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Long-term infant outcome of a randomized trial of plasma volume expansion in women with preeclampsia remote from term
S36 SMFM Abstracts 89
DYNAMIC ASPECTS OF PREECLAMPSIA WESSEL GANZEVOORT1, ANNELIES REP2, HANNEKE DE VRIES2, GOUKE BONSEL3, HANS WOLF4, 1Academisch Medisch Centrum, Amsterdam, Netherlands, 2VU University Medical Center, Amsterdam, Netherlands, 3Academic Medical Center, Amsterdam, Netherlands, Amsterdam, Netherlands, 4Academisch Medisch Centrum Amsterdam, Obstetrics, Amsterdam, Netherlands OBJECTIVE: Exploration of the dynamic aspects of preeclampsia. STUDY DESIGN: 216 patients with (H)ELLP-syndrome (n = 54), severe preeclampsia (n = 80),or pregnancy-induced-hypertension related fetal growth restriction (n = 82) and gestational age between 24 and 34 completed weeks were randomized for temporizing management with plasma volume expansion (n = 111; 250 ml HydroxyEthylStarch 6% twice daily in 4 hours) or without (n = 105). Primary endpoints of the study were a neurological optimality score of the neonate at term age (Prechtl) and perinatal mortality. Composite maternal complications (CMC) were defined as major maternal morbidity (abruptio placentae, pulmonary edema, liver hematoma, sepsis, pulmonary embolism), newly acquired, persistent or recurrent HELLP and eclampsia after inclusion. Onset of morbidity after admission was categorized in three-day periods. RESULTS: Median prolongation until delivery was 7.4 (0.2-35) days in the treatment group and 10.5 (0.2-44) days (P = .054) in the control group, and the incidence of CMC 32% and 35% (P = .6). Primary outcome criteria were similar. The incidence of CMC in the total group was 8 % (range 4-11) / 3 days during the first 14 days after admission and thereafter 3% (range 0-6) / 3 days. Postpartum incidence of CMC was 8%.
91
MICROARRAY ANALYSIS OF GENE EXPRESSION IN LEUKOCYTES FROM WOMEN WITH PREECLAMPSIA YUPING WANG1, DAVID F. LEWIS1, YANG GU1, LYNN GROOME1, LISA PHILIBERT1, 1Louisiana State University Health Sciences Center at Shreveport, Obstetrics and Gynecology, Shreveport, Louisiana OBJECTIVE: Altered leukocyte function contributes to the maternal vascular dysfunction in women with preeclampsia (PE). The purpose of this study was to gain insight of gene profiles in leukocytes in PE. STUDY DESIGN: Venous blood was obtained from women with PE (n = 4) between 31-34 weeks of gestation before delivery. Leukocytes were isolated. Total RNA was extracted and biotin-labeled cRNA was synthesized. cRNA samples were hybridized to the Affymetrix U133A human microarray chip. Results were analyzed using Data mining tool to identify gene transcripts and Microarray Suite for statistical analysis by t-test and P ! .05 was set as statistically significant. Ontology analysis was performed using Spotfire computer software. RESULTS: Transcripts were identified as ‘‘present’’ or ‘‘absent’’ in all 4 samples (two were African Americans (AA) and two were Caucasians (C). Among the 22283 known genes, a total of 7089 (32%) transcripts were present in all 4 samples. 7926 (35.5%) transcripts were present only in the AA group and 7430 (33.3%) transcripts were present only in the C group. Expression profiles of the known genes revealed 17 transcripts identified with more than 2-fold increase in the AA group compared to that in the C group, P ! .05. In contrast, 13 transcripts were identified with more than 2-fold increase in the C group compared to that in the AA group, P ! .05. Based on ontology analysis, significant patterns of gene clusters that are involved in physiological process and cellular process were identified either increased in the AA group or increased in the C group. Specific functional related gene changes include: responses to stress (9 genes), external stimulus (10 genes), cellular defense (4 genes), inflammatory (2 genes), innate immune response (2 genes), and genes related to antigen and MHC protein binding (3 genes). CONCLUSION: Significant gene profile changes that relate to stress, defense and immune responses were identified in leukocytes in PE. These findings represent the first step towards the identification of altered leukocyte gene expression during PE.
92
RECURRENCT PREECLAMPSIA IN THE SECOND PREGNANCY – EFFECTS OF GESTATIONAL AGE AT FIRST BIRTH, PATERNITY, AND INTERVAL BETWEEN BIRTHS DORINA KALLOGJERI1, RACHATA TUNGSIRIPAT1, DOROTHEA MOSTELLO2, TERRY LEET1, 1Saint Louis University, School of Public Health, St. Louis, Missouri, 2Saint Louis University, Maternal-Fetal Medicine, St. Louis, Missouri OBJECTIVE: The purpose of this study was to evaluate the effect of preeclampsia in the first pregnancy on the likelihood of preeclampsia in the second pregnancy and to determine the effects of gestational age at the first delivery, inter-birth interval, change in paternity, and body mass index (BMI) on this relationship. STUDY DESIGN: We performed a population-based, cohort study using data from the Missouri maternally-linked cohort. The study population included women who had two singleton deliveries between 1989 and 1997. 6,152 women with preeclampsia and 96,608 women without preeclampsia in the first pregnancy were identified. Data were analyzed by stratified analysis and logistic regression. RESULTS: In the second pregnancy, 907 (14.7%) of women with prior preeclampsia developed preeclampsia in contrast to 1704 (1.4%) without prior preeclampsia. As inter-birth interval increased, rate of recurrent preeclampsia increased from 14.3% for women with both deliveries within one year to 17.4% for women with both deliveries within 6-7 years. Change in paternity did not affect the risk of recurrent preeclampsia. Rate of recurrent preeclampsia was higher for women whose first delivery was preterm (38.6% for 20-28 weeks, 29.1% for 29-32 weeks, 21.9% for 33-36 weeks vs. 12.9% for R37 weeks gestation). Obese and overweight women had higher rates of recurrent preeclampsia, compared to women with normal BMI (19.3% and 14.2% vs. 11.2%). In women with preeclampsia in the first pregnancy, adjusted odds ratio for recurrent preeclampsia was 6.6 (95% CI: 5.9-7.3). CONCLUSION: Among women with prior preeclampsia, risk of recurrent preeclampsia is high, but less than predicted by non-population-based studies. Change in paternity does not modify the recurrence risk. Longer inter-birth interval, obesity and prior preterm delivery increase the likelihood of recurrent preeclampsia.
CONCLUSION: The incidence of CMC was constant during the first two weeks afer admission and diminished thereafter. Treatment allocation had no influence.
90
LONG-TERM INFANT OUTCOME OF A RANDOMIZED TRIAL OF PLASMA VOLUME EXPANSION IN WOMEN WITH PREECLAMPSIA REMOTE FROM TERM WESSEL GANZEVOORT1, ANNELIES REP2, ALEID G. VAN WASSENAER3, AGAATH G. KASPERS3, HANNEKE DE VRIES2, GOUKE BONSEL4, HANS WOLF5, 1Academisch Medisch Centrum, Amsterdam, Netherlands, 2VU University Medical Center, Amsterdam, Netherlands, 3Academisch Medisch Centrum Amsterdam, Neonatology, Amsterdam, Netherlands, 4Academic Medical Center, Amsterdam, Netherlands, Amsterdam, Netherlands, 5Academisch Medisch Centrum Amsterdam, Obstetrics, Amsterdam, Netherlands OBJECTIVE: We report major long-term infant outcome parameters from the first large randomised trial on plasma volume expansion (PVE) in temporising management of severe and early hypertensive disorders of pregnancy. The hypothesis of the study was that plasma volume expansion might facilitate antihypertensive treatment and improve placental perfusion, thereby reducing the risk for poor cognitive outcome of the infant. STUDY DESIGN: Between April 1, 2000, and May 31, 2003, 216 patients with a gestational age between 24 and 34 weeks were randomized for temporizing management with PVE (treatment group; n = 111) or without PVE (control group; n = 105). Endpoints were neonatal neurological development at term age (Prechtl), mental development index (MDI) and psychomotor development index (PDI) at one year corrected age (Bayley), perinatal death, neonatal morbidity and maternal morbidity. RESULTS: At baseline groups were comparable, median gestational age 30 weeks. In the treatment group, patients received higher amounts of intravenous fluids than in the control group (median 813 mL/day versus 14 mL/day; P ! .001) with concomitant decreased hemoglobin count (median 0,6 versus 0.2 mmol/L; P ! .001). Neither neurological score at term age, nor MDI or PDI score at one year corrected age were different. There was no difference in major maternal morbidity (total 11%). CONCLUSION: Development index (Bayley) at one year corrected age is equivalent following temporising management with or without PVE. The study hypothesis could not be confirmed. (At submission follow-up not yet completed.)
Perinatal mortality Term age score (Prechtl) One year MDI (Bayley) One year PDI (Bayley)
Treatment group (n = 111)
Control group (n = 105)
Follow-up
23 59 88 77
15 59 86 77
100% 98% 76% 76%
(21%) (47-60) (66-123) (50-118)
(14%) (49-60) (59-102) (53-114)
DYNAMIC ASPECTS OF PREECLAMPSIA WESSEL GANZEVOORT1, ANNELIES REP2, HANNEKE DE VRIES2, GOUKE BONSEL3, HANS WOLF4, 1Academisch Medisch Centrum, Amsterdam, Netherlands, 2VU University Medical Center, Amsterdam, Netherlands, 3Academic Medical Center, Amsterdam, Netherlands, Amsterdam, Netherlands, 4Academisch Medisch Centrum Amsterdam, Obstetrics, Amsterdam, Netherlands OBJECTIVE: Exploration of the dynamic aspects of preeclampsia. STUDY DESIGN: 216 patients with (H)ELLP-syndrome (n = 54), severe preeclampsia (n = 80),or pregnancy-induced-hypertension related fetal growth restriction (n = 82) and gestational age between 24 and 34 completed weeks were randomized for temporizing management with plasma volume expansion (n = 111; 250 ml HydroxyEthylStarch 6% twice daily in 4 hours) or without (n = 105). Primary endpoints of the study were a neurological optimality score of the neonate at term age (Prechtl) and perinatal mortality. Composite maternal complications (CMC) were defined as major maternal morbidity (abruptio placentae, pulmonary edema, liver hematoma, sepsis, pulmonary embolism), newly acquired, persistent or recurrent HELLP and eclampsia after inclusion. Onset of morbidity after admission was categorized in three-day periods. RESULTS: Median prolongation until delivery was 7.4 (0.2-35) days in the treatment group and 10.5 (0.2-44) days (P = .054) in the control group, and the incidence of CMC 32% and 35% (P = .6). Primary outcome criteria were similar. The incidence of CMC in the total group was 8 % (range 4-11) / 3 days during the first 14 days after admission and thereafter 3% (range 0-6) / 3 days. Postpartum incidence of CMC was 8%.
91
MICROARRAY ANALYSIS OF GENE EXPRESSION IN LEUKOCYTES FROM WOMEN WITH PREECLAMPSIA YUPING WANG1, DAVID F. LEWIS1, YANG GU1, LYNN GROOME1, LISA PHILIBERT1, 1Louisiana State University Health Sciences Center at Shreveport, Obstetrics and Gynecology, Shreveport, Louisiana OBJECTIVE: Altered leukocyte function contributes to the maternal vascular dysfunction in women with preeclampsia (PE). The purpose of this study was to gain insight of gene profiles in leukocytes in PE. STUDY DESIGN: Venous blood was obtained from women with PE (n = 4) between 31-34 weeks of gestation before delivery. Leukocytes were isolated. Total RNA was extracted and biotin-labeled cRNA was synthesized. cRNA samples were hybridized to the Affymetrix U133A human microarray chip. Results were analyzed using Data mining tool to identify gene transcripts and Microarray Suite for statistical analysis by t-test and P ! .05 was set as statistically significant. Ontology analysis was performed using Spotfire computer software. RESULTS: Transcripts were identified as ‘‘present’’ or ‘‘absent’’ in all 4 samples (two were African Americans (AA) and two were Caucasians (C). Among the 22283 known genes, a total of 7089 (32%) transcripts were present in all 4 samples. 7926 (35.5%) transcripts were present only in the AA group and 7430 (33.3%) transcripts were present only in the C group. Expression profiles of the known genes revealed 17 transcripts identified with more than 2-fold increase in the AA group compared to that in the C group, P ! .05. In contrast, 13 transcripts were identified with more than 2-fold increase in the C group compared to that in the AA group, P ! .05. Based on ontology analysis, significant patterns of gene clusters that are involved in physiological process and cellular process were identified either increased in the AA group or increased in the C group. Specific functional related gene changes include: responses to stress (9 genes), external stimulus (10 genes), cellular defense (4 genes), inflammatory (2 genes), innate immune response (2 genes), and genes related to antigen and MHC protein binding (3 genes). CONCLUSION: Significant gene profile changes that relate to stress, defense and immune responses were identified in leukocytes in PE. These findings represent the first step towards the identification of altered leukocyte gene expression during PE.
92
RECURRENCT PREECLAMPSIA IN THE SECOND PREGNANCY – EFFECTS OF GESTATIONAL AGE AT FIRST BIRTH, PATERNITY, AND INTERVAL BETWEEN BIRTHS DORINA KALLOGJERI1, RACHATA TUNGSIRIPAT1, DOROTHEA MOSTELLO2, TERRY LEET1, 1Saint Louis University, School of Public Health, St. Louis, Missouri, 2Saint Louis University, Maternal-Fetal Medicine, St. Louis, Missouri OBJECTIVE: The purpose of this study was to evaluate the effect of preeclampsia in the first pregnancy on the likelihood of preeclampsia in the second pregnancy and to determine the effects of gestational age at the first delivery, inter-birth interval, change in paternity, and body mass index (BMI) on this relationship. STUDY DESIGN: We performed a population-based, cohort study using data from the Missouri maternally-linked cohort. The study population included women who had two singleton deliveries between 1989 and 1997. 6,152 women with preeclampsia and 96,608 women without preeclampsia in the first pregnancy were identified. Data were analyzed by stratified analysis and logistic regression. RESULTS: In the second pregnancy, 907 (14.7%) of women with prior preeclampsia developed preeclampsia in contrast to 1704 (1.4%) without prior preeclampsia. As inter-birth interval increased, rate of recurrent preeclampsia increased from 14.3% for women with both deliveries within one year to 17.4% for women with both deliveries within 6-7 years. Change in paternity did not affect the risk of recurrent preeclampsia. Rate of recurrent preeclampsia was higher for women whose first delivery was preterm (38.6% for 20-28 weeks, 29.1% for 29-32 weeks, 21.9% for 33-36 weeks vs. 12.9% for R37 weeks gestation). Obese and overweight women had higher rates of recurrent preeclampsia, compared to women with normal BMI (19.3% and 14.2% vs. 11.2%). In women with preeclampsia in the first pregnancy, adjusted odds ratio for recurrent preeclampsia was 6.6 (95% CI: 5.9-7.3). CONCLUSION: Among women with prior preeclampsia, risk of recurrent preeclampsia is high, but less than predicted by non-population-based studies. Change in paternity does not modify the recurrence risk. Longer inter-birth interval, obesity and prior preterm delivery increase the likelihood of recurrent preeclampsia.
CONCLUSION: The incidence of CMC was constant during the first two weeks afer admission and diminished thereafter. Treatment allocation had no influence.
90
LONG-TERM INFANT OUTCOME OF A RANDOMIZED TRIAL OF PLASMA VOLUME EXPANSION IN WOMEN WITH PREECLAMPSIA REMOTE FROM TERM WESSEL GANZEVOORT1, ANNELIES REP2, ALEID G. VAN WASSENAER3, AGAATH G. KASPERS3, HANNEKE DE VRIES2, GOUKE BONSEL4, HANS WOLF5, 1Academisch Medisch Centrum, Amsterdam, Netherlands, 2VU University Medical Center, Amsterdam, Netherlands, 3Academisch Medisch Centrum Amsterdam, Neonatology, Amsterdam, Netherlands, 4Academic Medical Center, Amsterdam, Netherlands, Amsterdam, Netherlands, 5Academisch Medisch Centrum Amsterdam, Obstetrics, Amsterdam, Netherlands OBJECTIVE: We report major long-term infant outcome parameters from the first large randomised trial on plasma volume expansion (PVE) in temporising management of severe and early hypertensive disorders of pregnancy. The hypothesis of the study was that plasma volume expansion might facilitate antihypertensive treatment and improve placental perfusion, thereby reducing the risk for poor cognitive outcome of the infant. STUDY DESIGN: Between April 1, 2000, and May 31, 2003, 216 patients with a gestational age between 24 and 34 weeks were randomized for temporizing management with PVE (treatment group; n = 111) or without PVE (control group; n = 105). Endpoints were neonatal neurological development at term age (Prechtl), mental development index (MDI) and psychomotor development index (PDI) at one year corrected age (Bayley), perinatal death, neonatal morbidity and maternal morbidity. RESULTS: At baseline groups were comparable, median gestational age 30 weeks. In the treatment group, patients received higher amounts of intravenous fluids than in the control group (median 813 mL/day versus 14 mL/day; P ! .001) with concomitant decreased hemoglobin count (median 0,6 versus 0.2 mmol/L; P ! .001). Neither neurological score at term age, nor MDI or PDI score at one year corrected age were different. There was no difference in major maternal morbidity (total 11%). CONCLUSION: Development index (Bayley) at one year corrected age is equivalent following temporising management with or without PVE. The study hypothesis could not be confirmed. (At submission follow-up not yet completed.)
Perinatal mortality Term age score (Prechtl) One year MDI (Bayley) One year PDI (Bayley)
Treatment group (n = 111)
Control group (n = 105)
Follow-up
23 59 88 77
15 59 86 77
100% 98% 76% 76%
(21%) (47-60) (66-123) (50-118)
(14%) (49-60) (59-102) (53-114)