Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
PP106. Risk of long term renal graft loss after pregnancy in renal transplant recipients immunosuppressed with calcineurin inhibitors V. Cararach 1,*, F. Oppenheimer 2, J. Rios 3 (1 Obstetrics and Gynecology and Neonatology, Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain, 2 Nephrology and Urology, Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain, 3 UASP, Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain) Introduction: Intron long-term graft function are uncertain. Although there have been a large number of successful pregnancies in renal graft recipients, the effects of pregnancy and type of immunosuppressant drugs. Objectives: To analyze (1) the impact of pregnancy on the long term renal function and graft survival of kidney transplant recipients (KTx), and (2) the impact og the pregnancy in (KTx) immunosupressed with calcineurin inhibitors (CNI). Methods: Retrospective analysis of two cohorts: one (PG) formed by all the KTx recipients from our institution that became pregnant between 1973 and 2004, and the other one (NPG) formed by, when possible, up two KTx patients of similar demographic and clinical characteristics: patient age, donor source, donor age, interval between KTx and pregnancy (or a matched interval for NPG), baseline renal function before pregnancy, hypertension, proteinuria >1 g, and CNI-based immunosuppression. but without pregnancies. Particular attention has been paid to long-term (5 and 10 years) renal function and graft survival. Males were selected to complete NPG if no matched women were available. Statistical analysis: Assessment of baseline homogeneity between the two cohorts was performed by appropriate analysis. Time of survival of kidney was estimated by means Kaplan–Meier method and the Cox proportional hazard model was used to perform adjusted analysis. Results: Fifty five pregnancies in 43 patients (PG) and 68 paired controls (NPG) were included in the study. The basal and functional characteristics of PG before pregnancy and NPG were not statistical and clinical significantly different. In a univariate Cox regression analysis, 10 years graft survival after pregnancy/study entry was significantly better in CG (79.9%) than PG (60.9%) (P = 0.02). Multivariate analysis of graft survival showed an increased risk of long-term graft loss in pregnant women that had been treated with CNI as immunosuppressant drug compared with NP KTx that received CNIs (HR: 2.4, 95% CI, 1.17–5.00; P = 0.02). In a stratified analysis, evaluating separately the recipients that had received or not CNIs, the risk of graft loss was only increased among recipients that became pregnant posttransplantation treated with CNI compared with recipients that had received CNIs but had not become pregnant (HR: 3.3, 95% CI, 1.42–7.45; P = 0.005), but not among recipients that became pregnant post-transplantation and received other immunosuppressant agents (HR: 0.9, 95% CI, 0.24– 3.80; P = 0.94). Conclusion: Pregnancy in women receiving baseline immunosuppression with CNI significantly increases the risk of long-term graft loss, non observed in KTx patients treated with CNI that not became pregnant, nor in KTx patients that became pregnant but are treated with other immunosup-
297
pressant drugs . At our knowledge, this observation has not been previously reported Disclosure of interest: None declared doi:10.1016/j.preghy.2012.04.217
PP107. Cardiovascular parameters 40 years after hypertensive pregnancies M. Hellgren *, A.-C. Collen, K. Manhem (University of Gothenburg, Göteborg, Sweden) Introduction: Epidemiological data indicate an increased cardiovascular risk in women with previous hypertensive pregnancies. There are few clinical investigations regarding the mechanisms that could mediate this increased risk. Objectives: The aim of the present study was to clarify if any deterioration in the cardiovascular, metabolic or neuroendocrine status is present in women 40 years after pregnancies complicated by hypertension. Methods: Three hundred and nineteen women were invited to take part in a follow up investigation regarding cardiovascular regulation. One hundred and five women accepted to participate – 50 with previously hypertensive pregnancies (HTP) and 55 with normotensive pregnancies (NTP). Office and ambulatory blood pressure levels, central blood pressure and pulse wave velocity, echocardiographic measurements (RWT, LVMI, LA, LA-RA, diastolic function, strain) and P-glucose, HbA1c, S-leptin, S-hsCRP, P-renin, PNoradrenaline and NT-proBNP were examined. Women who choose not to participate (n = 214) were followed up with a questionnaire regarding their previous pregnancies and present cardiovascular health. Results: The investigations did not reveal differences in any examined variables regarding blood pressure, echocardiographic parameters or blood analysis for metabolic and neurohumoral balance. Twenty-five individuals were diagnosed with hypertension in the HTP group (mean BP 145/ 86 mm Hg) and 17 subjects in the NTP group (mean BP 145/ 87 mm Hg). The questionnaire was answered by 79% of the participants and revealed that these women had an impaired cardiovascular health compared to the group investigated. Conclusion: Blood pressure, metabolic and neuroendocrine parameters are not permanently worsened in all women with previous hypertensive pregnancies. There exist disparities within the group of women with previous hypertensive pregnancies and there are women without obvious cardiovascular or metabolic dysfunction 40 years after the hypertensive manifestation during pregnancy. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.218
PP108. Post-partum evaluation of the blood pressure and the kidney function in pre-eclamptic women A. Pechère-Bertschi 1,*, P. Montillier 1, M. Boulvain 2, G. Wuerzner 3, J.-M. Gaspoz 4, M. Burnier 3, O.P. Irion 2
298
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
(1 Hypertension Unit, University Hospital Geneva, Switzerland, 2 Obstetrics, University Hospital, Geneva 4, Switzerland, 3 Nephrology, CHUV, Lausanne, Switzerland, 4 Primary Care and Emergencies, University Hospital, Geneva 4, Switzerland) Introduction: Recent data have shown that preeclampsia is not just a disease of pregnancy that resolves with delivery. Preeclampsia may be considered a ‘risk marker’ for later-life diseases, including cardiovascular and renal diseases and the metabolic syndrome. Objectives: We aimed a longitudinal prospective study to analyze the renal abnormalities in the post-partum. Methods: We studied 127 post-preeclamptic women at 6 weeks post-partum. Twenty-four hour urine collection, ambulatory blood pressure and renal function were evaluated. Results: The mean age (±SD) was 32 ± 6 years, BMI was 29.4 ± 5.7, the race distribution was Caucasian 69%, Hispanic 14%, Black 12% and Orient 5%. Ten % were active smokers, 10% have been suffering from gestational diabetes. The mean duration of the pregnancy was 36 weeks 3/7 ± 4. Our results show that the prevalence of hypertension defined by office blood pressure 140/90 mmHg or ongoing antihypertensive treatment was 35%. The daytime ambulatory blood pressure (ABPM) was 122 ± 16/85 ± 11 mmHg, heart rate 84 ± 8, and 111 ± 20/75 ± 11 mmHg at nighttime. Sixteen % had a daytime ABPM 135/85 mmHg corresponding to the definition of ambulatory hypertension. Ultrasensitive CRP was 4.9 ± 5.1 mg/ml, of them 31% had a frank elevation of the CRP >4. The glomerular filtration rate evaluated by the Gault-Cockroft equation showed a hyperfiltration with a mean value of 150 ± 42 ml/min. Eleven% had a decreased GFR < 90 ml/min. Microalbumine/creatinine ratio measured in the urine spot was 7 ±4. Mean microalbuminuria was 225 ± 529 mg/d measured on the 24 h urine collection.Urine 24 h Na excretion rate was 204 ± 48 mmol/d. Conclusion: In conclusion, after the post-partum period, women having suffered from a pre-eclampsia display many cardiovascular risk factors with a high prevalence of hypertension, microalbuminuria, renal hyperfiltration and elevated CRP. These women should be carefully screened, and sub-groups with the higher risk have to be targeted for prevention and treatment, and close follow-up.
Objectives: The aim of this case-control study is to compare the incidence and the characteristics of preeclampsia in women who conceived by oocyte donor or by homologous IVF. Methods: Data were collected from 65 consecutive women who conceived through oocyte donor IVF and 71 consecutive pregnancies from homologous IVF in women older than 35 years (control group), who attended our institution between 2009 and 2011. Data are expressed as percentage, average and standard deviation (SD). Statistical analysis was performed by chi-square test for unpaired data and the results were considered significant with p < 0.05. Results: Thirteen women from the donor oocyte group were excluded because of first trimester miscarriage, ectopic pregnancy and lack of data. After the exclusion, 52 pregnancies from oocyte donation were compared to the control group. Baseline characteristics, such as maternal age, BMI, parity and prevalence of twin pregnancies were similar in the two groups. Preexisting hypertension was present only in the oocyte donor IVF group (n = 6 cases). The risk of preeclampsia was significantly related to oocyte donor IVF (27% vs 5.6%, p = 0.0024 OR = 6.17), even when only singleton pregnancies were considered (16.7 vs 1.9%; p = 0.02, OR = 9). When women with preexisting hypertension were excluded, the incidence of severe preeclampsia remained significant (p = 0.02). This result was not confirmed when both preexisting hypertension and twin pregnancies were excluded (p = 0.09), even if the percentage of cases was higher in the oocyte donor IVF group (10.7% vs 1.85%). Three cases of life threatening severe preeclampsia occurred before the 24th week, two of which required interruption of pregnancy; one case was complicated by eclampsia. The two groups did not show significant differences in terms of prevalence of IUGR, both in multiple and singleton pregnancies, even if percentage values were higher in the donor IVF group (multiple: 21.2% vs 11.3%, p = 0.21/ singleton 10% vs 5.6%, p = 0.48). Conclusion: IVF with oocyte donation stands as an independent risk factor for preeclampsia. The risk of developing a severe and early preeclampsia may be increased when chronic hypertension occurs. Disclosure of interest: None declared.
Disclosure of Interest: None Declared doi:10.1016/j.preghy.2012.04.220 doi:10.1016/j.preghy.2012.04.219
PP109. Risk of preeclampsia in homologous and oocyte donation IVF pregnancies S. Simeone *, M.P. Rambaldi, S. Ottanelli, C. Serena, G. Mello, F. Mecacci (Centro di Riferimento Regionale per la Medicina materno–fetale e le gravidanze ad alto rischio, AOU Careggi– Università degli Studi di Firenze, Florence, Italy)
PP110. The role of doppler to predict adverse pregnancy outcome in patients with pre-eclampsia G. Pagani *, V. Gerosa, M.E. Gregorini, P.L. Rovida, F. Prefumo, A. Valcamonico, T. Frusca, L. Andrea (Maternal Fetal Medicine Unit, Dept. Obstetrics and Gynecology–University of Brescia, Brescia, Italy)
Introduction: Women who conceived by donor oocyte in vitro fertilization (IVF) are at high risk for placenta-related complications, because of advanced maternal age, nulliparity and maybe for an altered immune response.
Introduction: Recently Middle Cerebral Artery (MCA) to uterine artery (UtA) Pulsatility Index (PI) ratio and MCA to Umblical Artery (UA) PI ratio have been described to be good predictors of neonatal outcome in pre-eclamptic patients in
PP106. Risk of long term renal graft loss after pregnancy in renal transplant recipients immunosuppressed with calcineurin inhibitors V. Cararach 1,*, F. Oppenheimer 2, J. Rios 3 (1 Obstetrics and Gynecology and Neonatology, Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain, 2 Nephrology and Urology, Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain, 3 UASP, Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain) Introduction: Intron long-term graft function are uncertain. Although there have been a large number of successful pregnancies in renal graft recipients, the effects of pregnancy and type of immunosuppressant drugs. Objectives: To analyze (1) the impact of pregnancy on the long term renal function and graft survival of kidney transplant recipients (KTx), and (2) the impact og the pregnancy in (KTx) immunosupressed with calcineurin inhibitors (CNI). Methods: Retrospective analysis of two cohorts: one (PG) formed by all the KTx recipients from our institution that became pregnant between 1973 and 2004, and the other one (NPG) formed by, when possible, up two KTx patients of similar demographic and clinical characteristics: patient age, donor source, donor age, interval between KTx and pregnancy (or a matched interval for NPG), baseline renal function before pregnancy, hypertension, proteinuria >1 g, and CNI-based immunosuppression. but without pregnancies. Particular attention has been paid to long-term (5 and 10 years) renal function and graft survival. Males were selected to complete NPG if no matched women were available. Statistical analysis: Assessment of baseline homogeneity between the two cohorts was performed by appropriate analysis. Time of survival of kidney was estimated by means Kaplan–Meier method and the Cox proportional hazard model was used to perform adjusted analysis. Results: Fifty five pregnancies in 43 patients (PG) and 68 paired controls (NPG) were included in the study. The basal and functional characteristics of PG before pregnancy and NPG were not statistical and clinical significantly different. In a univariate Cox regression analysis, 10 years graft survival after pregnancy/study entry was significantly better in CG (79.9%) than PG (60.9%) (P = 0.02). Multivariate analysis of graft survival showed an increased risk of long-term graft loss in pregnant women that had been treated with CNI as immunosuppressant drug compared with NP KTx that received CNIs (HR: 2.4, 95% CI, 1.17–5.00; P = 0.02). In a stratified analysis, evaluating separately the recipients that had received or not CNIs, the risk of graft loss was only increased among recipients that became pregnant posttransplantation treated with CNI compared with recipients that had received CNIs but had not become pregnant (HR: 3.3, 95% CI, 1.42–7.45; P = 0.005), but not among recipients that became pregnant post-transplantation and received other immunosuppressant agents (HR: 0.9, 95% CI, 0.24– 3.80; P = 0.94). Conclusion: Pregnancy in women receiving baseline immunosuppression with CNI significantly increases the risk of long-term graft loss, non observed in KTx patients treated with CNI that not became pregnant, nor in KTx patients that became pregnant but are treated with other immunosup-
297
pressant drugs . At our knowledge, this observation has not been previously reported Disclosure of interest: None declared doi:10.1016/j.preghy.2012.04.217
PP107. Cardiovascular parameters 40 years after hypertensive pregnancies M. Hellgren *, A.-C. Collen, K. Manhem (University of Gothenburg, Göteborg, Sweden) Introduction: Epidemiological data indicate an increased cardiovascular risk in women with previous hypertensive pregnancies. There are few clinical investigations regarding the mechanisms that could mediate this increased risk. Objectives: The aim of the present study was to clarify if any deterioration in the cardiovascular, metabolic or neuroendocrine status is present in women 40 years after pregnancies complicated by hypertension. Methods: Three hundred and nineteen women were invited to take part in a follow up investigation regarding cardiovascular regulation. One hundred and five women accepted to participate – 50 with previously hypertensive pregnancies (HTP) and 55 with normotensive pregnancies (NTP). Office and ambulatory blood pressure levels, central blood pressure and pulse wave velocity, echocardiographic measurements (RWT, LVMI, LA, LA-RA, diastolic function, strain) and P-glucose, HbA1c, S-leptin, S-hsCRP, P-renin, PNoradrenaline and NT-proBNP were examined. Women who choose not to participate (n = 214) were followed up with a questionnaire regarding their previous pregnancies and present cardiovascular health. Results: The investigations did not reveal differences in any examined variables regarding blood pressure, echocardiographic parameters or blood analysis for metabolic and neurohumoral balance. Twenty-five individuals were diagnosed with hypertension in the HTP group (mean BP 145/ 86 mm Hg) and 17 subjects in the NTP group (mean BP 145/ 87 mm Hg). The questionnaire was answered by 79% of the participants and revealed that these women had an impaired cardiovascular health compared to the group investigated. Conclusion: Blood pressure, metabolic and neuroendocrine parameters are not permanently worsened in all women with previous hypertensive pregnancies. There exist disparities within the group of women with previous hypertensive pregnancies and there are women without obvious cardiovascular or metabolic dysfunction 40 years after the hypertensive manifestation during pregnancy. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.218
PP108. Post-partum evaluation of the blood pressure and the kidney function in pre-eclamptic women A. Pechère-Bertschi 1,*, P. Montillier 1, M. Boulvain 2, G. Wuerzner 3, J.-M. Gaspoz 4, M. Burnier 3, O.P. Irion 2
298
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
(1 Hypertension Unit, University Hospital Geneva, Switzerland, 2 Obstetrics, University Hospital, Geneva 4, Switzerland, 3 Nephrology, CHUV, Lausanne, Switzerland, 4 Primary Care and Emergencies, University Hospital, Geneva 4, Switzerland) Introduction: Recent data have shown that preeclampsia is not just a disease of pregnancy that resolves with delivery. Preeclampsia may be considered a ‘risk marker’ for later-life diseases, including cardiovascular and renal diseases and the metabolic syndrome. Objectives: We aimed a longitudinal prospective study to analyze the renal abnormalities in the post-partum. Methods: We studied 127 post-preeclamptic women at 6 weeks post-partum. Twenty-four hour urine collection, ambulatory blood pressure and renal function were evaluated. Results: The mean age (±SD) was 32 ± 6 years, BMI was 29.4 ± 5.7, the race distribution was Caucasian 69%, Hispanic 14%, Black 12% and Orient 5%. Ten % were active smokers, 10% have been suffering from gestational diabetes. The mean duration of the pregnancy was 36 weeks 3/7 ± 4. Our results show that the prevalence of hypertension defined by office blood pressure 140/90 mmHg or ongoing antihypertensive treatment was 35%. The daytime ambulatory blood pressure (ABPM) was 122 ± 16/85 ± 11 mmHg, heart rate 84 ± 8, and 111 ± 20/75 ± 11 mmHg at nighttime. Sixteen % had a daytime ABPM 135/85 mmHg corresponding to the definition of ambulatory hypertension. Ultrasensitive CRP was 4.9 ± 5.1 mg/ml, of them 31% had a frank elevation of the CRP >4. The glomerular filtration rate evaluated by the Gault-Cockroft equation showed a hyperfiltration with a mean value of 150 ± 42 ml/min. Eleven% had a decreased GFR < 90 ml/min. Microalbumine/creatinine ratio measured in the urine spot was 7 ±4. Mean microalbuminuria was 225 ± 529 mg/d measured on the 24 h urine collection.Urine 24 h Na excretion rate was 204 ± 48 mmol/d. Conclusion: In conclusion, after the post-partum period, women having suffered from a pre-eclampsia display many cardiovascular risk factors with a high prevalence of hypertension, microalbuminuria, renal hyperfiltration and elevated CRP. These women should be carefully screened, and sub-groups with the higher risk have to be targeted for prevention and treatment, and close follow-up.
Objectives: The aim of this case-control study is to compare the incidence and the characteristics of preeclampsia in women who conceived by oocyte donor or by homologous IVF. Methods: Data were collected from 65 consecutive women who conceived through oocyte donor IVF and 71 consecutive pregnancies from homologous IVF in women older than 35 years (control group), who attended our institution between 2009 and 2011. Data are expressed as percentage, average and standard deviation (SD). Statistical analysis was performed by chi-square test for unpaired data and the results were considered significant with p < 0.05. Results: Thirteen women from the donor oocyte group were excluded because of first trimester miscarriage, ectopic pregnancy and lack of data. After the exclusion, 52 pregnancies from oocyte donation were compared to the control group. Baseline characteristics, such as maternal age, BMI, parity and prevalence of twin pregnancies were similar in the two groups. Preexisting hypertension was present only in the oocyte donor IVF group (n = 6 cases). The risk of preeclampsia was significantly related to oocyte donor IVF (27% vs 5.6%, p = 0.0024 OR = 6.17), even when only singleton pregnancies were considered (16.7 vs 1.9%; p = 0.02, OR = 9). When women with preexisting hypertension were excluded, the incidence of severe preeclampsia remained significant (p = 0.02). This result was not confirmed when both preexisting hypertension and twin pregnancies were excluded (p = 0.09), even if the percentage of cases was higher in the oocyte donor IVF group (10.7% vs 1.85%). Three cases of life threatening severe preeclampsia occurred before the 24th week, two of which required interruption of pregnancy; one case was complicated by eclampsia. The two groups did not show significant differences in terms of prevalence of IUGR, both in multiple and singleton pregnancies, even if percentage values were higher in the donor IVF group (multiple: 21.2% vs 11.3%, p = 0.21/ singleton 10% vs 5.6%, p = 0.48). Conclusion: IVF with oocyte donation stands as an independent risk factor for preeclampsia. The risk of developing a severe and early preeclampsia may be increased when chronic hypertension occurs. Disclosure of interest: None declared.
Disclosure of Interest: None Declared doi:10.1016/j.preghy.2012.04.220 doi:10.1016/j.preghy.2012.04.219
PP109. Risk of preeclampsia in homologous and oocyte donation IVF pregnancies S. Simeone *, M.P. Rambaldi, S. Ottanelli, C. Serena, G. Mello, F. Mecacci (Centro di Riferimento Regionale per la Medicina materno–fetale e le gravidanze ad alto rischio, AOU Careggi– Università degli Studi di Firenze, Florence, Italy)
PP110. The role of doppler to predict adverse pregnancy outcome in patients with pre-eclampsia G. Pagani *, V. Gerosa, M.E. Gregorini, P.L. Rovida, F. Prefumo, A. Valcamonico, T. Frusca, L. Andrea (Maternal Fetal Medicine Unit, Dept. Obstetrics and Gynecology–University of Brescia, Brescia, Italy)
Introduction: Women who conceived by donor oocyte in vitro fertilization (IVF) are at high risk for placenta-related complications, because of advanced maternal age, nulliparity and maybe for an altered immune response.
Introduction: Recently Middle Cerebral Artery (MCA) to uterine artery (UtA) Pulsatility Index (PI) ratio and MCA to Umblical Artery (UA) PI ratio have been described to be good predictors of neonatal outcome in pre-eclamptic patients in
