Lectures / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 1 (2011) 238–272
O4. Predisposing factors for early- and late-onset preclampsia S. Ornaghi, A. Tyurmorezova, V. Giardini, P. Algeri, P. Ceruti, E. Vertemati, P. Vergani (Department of Obstetrics and Gynecology, San Gerardo Hospital – University of Milano – Bicocca, Monza, Italy) Objectives: Early (34.0 wks) and late (>34.0 wks) onset preeclampsia (EO–LO PE) are supposed to have different etiologies, vascular and inflammatory disfunction respectively. The aim of our study is to evaluate general characteristics of women affected by either EO or LO PE, to identify risk factors for the two forms of disease. Study design: Retrospective cohort study of 197 consecutive singleton women diagnosed as preeclamptic at 22.4– 41.4 wks, from 1/2005 to 9/2009, evaluating demographic, clinical, and ultrasonographic (US) variables on hospital admission, in relation to EO vs LO PE. HELLP syndrome and stillbirth cases, and fetus with congenital anomalies were excluded. Obesity was defined as a BMI 30 kg/m2. First abnormal uterine arteries (UtA) Doppler, evaluated in women with history of APO (previous PE/IUGR/SGA), was defined as mean RI > 0.58 or bilateral Notch within 26.0 wks. IUGR was considered as an US AC < 10th. Results: 136 women had previous APO. EO PE was identified in 98 cases (49.7%). Results of univariate analysis are showed in Table 1. Multivariate analysis weighed for GA at delivery showed age > 35 yrs and UtA Doppler related to
Table 1 Univariate analysis. Variables
EO (N = 98)
LO (N = 99)
pValue
Age > 35 years Nulliparity History of APO Pre-pregnancy BMI (kg/m2) Obesity I abnormal UtA Doppler
47% 49% 52% 24.1 ± 5.3 14% 90% (64/ 71) 48% 4% 28.3 ± 5.0 33% 29% 14% 24%
22% 62% 48% 24.5 ± 5.9 15% 57% (37/ 65) 15% 11% 30.2 ± 5.4 71% 65% 23% 57%
0.00 0.09 0.36 0.63 N.S. 0.00 0.00 0.10 0.02 0.00 0.00 0.13 0.00
30.9 ± 2.9
37.6 ± 1.8
0.00
IUGR GDM End-pregnancy BMI (kg/m2) WG > 12 kg 5 kg/m2 BMI increase 7 kg/m2 BMI increase Admission-to-delivery interval < 48 h GA at delivery (weeks)
Table 2 Weight estimation regression. EO PE. Variables
p-Value
OR
CI (95%)
Age > 35 yrs I abnormal UtA Doppler Current IUGR
0.04 0.00 0.26
3.10 6.50
1.60 – 6.03 2.46–17.56
259
EO PE (Table 2), whereas WG > 12 kg to LO PE (p = 0.04; OR = 4.6, CI (95%) = 2.39–8.87). Conclusions: Age > 35 yrs and UtA Doppler appeared risk factors for EO PE, whereas WG > 12 kg for the late form, supporting the hypothesis of a different pathogenesis.
doi:10.1016/j.preghy.2011.08.036
PREDICTION AND PREVENTION OF PREECLAMPSIA O5. Low-dose aspirin therapy in pregnant women with chronic hypertension E. Baptista, B. Moita, A. Gomes, N. Bento, M.S.J. Pais, E. Marta, P. Moura (Obstetrics Department, Coimbra’s University Hospital, Coimbra, Portugal) Objectives: To determine if low-dose aspirin prophylactic therapy improves obstetric and perinatal outcome in women with chronic hypertension. Materials and methods: The clinical records of 179 pregnant women with chronic hypertension, between Jan/2005 and Dec/2009, were analysed retrospectively. From these, 65 were submitted to low-dose (100 mg) aspirin therapy (group-A) against 114 without therapy (group-B). Obstetric and perinatal outcome in both groups was analyzed. The main parameters under analysis were: development of pre-eclampsia, HELLP syndrome, intra-uterine growth restriction (IUGR), birthweight and neonatal intensive care unit admission. Results: Mean maternal age was 32.11 years in group-A and 30.74 in group-B (p = n.s.). No statistical significance was observed in pre-eclampsia development (A: 10,76% vs. B: 15,78%; p = n.s.). One case of HELLP syndrome and one case of placental abruption were reported in group B. Statistically significant difference in IUGR development was observed between both groups (A: 6,15% vs. B: 16,67%; p = 0,032). Mean gestational age at delivery was 37.5 weeks in group-A and 37.2 weeks in group-B (p = n.s.). Caesarean section was performed in 50.77% in group-A and 59.65% in group-B (p = n.s.). Mean birth weight was 3086,4g in group-A and 2948.0 g in group-B (p = n.s.). Neonatal intensive care unit admission rate was 16.92% in group-A and 18.42% in group-B (p = n.s.). Placental pathology revealed signs of utero-placental chronic ischemia in 9.23% (groupA) and 9.65% (group-B) (p = n.s.). No significant complications associated to aspirin therapy were reported in any of these groups. Conclusions: In this subgroup of high risk women, lowdose aspirin prophylaxis was effective in reducing incidence of IUGR. The other parameters analysed in this study revealed no statistically significant differences.
doi:10.1016/j.preghy.2011.08.037
O4. Predisposing factors for early- and late-onset preclampsia S. Ornaghi, A. Tyurmorezova, V. Giardini, P. Algeri, P. Ceruti, E. Vertemati, P. Vergani (Department of Obstetrics and Gynecology, San Gerardo Hospital – University of Milano – Bicocca, Monza, Italy) Objectives: Early (34.0 wks) and late (>34.0 wks) onset preeclampsia (EO–LO PE) are supposed to have different etiologies, vascular and inflammatory disfunction respectively. The aim of our study is to evaluate general characteristics of women affected by either EO or LO PE, to identify risk factors for the two forms of disease. Study design: Retrospective cohort study of 197 consecutive singleton women diagnosed as preeclamptic at 22.4– 41.4 wks, from 1/2005 to 9/2009, evaluating demographic, clinical, and ultrasonographic (US) variables on hospital admission, in relation to EO vs LO PE. HELLP syndrome and stillbirth cases, and fetus with congenital anomalies were excluded. Obesity was defined as a BMI 30 kg/m2. First abnormal uterine arteries (UtA) Doppler, evaluated in women with history of APO (previous PE/IUGR/SGA), was defined as mean RI > 0.58 or bilateral Notch within 26.0 wks. IUGR was considered as an US AC < 10th. Results: 136 women had previous APO. EO PE was identified in 98 cases (49.7%). Results of univariate analysis are showed in Table 1. Multivariate analysis weighed for GA at delivery showed age > 35 yrs and UtA Doppler related to
Table 1 Univariate analysis. Variables
EO (N = 98)
LO (N = 99)
pValue
Age > 35 years Nulliparity History of APO Pre-pregnancy BMI (kg/m2) Obesity I abnormal UtA Doppler
47% 49% 52% 24.1 ± 5.3 14% 90% (64/ 71) 48% 4% 28.3 ± 5.0 33% 29% 14% 24%
22% 62% 48% 24.5 ± 5.9 15% 57% (37/ 65) 15% 11% 30.2 ± 5.4 71% 65% 23% 57%
0.00 0.09 0.36 0.63 N.S. 0.00 0.00 0.10 0.02 0.00 0.00 0.13 0.00
30.9 ± 2.9
37.6 ± 1.8
0.00
IUGR GDM End-pregnancy BMI (kg/m2) WG > 12 kg 5 kg/m2 BMI increase 7 kg/m2 BMI increase Admission-to-delivery interval < 48 h GA at delivery (weeks)
Table 2 Weight estimation regression. EO PE. Variables
p-Value
OR
CI (95%)
Age > 35 yrs I abnormal UtA Doppler Current IUGR
0.04 0.00 0.26
3.10 6.50
1.60 – 6.03 2.46–17.56
259
EO PE (Table 2), whereas WG > 12 kg to LO PE (p = 0.04; OR = 4.6, CI (95%) = 2.39–8.87). Conclusions: Age > 35 yrs and UtA Doppler appeared risk factors for EO PE, whereas WG > 12 kg for the late form, supporting the hypothesis of a different pathogenesis.
doi:10.1016/j.preghy.2011.08.036
PREDICTION AND PREVENTION OF PREECLAMPSIA O5. Low-dose aspirin therapy in pregnant women with chronic hypertension E. Baptista, B. Moita, A. Gomes, N. Bento, M.S.J. Pais, E. Marta, P. Moura (Obstetrics Department, Coimbra’s University Hospital, Coimbra, Portugal) Objectives: To determine if low-dose aspirin prophylactic therapy improves obstetric and perinatal outcome in women with chronic hypertension. Materials and methods: The clinical records of 179 pregnant women with chronic hypertension, between Jan/2005 and Dec/2009, were analysed retrospectively. From these, 65 were submitted to low-dose (100 mg) aspirin therapy (group-A) against 114 without therapy (group-B). Obstetric and perinatal outcome in both groups was analyzed. The main parameters under analysis were: development of pre-eclampsia, HELLP syndrome, intra-uterine growth restriction (IUGR), birthweight and neonatal intensive care unit admission. Results: Mean maternal age was 32.11 years in group-A and 30.74 in group-B (p = n.s.). No statistical significance was observed in pre-eclampsia development (A: 10,76% vs. B: 15,78%; p = n.s.). One case of HELLP syndrome and one case of placental abruption were reported in group B. Statistically significant difference in IUGR development was observed between both groups (A: 6,15% vs. B: 16,67%; p = 0,032). Mean gestational age at delivery was 37.5 weeks in group-A and 37.2 weeks in group-B (p = n.s.). Caesarean section was performed in 50.77% in group-A and 59.65% in group-B (p = n.s.). Mean birth weight was 3086,4g in group-A and 2948.0 g in group-B (p = n.s.). Neonatal intensive care unit admission rate was 16.92% in group-A and 18.42% in group-B (p = n.s.). Placental pathology revealed signs of utero-placental chronic ischemia in 9.23% (groupA) and 9.65% (group-B) (p = n.s.). No significant complications associated to aspirin therapy were reported in any of these groups. Conclusions: In this subgroup of high risk women, lowdose aspirin prophylaxis was effective in reducing incidence of IUGR. The other parameters analysed in this study revealed no statistically significant differences.
doi:10.1016/j.preghy.2011.08.037
