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P6 Calcium to creatinine ratio in preeclampsia
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Poster Presentations / Pregnancy Hypertension 1, Supplement 1 (2010) S43–S76
P4 Calciuria in pregnancy-induced hypertension and perinatal outcomes Rose Gasnier 1 , Edimarlei Valerio 2 , Janete Vettorazzi 2 , Elvino Barros 1 , Sergio Martins-Costa 1 , Jose Geraldo Ramos 1 . 1 Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; 2 Hospital de Clínicas de Porto Alegre, Brazil Introduction: Calciuria has been reported to be diminished in preeclampsia. The aim of the present study was to compare calciuria between severe and mild preeclampsia, hypertensive and normotensive pregnant women and its correlation with disease severity. Methods: Case control study including pregnant patients with mild and severe preeclampsia, chronic hypertension and normal pregnancy. Results: There were statistically significant difference in calciuria between the groups when comparing severe preeclampsia and chronic hypertension and severe preeclampsia and normal pregnancy (p < 0.0001). The results showed more patients with cesarean delivery, cesarean for fetal distress and abruptio placentae, Neonatal Intensive Care Unit admission, serum uric acid, gestational age at birth and 5 minute Apgar with lower calciuria, especially when less than or equal to 100 mg/24h. The outcomes seem to be more severe in more severe hypocalciuria. Conclusions: Hypocalciuria can differentiate between severe preeclampsia and chronic hypertension, also being a marker for disease severity. This project was supported by Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre.
P5 Natriuria associated to calciuria in pregnancy-induced hypertension Sergio Martins-Costa 1 , Rose Gasnier 1 , Edimarlei Valerio 2 , Janete Vettorazzi 2 , Elvino Barros 1 , Jose Geraldo Ramos 1 . 1 Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; 2 Hospital de Clínicas de Porto Alegre, Brazil Introduction: Alterations in sodium excretion have been studied in preeclampsia patients and related to several factors. The objective of this study was to study natriuria associated to calciuria in preeclampsia. Methods: Case control study including mild and severe preeclampsia patients, chronic hypertension and normal pregnancy in which the factors evaluated were calciuria and natriuria related with preeclampsia. Results: There were significant differences between the groups when comparing severe preeclampsia and chronic hypertension and severe preeclampsia and normal pregnancy (p<0.0001) for both measurements. The calciuria and natriuria showed progressive hypocalciuria and hyponatriuria from normal pregnancy to severe preeclampsia, which is statistically significant between severe preeclampsia and chronic hypertension and severe preeclampsia and normal pregnancy (p<0.0001). The Spearman correlation was 0.734 between calciuria and natriuria. The ROC Curve demonstrates the concordance of sensitivity and specificity of 24h natriuria and preeclampsia diagnosis, with an area under the curve of 0.841 (p=0.0001). The best cutoff was 177 mEq/L, showing sensitivity and specificity of 67%. Conclusion: Natriuria can be one more test for differential diagnosis of hypertensive diseases in pregnancy when associated with calciuria, but a poor predictor alone. This project was supported by Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre.
P6 Calcium to creatinine ratio in preeclampsia Jose Geraldo Ramos 1 , Rose Gasnier 2 , Edimarlei Valerio 2 , Elvino Barros 1, Sergio Martins-Costa 1 . 1 Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; 2 Hospital de Clínicas de Porto Alegre, Brazil Introduction: Hypocalciuria has been correlated with preeclampsia. A calcium to creatinine ratio in urine spot sample is more practical for diagnosis and prognosis study for hypertension diseases than a 24 hour collection. The objective of this paper is to compare this ratio between the groups and its correlation with the 24h measurement with preeclampsia diagnosis. Methods: Case control study including mild and severe preeclampsia, chronic hypertension and normal pregnancy with 14 patients in each group. Results: There was statistically significant difference between the groups comparing severe preeclampsia and chronic hypertension, severe preeclampsia and normal pregnancy, and even mild and severe preeclampsia (p < 0.0001). The calcium to creatinine ratio medians were 0.0108
mg/mg for severe preeclampsia, 0.05 mg/mg for mild preeclampsia, 0.14 mg/mg for chronic hypertension and 0.0995 mg/mg for normal pregnancy. The Spearman index between the ratio and 24h calciuria was 0.65 (high correlation). In ROC Curve analysis, the best cutoff point was 0.053 mg/mg, with a sensitivity of 70% and a specificity of 85%. Patients with a Doppler ultrasound, a high resistance index or notching presence in the uterine arteries seems to be related with a lower calcium to creatinine ratio. Conclusions: Calcium to creatinine ratio can estimate the 24h calciuria, differentiating severe from mild preeclampsia, chronic hypertension and normal pregnancy. This project was supported by Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre.
P7 Therapy in preeclampsia is modulated by VEGF polymorphisms Valeria Sandrim 1 , Ana Carolina Palei 2 , Tatiane Izidoro-Toledo 3, Ricardo Cavalli 3 , Jose Tanus-Santos 3 . 1 Santa Casa de Belo Horizonte - Nucleo Pos-Graduacao, Minas Gerais, Brazil; 2 Unicamp, Brazil; 3 Faculdade de Medicina de Ribeirao Preto - Universidade de Sao Paulo, Brazil Introduction: Vascular endothelial growth factor (VEGF) is relevant for normal pregnancy, and abnormalities in VEGF functions have been associated with hypertensive disorders of pregnancy. Our group recently demonstrated that VEGF genetic polymorphisms affect the susceptibility to preeclampsia. Objective: Therefore, in this study our aim is examine whether VEGF polymorphisms affect the therapeutic responses of women with preeclampsia (PE). Methods: We studied 113 white PE patients, which were stratified according to clinical and laboratorial parameters of therapeutic responsiveness (60 responsive and 53 non-responsive). We compared the frequencies of two VEGF genetic polymorphisms (C-2578A and G- 634C) between responsive and non-responsive PE patients. Results: We found no significant differences in genotype or allele distributions when responsive and non-responsive groups were compared (P>0.05). Also, no difference was observed in overall haplotypes distribution. However, when we analyzed each haplotype separately, the “C-636 C-2578” haplotype was associated with non responsiveness to therapy (70 versus 56% responsive). Conclusion: Our data suggest that VEGF haplotypes affect the responsiveness to antihypertensive therapy in PE. Financial support: FAPEMIG, FAPESP, CNPq, CAPES, British Council – Researcher Exchange Programme and LOREAL-UNESCO (For Women in Science-Brazil)
P8 Mid-trimester uterine artery Doppler screening in prediction of preeclampsia in high risk women Densak Pongrojpaw, Charintip Somprasit, Athita Chanthasenanont, Tongta Nanthakomon. Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand Objective: To assess the value of uterine artery colour Doppler waveform analysis in the prediction of preeclampsia in high risk pregnancy women. Methods: Uterine artery Doppler screening was performed as part of mid-trimester screening between 20 and 24 weeks gestation in high risk pregnancy women at Matermal Fetal Medicine unit, Thammasat university hospital between June 1, 2008 and May 31, 2009. A pulsatility index (PI) was calculated from each uterine artery and the presence or absence of a notch was determined. A PI of >1.58 or the presence of any diastolic notch were defined as abnormal. The main outcome measures was pre-eclampsia. Results: Doppler examination of the uterine arteries were performed in 330 singleton pregnancies.Twenty-seven (8.18%) women developed preeclampsia. The sensitivity of PI >1.58 and diastolic notch for pre-eclampsia was 59.25%. The specificity of PI >1.58 and diastolic notch for these outcomes was 66.67%. Positive predictive value was 13.67% and negative predictive value was 94.83%. Conclusion: In high-risk women, mid trimester uterine artery Doppler waveform analysis can not use as screening test in women at higher risk for the development of pre-eclampsia. However women with normal uterine artery Doppler results are unlikely to develop preeclampsia and therefore do not necessarily need repeated Doppler ultrasound follow-up.
Poster Presentations / Pregnancy Hypertension 1, Supplement 1 (2010) S43–S76
P4 Calciuria in pregnancy-induced hypertension and perinatal outcomes Rose Gasnier 1 , Edimarlei Valerio 2 , Janete Vettorazzi 2 , Elvino Barros 1 , Sergio Martins-Costa 1 , Jose Geraldo Ramos 1 . 1 Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; 2 Hospital de Clínicas de Porto Alegre, Brazil Introduction: Calciuria has been reported to be diminished in preeclampsia. The aim of the present study was to compare calciuria between severe and mild preeclampsia, hypertensive and normotensive pregnant women and its correlation with disease severity. Methods: Case control study including pregnant patients with mild and severe preeclampsia, chronic hypertension and normal pregnancy. Results: There were statistically significant difference in calciuria between the groups when comparing severe preeclampsia and chronic hypertension and severe preeclampsia and normal pregnancy (p < 0.0001). The results showed more patients with cesarean delivery, cesarean for fetal distress and abruptio placentae, Neonatal Intensive Care Unit admission, serum uric acid, gestational age at birth and 5 minute Apgar with lower calciuria, especially when less than or equal to 100 mg/24h. The outcomes seem to be more severe in more severe hypocalciuria. Conclusions: Hypocalciuria can differentiate between severe preeclampsia and chronic hypertension, also being a marker for disease severity. This project was supported by Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre.
P5 Natriuria associated to calciuria in pregnancy-induced hypertension Sergio Martins-Costa 1 , Rose Gasnier 1 , Edimarlei Valerio 2 , Janete Vettorazzi 2 , Elvino Barros 1 , Jose Geraldo Ramos 1 . 1 Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; 2 Hospital de Clínicas de Porto Alegre, Brazil Introduction: Alterations in sodium excretion have been studied in preeclampsia patients and related to several factors. The objective of this study was to study natriuria associated to calciuria in preeclampsia. Methods: Case control study including mild and severe preeclampsia patients, chronic hypertension and normal pregnancy in which the factors evaluated were calciuria and natriuria related with preeclampsia. Results: There were significant differences between the groups when comparing severe preeclampsia and chronic hypertension and severe preeclampsia and normal pregnancy (p<0.0001) for both measurements. The calciuria and natriuria showed progressive hypocalciuria and hyponatriuria from normal pregnancy to severe preeclampsia, which is statistically significant between severe preeclampsia and chronic hypertension and severe preeclampsia and normal pregnancy (p<0.0001). The Spearman correlation was 0.734 between calciuria and natriuria. The ROC Curve demonstrates the concordance of sensitivity and specificity of 24h natriuria and preeclampsia diagnosis, with an area under the curve of 0.841 (p=0.0001). The best cutoff was 177 mEq/L, showing sensitivity and specificity of 67%. Conclusion: Natriuria can be one more test for differential diagnosis of hypertensive diseases in pregnancy when associated with calciuria, but a poor predictor alone. This project was supported by Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre.
P6 Calcium to creatinine ratio in preeclampsia Jose Geraldo Ramos 1 , Rose Gasnier 2 , Edimarlei Valerio 2 , Elvino Barros 1, Sergio Martins-Costa 1 . 1 Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; 2 Hospital de Clínicas de Porto Alegre, Brazil Introduction: Hypocalciuria has been correlated with preeclampsia. A calcium to creatinine ratio in urine spot sample is more practical for diagnosis and prognosis study for hypertension diseases than a 24 hour collection. The objective of this paper is to compare this ratio between the groups and its correlation with the 24h measurement with preeclampsia diagnosis. Methods: Case control study including mild and severe preeclampsia, chronic hypertension and normal pregnancy with 14 patients in each group. Results: There was statistically significant difference between the groups comparing severe preeclampsia and chronic hypertension, severe preeclampsia and normal pregnancy, and even mild and severe preeclampsia (p < 0.0001). The calcium to creatinine ratio medians were 0.0108
mg/mg for severe preeclampsia, 0.05 mg/mg for mild preeclampsia, 0.14 mg/mg for chronic hypertension and 0.0995 mg/mg for normal pregnancy. The Spearman index between the ratio and 24h calciuria was 0.65 (high correlation). In ROC Curve analysis, the best cutoff point was 0.053 mg/mg, with a sensitivity of 70% and a specificity of 85%. Patients with a Doppler ultrasound, a high resistance index or notching presence in the uterine arteries seems to be related with a lower calcium to creatinine ratio. Conclusions: Calcium to creatinine ratio can estimate the 24h calciuria, differentiating severe from mild preeclampsia, chronic hypertension and normal pregnancy. This project was supported by Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre.
P7 Therapy in preeclampsia is modulated by VEGF polymorphisms Valeria Sandrim 1 , Ana Carolina Palei 2 , Tatiane Izidoro-Toledo 3, Ricardo Cavalli 3 , Jose Tanus-Santos 3 . 1 Santa Casa de Belo Horizonte - Nucleo Pos-Graduacao, Minas Gerais, Brazil; 2 Unicamp, Brazil; 3 Faculdade de Medicina de Ribeirao Preto - Universidade de Sao Paulo, Brazil Introduction: Vascular endothelial growth factor (VEGF) is relevant for normal pregnancy, and abnormalities in VEGF functions have been associated with hypertensive disorders of pregnancy. Our group recently demonstrated that VEGF genetic polymorphisms affect the susceptibility to preeclampsia. Objective: Therefore, in this study our aim is examine whether VEGF polymorphisms affect the therapeutic responses of women with preeclampsia (PE). Methods: We studied 113 white PE patients, which were stratified according to clinical and laboratorial parameters of therapeutic responsiveness (60 responsive and 53 non-responsive). We compared the frequencies of two VEGF genetic polymorphisms (C-2578A and G- 634C) between responsive and non-responsive PE patients. Results: We found no significant differences in genotype or allele distributions when responsive and non-responsive groups were compared (P>0.05). Also, no difference was observed in overall haplotypes distribution. However, when we analyzed each haplotype separately, the “C-636 C-2578” haplotype was associated with non responsiveness to therapy (70 versus 56% responsive). Conclusion: Our data suggest that VEGF haplotypes affect the responsiveness to antihypertensive therapy in PE. Financial support: FAPEMIG, FAPESP, CNPq, CAPES, British Council – Researcher Exchange Programme and LOREAL-UNESCO (For Women in Science-Brazil)
P8 Mid-trimester uterine artery Doppler screening in prediction of preeclampsia in high risk women Densak Pongrojpaw, Charintip Somprasit, Athita Chanthasenanont, Tongta Nanthakomon. Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand Objective: To assess the value of uterine artery colour Doppler waveform analysis in the prediction of preeclampsia in high risk pregnancy women. Methods: Uterine artery Doppler screening was performed as part of mid-trimester screening between 20 and 24 weeks gestation in high risk pregnancy women at Matermal Fetal Medicine unit, Thammasat university hospital between June 1, 2008 and May 31, 2009. A pulsatility index (PI) was calculated from each uterine artery and the presence or absence of a notch was determined. A PI of >1.58 or the presence of any diastolic notch were defined as abnormal. The main outcome measures was pre-eclampsia. Results: Doppler examination of the uterine arteries were performed in 330 singleton pregnancies.Twenty-seven (8.18%) women developed preeclampsia. The sensitivity of PI >1.58 and diastolic notch for pre-eclampsia was 59.25%. The specificity of PI >1.58 and diastolic notch for these outcomes was 66.67%. Positive predictive value was 13.67% and negative predictive value was 94.83%. Conclusion: In high-risk women, mid trimester uterine artery Doppler waveform analysis can not use as screening test in women at higher risk for the development of pre-eclampsia. However women with normal uterine artery Doppler results are unlikely to develop preeclampsia and therefore do not necessarily need repeated Doppler ultrasound follow-up.