - venous
⬍0.001
.......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
Zn (mcg/L)
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
911.1 ⫾ 220
422.4 ⫾145
Maternal - venous
98.6 ⫾ 24
110.7 ⫾19
⬍0.001
Cord - artery
82.0 ⫾ 18
111.6 ⫾ 17
⬍0.001
Cord - vein
82.1 ⫾ 17
107.1 ⫾ 26
⬍0.001
..........................................................................................................................................................................................
Se (mcg/L)
.......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.798
782 A prospective study of obesity and serum angiogenic markers in normal pregnancies
Figure 1: sFlt:PlGF by BMI, longitudinal regression 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.799
Chloe Zera1, Ellen Seely2, Louise Wilkins-Haug1, Donald Laird3, Dominick Pucci3, Thomas McElrath4 1 Brigham and Women’s Hospital, Boston, Massachusetts, 2Brigham and Women’s Hospital, Massachusetts, 3Abbott Diagnostics, Illinois, 4Harvard University, Boston, Massachusetts
783 Urinary nephrin as a marker of preeclampsia
OBJECTIVE: As increased BMI is a risk factor for preeclampsia (PE), we sought to assess whether maternal obesity influences serum angiogenic markers associated with PE in normal pregnancies. STUDY DESIGN: 339 women with singleton gestations were enrolled at Brigham and Women’s Hospital as part of a multi-center prospective cohort designed to evaluate the utility of serum angiogenic markers for the early prediction of PE. Blood and urine samples were collected in each trimester, near term and at delivery. Blood samples were analyzed for soluble Fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). 7 women who developed PE were excluded from the analysis. We performed linear regression to assess the relationship between first trimester body mass index (BMI) and sFlt-1, and longitudinal regression to assess the effect of BMI on sFlt-1:PlGF ratio over gestation. RESULTS: 49 women were obese (BMI ⬎30), 84 were overweight (BMI 25-30) and 199 were normal weight (BMI⬍25) in the first trimester. Obese women had lower mean first trimester sFlt-1 levels than women with a BMI in the normal range (p⫽0.00179, Table 1). When compared to normal weight women in a multivariate model adjusting for diabetes and parity, women with a BMI ⬎30 had a significantly different trend in sFlt:PlGF ratio over the length of gestation than normal weight women (p⫽0.0033; Figure 1). CONCLUSION: Maternal BMI affects sFlt-1 and sFlt-1:PlGF in pregnancies not complicated by PE. Further study is needed to fully charac-
Gahyun Son1, Yong-Won Park2, Young Han Kim1, Jayoung Kwon1 1 Yonsei University Health System, Obsterics and Gynecology, Seoul, South Korea, 2Yonsei University Health System, Seoul, South Korea
OBJECTIVE: The objective of this study was to examine whether neph-
rin is present in the urine of patients with severe preeclampsia. STUDY DESIGN: In total, 50 women were recruited. Severe preeclamp-
sia was present in 25 of the patients, and gestational proteinuria was diagnosed in 5 patients. 20 gestational age-matched normotensive women without proteinuria served as control subjects. Urine samples were collected close to delivery, and typically 24 hours before delivery. Western blot analysis was performed to assess the nephrin excretion in the urine. RESULTS: Nephrin was detected in all of preeclamptic urine samples by Western blotting, whereas 5 patients with gestational proteinuria and normotensive control subjects except for one did not exhibit nephrin specific protein bands in the urine. Moreover, urinary nephrin was detected in 3 women with pregnancy-induced hypertension without proteinuria, and finally in all of them severe preeclampsia developed. CONCLUSION: Urinary nephrin could be a highly sensitive and specific marker for preeclampsia. It may represent podocyte damage, which could result in proteinuria in preeclampsia. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.800
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S281
Fetus Diabetes, etc
778 Risk indicators for eclampsia in women with gestational hypertension or mild preeclampsia at term: a case-control study Corine M Koopmans1, Joost J Zwart2, Henk Groen3, Kitty WM Bloemenkamp2, Ben Willem J Mol4, Maria G Van Pampus1, Jos Van Roosmalen2 1
University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, Netherlands, 2Leiden University Medical Center, Department of Obstetrics and Gynaecology, Leiden, Netherlands, 3University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands, 4Academic Medical Center, Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, Netherlands
OBJECTIVE: To evaluate whether eclampsia can be predicted in women with gestational hypertension or mild preeclampsia at term. STUDY DESIGN: We performed a nationwide case-control study in the Netherlands. Cases were women in whom pregnancy was complicated by eclampsia, and selected from the LEMMoN study, a nationwide cohort study on severe maternal morbidity (Zwart JJ et al. BJOG 2008). Controls were women who had a pregnancy complicated by gestational hypertension or mild preeclampsia, but who did not develop eclampsia. These controls were collected from a multicentre randomized controlled trial (HYPITAT trial), in which we compared induction of labor to expectant monitoring in women with gestational hypertension or mild preeclampsia at term (Koopmans CM et al. Lancet 2009). Risk indicators studied included data from clinical characteristics and laboratory findings. Multivariable logistic regression analysis was performed to develop a model for the prediction of eclampsia. The predictive capacity of our model was assessed with receiver-operating-characteristic (ROC) analysis. RESULTS: We compared 83 cases to 1153 controls. In the multivariable analysis maternal age (OR 0.93 per year), ethnicity (OR 0.31 for Caucasian ethnicity), systolic blood pressure (1.1 per mm Hg), proteinuria (OR 3.9 and 7.5 for 2⫹ and 3⫹ respectively), platelets (OR 0.99 per unit), uric acid (OR 1.8 per unit), creatinin (OR 1.02 per unit), aspartate aminotransferase (OR 1.03 per unit), lactate dehydrogenase (OR 1.01 per unit) and prophylactic use of magnesium sulphate (OR 0.30) showed a statistically significant association with the occurrence of eclampsia. Other variables included in the model were fetal loss in history (OR 3.6) and miscarriage in history (OR 0.57). The area under the ROC-curve of this model was 0.92. CONCLUSION: In women with gestational hypertension or mild preeclampsia at term, eclampsia can be predicted. The identified predictors may provide physicians guidance to start prophylactic treatment with magnesium sulphate or to induce labor without delay. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.795
779 Role of preeclampsia and BMI in determining baroreceptor Keith Williams1, France Galerneau2, Linda Elgart3 1
Yale University, New Haven, Connecticut, 2Yale University School of Medicine, OB/GYN, New Haven, Connecticut, 3Hospital of St Raphael, Women and Children, New Haven, Connecticut
OBJECTIVE: Elevated sympathetic activity in pregnant patients might contribute to vasoconstriction in preeclampsia (PET). Baroreflex sensitivity (BRS) has become a powerful tool to assess autonomic nervous system control in cardiac cases. We previously demonstrated that BRS is diminished in preeclampsia because of increased sympathetic activity. We investigated whether Body Mass Index (BMI) and preeclampsia were independent risk factors for the changes in BRS. STUDY DESIGN: We measured continuously beat to beat outputs of blood pressure (pilot 9200) for 5 minutes. Time series of systolic beatto-beat pressure values and RR intervals were extracted to analyze and assess BRS in forty pregnant patients at increased risk for PET. We divided patients into two groups (BMI ⬍35 and group two BMI ⬎35). We measured BRS by the Linear Spontaneous Sequence Technique assessing spontaneous sequences of 3 cycles and calculating the linear
S280
www.AJOG.org regression slope between BP and RR interval. Statistical significance was at the (p ⬍ .05) RESULTS: We used a two-way ANOVA to evaluate the interaction between BRS and the variables of PET and BMI. There was no interaction of PET and BMI (p⬎.05) on BRS. There was a significant main effect of PET and BMI on BRS (p⬍.05). Seven women developed PET. BRS was significantly reduced in the seven PET patients compared to the group that remained normotensive (10.7 ⫹ 4 vs 4.4 ⫹2) P⬍.05. CONCLUSION: A significant reduction in BRS is related to the development of PET and the degree of obesity. This indicates an altered autonomic nervous activity towards parasympathetic inhibition and sympathetic activation. BRS analysis may provide a useful marker of preeclampsia but has to be correlated with other factors including obesity. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.796
780 D6 decoy receptor in preeclampsia Geum Joon Cho1, Min Jeong Oh1, Hyun Joo Seol2, Hyun Chul Jeong1, Young Sun Yoon1, Yu Chin Paek1, Soon Cheol Hong1, Hai Joong Kim1 1 Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, South Korea, 2Department of Obstetrics and Gynecology, College of Medicine, Kyunghee University, South Korea
OBJECTIVE: Chemokines play a major role in the induction of inflam-
matory reactions and development of an appropriate immune response by coordinating leukocyte recruitment. D6 is a promiscuous decoy receptor defined as non-signalling receptor that can bind to the chemokines and target them to degradation resulting in inhibition of inflammation. In placenta, D6 is strongly expressed by invading extravillous trophoblast and on the apical side of syncytiotrophoblast cells, at the very interface between maternal blood and fetus. It has been reported that exposure of D6⫺/⫺ mice to LPS resulted in increased levels of inflammatory chemokines and increased leukocyte infiltrate in placenta causing an increased rate of fetal loss. Preeclampsia is associated with a more vigorous systemic inflammatory response than normal pregnancy. The purpose of this study was to investigate the expression of D6 decoy receptor in placentas from preeclamptic pregnancies and normal placentas. STUDY DESIGN: A study was carried out in 35 pregnant women (7 patients with mild preeclampsia, 16 patients with severe preeclampsia and 12 healthy normotensive pregnant women) during the third trimester of pregnancy. The expression of D6 mRNA and protein was determined with real time RT-PCR and Western blotting, respectively. RESULTS: The mRNA and protein expression of D6 decoy receptor were detected in all of placentas from preeclamptic pregnancies and normal placentas. Placental D6 mRNA expression was significantly lower in preeclampsia than in normal pregnancy. Western blot analysis revealed a decreased protein expression in preeclampsia. CONCLUSION: The expression of D6 decoy receptor in preeclamptic placenta was significantly lower than that of normal pregnancy. Decreased expression of D6 decoy receptor may involve an exaggeration of systemic inflammation in preeclampsia. Thus D6 decoy receptor in placenta might play an important role in the pathogenesis of preeclampsia. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.797
781 Severe preeclampsia is associated with abnormal trace elements concentrations in maternal and fetal blood Ohad Katz1, Ofra Paz-Tal2, Tal Lazer1, Barak Aricha-Tamir1, Moshe Mazor1, Arnon Wiznitzer1, Eyal Sheiner1 1 Soroka Uneversity Medical Center, Obstetrics and Gynecology, Be’’er Sheva, Israel, 2Nuclear Research Center Negev, Israel
OBJECTIVE: To compare trace elements concentrations in women with
and without severe preeclampsia (PET). STUDY DESIGN: A prospective case control study, comparing 42
women with PET and 80 healthy women and their newborns, matched for gestational age. Inductively coupled plasma mass spec-
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Fetus Diabetes, etc
www.AJOG.org trometry by an Elan-6000 (Perkin-Elmer/Sciex, Thornton) was used for the determination of zinc (Zn), copper (Cu), selenium (Se), manganes (Mn), and magnesium (Mg) concentrations in maternal as well as arterial and venous umbilical cord serum. RESULTS: Mg and Zn levels were significantly higher in the PET group. Mn, Se and Cu levels were significantly lower in the PET group expect for Cu levels in maternal blood which were significantly higher (Table). These differences remained significant while controlling for the mode of delivery (vaginal vs cesarean delivery). CONCLUSION: Severe preeclampsia is associated with abnormal concentrations of trace elements. Trace elements may play a role in the pathogenesis of PET.
Poster Session V
terize the relationship between BMI and serum angiogenic markers. Algorithms that incorporate these markers for the prediction of PE may need to consider the impact of maternal BMI.
Table 1: sFlt-1 by BMI, F test
Trace elements levels Elements
Blood source
Severe PET
Control
P value
Mg (mcg/dL)
Maternal - venous
3332.1 ⫾ 1027
1499.1 ⫾ 375
⬍0.001
Cord - artery
3326.9 ⫾ 856
1618.9 ⫾ 290
⬍0.001
Cord - vein
3300.3 ⫾ 886
1564.9 ⫾ 291
⬍0.001
.......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
Mn (mcg/L)
Maternal - venous
0.270 ⫾ 0.5
2.664 ⫾ .0.9
⬍0.001
Cord - artery
0.283 ⫾ 0.4
3.648 ⫾ 2.1
⬍0.001
0.262 ⫾ 0.4
⬍0.001
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
Cord - vein
2.533 ⫾ 1.0
..........................................................................................................................................................................................
Cu (mcg/L)
2264.6 ⫾ 751
1048.0 ⫾ 851
Cord - artery
581.6 ⫾ 367
949.0 ⫾ 788
0.001
Cord - vein
608.3 ⫾ 418
866.9 ⫾ 812
0.022
Maternal - venous
652.7 ⫾ 668
575.5 ⫾ 215
0.346
Cord - artery
947.3 ⫾ 42
543.1 ⫾ 226
⬍0.001
Cord - vein
⬍0.001
Maternal - venous
⬍0.001
.......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
Zn (mcg/L)
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
911.1 ⫾ 220
422.4 ⫾145
Maternal - venous
98.6 ⫾ 24
110.7 ⫾19
⬍0.001
Cord - artery
82.0 ⫾ 18
111.6 ⫾ 17
⬍0.001
Cord - vein
82.1 ⫾ 17
107.1 ⫾ 26
⬍0.001
..........................................................................................................................................................................................
Se (mcg/L)
.......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.798
782 A prospective study of obesity and serum angiogenic markers in normal pregnancies
Figure 1: sFlt:PlGF by BMI, longitudinal regression 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.799
Chloe Zera1, Ellen Seely2, Louise Wilkins-Haug1, Donald Laird3, Dominick Pucci3, Thomas McElrath4 1 Brigham and Women’s Hospital, Boston, Massachusetts, 2Brigham and Women’s Hospital, Massachusetts, 3Abbott Diagnostics, Illinois, 4Harvard University, Boston, Massachusetts
783 Urinary nephrin as a marker of preeclampsia
OBJECTIVE: As increased BMI is a risk factor for preeclampsia (PE), we sought to assess whether maternal obesity influences serum angiogenic markers associated with PE in normal pregnancies. STUDY DESIGN: 339 women with singleton gestations were enrolled at Brigham and Women’s Hospital as part of a multi-center prospective cohort designed to evaluate the utility of serum angiogenic markers for the early prediction of PE. Blood and urine samples were collected in each trimester, near term and at delivery. Blood samples were analyzed for soluble Fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). 7 women who developed PE were excluded from the analysis. We performed linear regression to assess the relationship between first trimester body mass index (BMI) and sFlt-1, and longitudinal regression to assess the effect of BMI on sFlt-1:PlGF ratio over gestation. RESULTS: 49 women were obese (BMI ⬎30), 84 were overweight (BMI 25-30) and 199 were normal weight (BMI⬍25) in the first trimester. Obese women had lower mean first trimester sFlt-1 levels than women with a BMI in the normal range (p⫽0.00179, Table 1). When compared to normal weight women in a multivariate model adjusting for diabetes and parity, women with a BMI ⬎30 had a significantly different trend in sFlt:PlGF ratio over the length of gestation than normal weight women (p⫽0.0033; Figure 1). CONCLUSION: Maternal BMI affects sFlt-1 and sFlt-1:PlGF in pregnancies not complicated by PE. Further study is needed to fully charac-
Gahyun Son1, Yong-Won Park2, Young Han Kim1, Jayoung Kwon1 1 Yonsei University Health System, Obsterics and Gynecology, Seoul, South Korea, 2Yonsei University Health System, Seoul, South Korea
OBJECTIVE: The objective of this study was to examine whether neph-
rin is present in the urine of patients with severe preeclampsia. STUDY DESIGN: In total, 50 women were recruited. Severe preeclamp-
sia was present in 25 of the patients, and gestational proteinuria was diagnosed in 5 patients. 20 gestational age-matched normotensive women without proteinuria served as control subjects. Urine samples were collected close to delivery, and typically 24 hours before delivery. Western blot analysis was performed to assess the nephrin excretion in the urine. RESULTS: Nephrin was detected in all of preeclamptic urine samples by Western blotting, whereas 5 patients with gestational proteinuria and normotensive control subjects except for one did not exhibit nephrin specific protein bands in the urine. Moreover, urinary nephrin was detected in 3 women with pregnancy-induced hypertension without proteinuria, and finally in all of them severe preeclampsia developed. CONCLUSION: Urinary nephrin could be a highly sensitive and specific marker for preeclampsia. It may represent podocyte damage, which could result in proteinuria in preeclampsia. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.800
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S281